Dual malignancy was first reported by Billroth in 1889. Incidence of second malignancy in cancer patients is as high as 10%, but synchronous anaplastic thyroid cancer along with breast tumor is a rare entity. We present a case of a 61-year-old female with a synchronous anaplastic carcinoma thyroid with ductal carcinoma breast. The plausible association of breast cancers with thyroid carcinomas should thus be evaluated in larger cohort studies. More importantly, this report is to highlight the unusual synchronous occurrence of anaplastic thyroid cancer with ductal breast cancer and the therapeutic challenges involved in such cases.
Dual malignancy was first reported by Billroth in 1889 [
A 61-year-old female presented with left anterior neck swelling after hemithyroidectomy with dyspnea and stridor. The neck swelling was there for the last 5 years, without any change in size. For the last 3 months, it suddenly increased diffusely up to a size of 6.0 cms × 3.5 cms. She underwent hemithyroidectomy for the thyroid swelling elsewhere. Histopathological examination of the neck swelling confirmed the diagnosis of anaplastic thyroid cancer (Figure
The tumor was composed of large sized, bizarre shaped cells with ample dense eosinophilic cytoplasm and highly pleomorphic vesicular nuclei with prominent nucleoli, without showing any organoid pattern. Multiple mitotic figures and neutrophilic infiltrate are also seen (H&E stain 100x).
CECT neck showing a 5.9 cm × 4.3 cm lesion involving the left lobe of thyroid and isthmus encasing the left common carotid artery and subclavian artery and extending into the left carotid space and anterosuperior mediastinum.
A well-defined lesion of size 4.1 cm × 4.6 cm in the middle lobe of right lung abutting the mediastinal pleura along with left axillary lymphadenopathy.
Smear shows malignant ductal epithelial cells arranged in sheets discretely. The cells are large showing pleomorphic nuclei with prominent nucleoli and ample dense greyish cytoplasm (H&E stain 400x).
Anaplastic thyroid cancer is a rare malignancy comprising of 1-2% of all thyroid cancers [
The synchronous occurrence of anaplastic carcinoma thyroid and ductal carcinoma breast remains a therapeutic challenge especially when the patient presents with acute symptoms. Synchronous thyroid and breast malignancies are often attributed to genetic aberrations and hormonal influences.
Thyroid and breast are both under the influence of same hormones. While estrogen plays a role in the development of the thyroid gland, TSH receptors are found to be present in breast tissue. Also increased thyroid peroxidase levels have been associated with better prognosis in breast cancers [
Both these cancers can also be genetically correlated with p53 or PTEN mutations, which is an extremely rare situation. Silencing of tumor suppressor gene PTEN has been found in anaplastic thyroid cancer. PTEN has also been found to be mutated or deleted or silenced in sporadic breast cancers [
Progression from papillary thyroid cancer to anaplastic carcinoma thyroid could be favored by TP53 mutations [
So the family members of these patients should be advised to undergo genetic screening at higher centers to exclude any probability of a genetic aberration which could link these two synchronous cancers and also a larger cohort study is needed to validate the synchronous presence of thyroid and breast malignancies and the genetic and hormonal factors associated with them.
The authors declare that there is no conflict of interests regarding the publication of this paper.
This case was presented in the 1st Indian Cancer Congress—November 2013—at New Delhi, India, as a poster presentation.