Neoadjuvant therapy and surgical resection successfully treating primary thyroid squamous cell carcinoma: a case report

Abstract

Background: Primary squamous cell carcinoma of the thyroid is a rare, highly lethal malignancy, comprising less than 1% of all thyroid cancers. It is associated with poor prognosis due to its rapid progression, resistance to conventional therapies, and frequent presentation at an advanced stage. The preferred treatment approach combines surgical resection with adjuvant radiotherapy or chemotherapy, yet outcomes remain unsatisfactory.

Case description: We report a case involving a 69-year-old female who presented with a progressively enlarging mass in the anterior neck. Computed tomography (CT) scans identified a right thyroid nodule measuring 4.0 cm × 4.7 cm × 5.3 cm. Subsequent fine needle aspiration biopsy confirmed thyroid squamous cell carcinoma, with molecular analysis revealing a positive BRAF (exon15:c.1801A>G:p.K601E) mutation. Given the substantial size of the neck mass and the unsuitability for surgical resection, neoadjuvant therapy was initiated. This included a combination of tislelizumab immunotherapy, chemotherapy, and anlotinib targeted therapy, which significantly reduced the size of tumor. The patient subsequently underwent a total thyroidectomy and remained disease-free for 2 years.

Conclusions: The present case demonstrates the potential of a multimodal treatment regimen encompassing chemotherapy, immunotherapy and targeted therapy, followed by surgical excision, for primary thyroid squamous cell carcinoma. Further studies are needed to validate the efficacy and safety of this combined treatment modality in larger patient populations.

Keywords: Thyroid squamous cell carcinoma; anlotinib; case report; neoadjuvant therapy; tislelizumab.

Figure 1

Case summary. (A) Disease course and treatment summary. (B) HE and IHC staining of the tumor. HE (×400), P63 (×100), PAX8 (×100), CK19 (×100), PD-L1 (×100), and postoperative HE (×400). (C) Representative images showing the patient response to the treatment of Anl, Pac, and Tis. Anl, anlotinib; FNAB, fine needle aspiration biopsy; HE, hematoxylin-eosin; IHC, immunohistochemistry; mos, months; Pac, paclitaxel; PR, partial response; Tis, tislelizumab.

Figure 2

Computed tomography images showing the patient response to the treatment of Anl, Pac, Tis, and the radical surgery. Red circles indicate tumor regions, which disappeared after radical surgery. Anl, anlotinib; Pac, paclitaxel; Tis, tislelizumab.