A Rare Entity: Papillary Thyroid Carcinoma with Squamous Differentiation Diagnosed in a Middle-aged Man Following Endoscopic Total Thyroidectomy via Axillo-Bilateral Breast Approach

Sheta, Heba; Abd El Hafez, Amal; Harb, Dina; Zuhdy, Mohammad; Elzahaby, Islam A.

doi:10.30476/mejc.2022.90671.1587

A Rare Entity: Papillary Thyroid Carcinoma with Squamous Differentiation Diagnosed in a Middle-aged Man Following Endoscopic Total Thyroidectomy via Axillo-Bilateral Breast Approach

Document Type : Case Report(s)

Authors

Heba Sheta ¹

Amal Abd El hafez ¹^{, 2}

Dina Harb ³

Mohammad Zuhdy ⁴

Islam A. Elzahaby ⁴

¹ Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

² Faculty of Medicine, Horus University - Egypt (HUE), New Damietta, Damietta, Egypt

³ Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

⁴ Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt

https://doi.org/10.30476/mejc.2022.90671.1587

Abstract

Although squamous metaplasia is a well-known occurrence in papillary thyroid carcinoma (PTC), it is extremely uncommon to diagnose a PTC with squamous differentiation (PTC-SD), especially in a non-elderly patient, thus raising a diagnostic challenge when considering its broad histopathological differential diagnosis. Endoscopic thyroidectomy via axillo-bilateral breast approach (ABBA) has been recently validated as an appropriate surgical alternative to conventional thyroidectomy for treating PTC in the selected patients. Hereby, we report a rare case of PTC-SD diagnosed in a solitary thyroid nodule (STN) in a 30-year-old man with a family history of thyroid cancer who was operated using the endoscopic ABBA. In fact, detection of the squamous cell carcinoma component may not be feasible through fine needle aspiration cytology or frozen section examinations, while permanent paraffin sections and immunohistochemistry (if required) usually allows for its identification. Due to their diverse clinical and biological behaviors, it is important to differentiate PTC-SD from other conditions in which a thyroid specimen contains a squamous epithelium. PTCSD patients with favorable clinicopathological criteria as young age and localized disease can be fortunate candidates for the minimally invasive thyroidectomy approaches as endoscopic ABBA.

Keywords

Papillary thyroid carcinoma

Squamous

Axillo-bilateral breast approach

Endoscopic thyroidectomy

Differential diagnosis

How to cite this article:

Sheta H, Abd El hafez A, Harb D, Zuhdy M, Elzahaby IA. A rare entity: Papillary thyroid carcinoma with squamous differentiation diagnosed in a middle-aged man following endoscopic total thyroidectomy via axillo-bilateral breast approach. Middle East J Cancer. 2023;14(1):170-5. doi: 10. 30476/mejc.2022.90671.1587.

Lloyd RV, Osamura RY, Klöppel G, Rosai J, editors. Tumors of the thyroid gland in World Health Organization (WHO) classification of tumors of endocrine organs. 4th ed. IARC: Lyon, France; 2019. p. 66-144.
Wan Sohaimi WF, Lee YF, Mat Nawi N, Mohd Rohani MF, Sapiai NA. A case rarity: Papillary thyroid carcinoma with squamous metaplasia complicated with chronic discharging ulcers. Indian J Surg Oncol. 2019;10(4):676-8. doi: 10.1007/s13193-019-00977- 8.
Beninato T, Kluijfhout WP, Drake FT, Khanafshar E, Gosnell JE, Shen WT, et al. Squamous differentiation in papillary thyroid carcinoma: a rare feature of aggressive disease. J Surg Res. 2018;223:39-45. doi: 10.1016/j.jss.2017.10.023.
Handra-Luca A. Squamous cell differentiation in metastatic papillary thyroid carcinoma: metaplastic reversion or progression? Iran J Pathol. 2018;13(2): 276-80.
Gadde R, Tafe LJ, Tsapakos MJ, Liu X. A case report of papillary thyroid carcinoma dedifferentiated to squamous cell carcinoma presenting as a lung metastasis: A potential diagnostic pitfall. Diagn Cytopathol. 2020;48(6):581-5. doi: 10.1002/dc.24422.
Thewjitcharoen Y, Krittiyawong S, Butadej S, Nakasatien S, Polchart S, Junyangdikul P, et al. Dedifferentiation of papillary thyroid carcinoma into squamous cell carcinoma in an elderly patient: A case report. Medicine (Baltimore). 2020;99(16):e19892. doi: 10.1097/MD.0000000000019892.
Kim SK, Kang SY, Youn HJ, Jung SH. Comparison of conventional thyroidectomy and endoscopic thyroidectomy via axillo-bilateral breast approach in papillary thyroid carcinoma patients. Surg Endosc. 2016;30(8):3419-25. doi: 10.1007/s00464-015-4624- 9.
Wirth U, von Ahnen T, Hampel J, Schardey J, Busch P, Schardey HM, et al. Quality of life and surgical outcome of ABBA versus EndoCATS endoscopic thyroid surgery: a single center experience. Surg Endosc. 2022;36:968-79. doi: 10.1007/ s00464-021- 08361-w.
Lam AK. Squamous cell carcinoma of thyroid: a unique type of cancer in World Health Organization Classification. Endocr Relat Cancer. 2020;27(6):R177- R192. doi: 10.1530/ERC-20-0045.
Limberg J, Ullmann TM, Stefanova D, Finnerty BM, Beninato T, Fahey TJ 3rd, et al. Prognostic characteristics of primary squamous cell carcinoma of the thyroid: A national cancer database analysis. World J Surg. 2020;44(2):348-55. doi: 10.1007/s00268-019- 05098-5.