Journal of Cytology
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 25  |  Issue : 2  |  Page : 65-66
Osteoclastoma-like anaplastic carcinoma of the thyroid


1 Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
2 Department of Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India

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   Abstract 

Anaplastic carcinoma is a highly malignant tumor that is partially or totally undifferentiated. The use of fine needle aspiration cytology (FNAC) to diagnose anaplastic carcinoma with osteoclast-like giant cells, has been rarely reported. We report here a case of osteoclastoma - anaplastic carcinoma - that was diagnosed on cytology in a 58 year-old female patient, who presented with a progressively increasing swelling over the anterior aspect of the neck. Multinucleated giant cells resembling osteoclasts are rarely seen in the giant cell variant of anaplastic carcinoma.

Keywords: Anaplastic carcinoma; fine needle aspiration cytology; giant cell; thyroid.

How to cite this article:
Joseph LD, Ravi A, Rekha A, Rao S, Aarthi R, Panicker VK. Osteoclastoma-like anaplastic carcinoma of the thyroid. J Cytol 2008;25:65-6

How to cite this URL:
Joseph LD, Ravi A, Rekha A, Rao S, Aarthi R, Panicker VK. Osteoclastoma-like anaplastic carcinoma of the thyroid. J Cytol [serial online] 2008 [cited 2019 Jun 26];25:65-6. Available from: http://www.jcytol.org/text.asp?2008/25/2/65/42450



   Introduction Top


Anaplastic carcinoma of the thyroid is a highly malignant tumor that constitutes approximately 10% of all thyroid malignancies. [1] Multinucleated giant cells resembling osteoclasts are occasionally seen in anaplastic thyroid carcinoma of either spindle or giant cell type. Tumors in which osteoclast-like giant cells predominate, are exceedingly rare. We report here a case of osteoclastoma-like anaplastic carcinoma of the thyroid in a 58 year-old female diagnosed with the aid of fine needle aspiration cytology (FNAC).


   Case Report Top


A 58 year-old female presented with a three and a half months old swelling over the anterior aspect of the neck that had been progressively increasing in size. She also complained of difficulty in breathing for the past one and a half months along with increased sweating, headache, loss of appetite and weight along with a rapid increase in the size of the neck mass. The patient had a two year history of hypertension. Examination revealed that there was a swelling over the anterior aspect of the neck, 10 7 cm in size, diffuse, and moving with deglutition. The lower margin could not be felt completely but the surface was felt to be nodular on palpation, and there was tenderness over the swelling. A clinical diagnosis of a multinodular goiter with retrosternal extension was made.

FNAC was positive for malignancy. The smears showed clusters and several individual pleomorphic cells with a high nucleocytoplasmic ratio [Figure 1]. Some of the cells were spindled out and a few were plasmacytoid; several multinucleated giant cells were also seen [Figure 2]. A poorly differentiated tumor was diagnosed; possibilities being suggested were anaplastic carcinoma and medullary carcinoma. The patient underwent a total thyroidectomy and the cut surface revealed solid, grey-white areas that were firm to hard in consistency. The histopathological diagnosis was given as anaplastic carcinoma of the giant cell type, with gross and microscopic capsular invasion [Figure 3]. Soft tissue extension and more than five tumor nodules were also noted.


   Discussion Top


Anaplastic carcinomas account for 10% of all types of thyroid malignancies. [1] These carcinomas present in elderly patients as a rapidly growing mass associated with hoarseness, dysphagia, and dyspnoea. The evolution of this tumor is very rapid with massive growth in the neck and infiltration of the ribbon muscles, esophagus, trachea, skin, and even contiguous bones. Nodal and distant metastasis are also common. Anaplastic carcinoma generally occurs in people in iodine-deficient areas and in settings of previous thyroid pathology ( e.g ., preexisting goiter, follicular thyroid cancer, papillary thyroid cancer etc.).

Diagnosis by FNAC permits palliative treatment without any operative intervention. FNAC shows two cell populations: multinucleated giant cells and smaller round to oval undifferentiated cells. [2],[3] Multinucleate giant cells of osteoclastoma-like appearance are seen in some anaplastic carcinomas, but diagnosis was made with the aid of aspiration cytology in only three cases reported in medical literature. [4],[5]

Microscopically squamoid, spindle-shaped cells and giant cell variants have been described in literature. All the three variants show high mitotic activity, large foci of necrosis, and significant infiltration. Osteoclast-like giant cells in the giant cell variant are nonneoplastic, reactive cells of monocytic / histiocytic lineage that have been derived from mononuclear cell fusion. They are immunohistochemically positive for low molecular weight keratins in 50-100% of all cases. [6] Vimentin positivity is seen in the spindle cell component. Stromal reactivity for laminin as well as focal EMA and CEA positivity are observed. Usually thyroglobulin and thyroid transcription factor 1 are absent whereas p53 gene protein products can be seen in the cytoplasm .

Although the presence of giant cells in anaplastic carcinoma is common, the occurrence of osteoclast-like giant cells is a rare event. The other variants like squamoid and spindle cell types lack giant cells. The spindle cell pattern is indistinguishable from a true sarcoma, resembling a fibrosarcoma, malignant fibrous histiocytoma, leiomyosarcoma, or an angiosarcoma. The paucicellular variant is characterized by dense fibrosis, calcification, and a poor patient outcome.

Anaplastic carcinoma of the thyroid is characterized by round to oval undifferentiated cells. The occurrence of osteoclast-like giant cells is rare and the diagnosis of these carcinomas with the aid of FNAC is even rarer. Hence, a cytological diagnosis aids in determining the treatment plan.

 
   References Top

1.Gaffey MJ, Lack EE, Miriam L, Lawrence C, Weiss M. Anaplastic thyroid carcinoma with osteoclast like giant cells: A clinicopathologic, immunohistochemical and ultrastructural study. Am J Surg Pathol 1991;15:160-8.  Back to cited text no. 1    
2.Berry B, MacFarlane J, Chan N. Osteoclastoma like anaplastic carcinoma of the thyroid: Diagnosis by fine needle aspiration cytology. Acta Cytol 1990;34:248-50.  Back to cited text no. 2  [PUBMED]  
3.Willems JS, Lowhagen T, Palombini L. The cytology of a giant cell osteoclastoma like malignant thyroid neoplasm. Acta Cytol 1979;23:214-6.  Back to cited text no. 3    
4.Lee JS, Lee MC, Park CS, Juhng SW. Fine needle aspiration cytology of anaplastic carcinoma with osteoclast like giant cells of the thyroid-a case report. Acta Cytol 1996;40:1309-12.  Back to cited text no. 4  [PUBMED]  
5.Mehdi G, Hena AA, Shahid SA. Cytology of anaplastic giant cell carcinoma of the thyroid with osteoclast like giant cells: A case report. Diagn Cytopathol 2007;35:111-2.  Back to cited text no. 5    
6.Carcangui ML, Steeper T, Zampi G, Rosai J. Anaplastic thyroid carcinoma: A study of 70 cases. Am J Clin Pathol 1985;83:135-58.  Back to cited text no. 6    

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Correspondence Address:
Leena D Joseph
Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai - 600 116
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.42450

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Epithelial neoplasms associated with osteoclast-like giant cells
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[Pubmed]



 

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    Abstract
    Introduction
    Case Report
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    References
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