CASE DESCRIPTION
tumor, isodose, dyspnea, Tumor, calcification, Necrosis, pain, Tumors, NCT04521348, thyroid cancer, Cancer
THYROID CARCINOMA, TUMOR, DEGENERATION, METASTASIS, TUMOR, HYPERTENSION, DISEASE, NECROSIS, TUMORS, MAY, INFLAMMATORY INFILTRATION, CERVICAL MASS, ONCOLOGY, THYROID CANCER, DESMOPLASIA, CANCER
A 51‐year‐old man inadvertently noticed a cervical mass that had been growing rapidly for 1 month. On May 26, 2020, the patient went to the outpatient department of Fudan University Shanghai Cancer Center. He had no dyspnea and was in good clinical condition with an Eastern Cooperative Oncology Group performance status score of 0. However, he complained of pain on touching the mass. Therefore, cervical ultrasound (US) and thyroid computed tomography (CT) were performed in May 2020. Imaging results showed calcified masses on both the lobes and isthmus of the thyroid, suggesting the possibility of thyroid carcinoma. The trachea was shifted to the right and invasion of the internal jugular vein and common carotid artery was observed (Figure The effects of the therapy on the disease. Tumor size and cervical nodes size change from (A) and (B) baseline; (C) and (D) after three cycles of famitinib and camrelizumab treatment; (E) and (F) then after surgery and external radiation therapy.Core needle biopsy on left lobe: (A) and (B) the touch imprint cytology show the neoplastic tumor cells with obvious pleomorphism and nucleoli in some cells. (A) is hematoxylin and eosin histology section at 400× and (B) is Liu's stain at 400×. (C) the epithelioid tumor cells show solid growth cells which are obviously heteromorphic (hematoxylin and eosin histology section at 100×). (D) the nuclei of tumor are large, nucleoli are apparent and mitosis is easy to see (hematoxylin and eosin histology section at 400×).Immunohistochemically stained slides of core needle biopsy revealed the tumor cells to be positive for AE1/AE3, TTF‐1, PAX8, P53 (70%) at 200×.In June 2020, the patient was recruited for a clinical trial that combined multiple‐target kinase inhibitors and anti‐PD‐1 antibodies in patients with advanced thyroid cancer (NCT04521348). He was administered three cycles of famitinib (20 mg/qd) and camrelizumab (200 mg/q3w). The patient exhibited a good clinical status, but suffered from famitinib‐induced grade 3 hypertension, which was controlled with nifedipine and valsartan. Famitinib was discontinued for 3 days during the second cycle.After three cycles of treatment, CT showed partial response (PR) of the lesion according to the Response Evaluation Criteria in Solid Tumors (version 1.1) (Figure Total thyroidectomy with removal of lymph node group VI and left radical neck dissection (groups II, III, IV, and V) were performed in July 2020. Postoperative pathological examination identified a 35‐mm (maximum diameter) lesion in the left thyroid lobe (Figure (A) and (B) show a surgical gross specimen; (C) and (D) show some foci poorly differentiated tumor nests were observed, with degeneration. Necrosis, desmoplasia, calcification, chronic inflammatory infiltration, and foamy histiocytes aggregates were found in surrounding areas, cholesterol crystals occasionally appeared (hematoxylin and eosin histology section at 40× and 100×).Postoperative therapy included L‐thyroxine (125 μg/d). Positron emission tomography CT showed no masses in the thyroid or neck lymph nodes and no distant metastasis. By August 2020, the patient had recovered well and received intensity‐modulated radiation therapy (IMRT) with a dose of 60 Gy (in 30 fractions) to the thyroid bed and cervical nodal regions and 54 Gy to the mediastinal nodes (Figure A coronal and a sagittal view of the post‐operative radiation planning CT scan. The blue and yellow lines represent the 60 Gy and 54 Gy isodose lines, respectively and the staining areas within these lines represent clinical targets specified at 60 and 54 Gy, respectively.Surveys of patient‐reported outcomes were obtained approximately 24 months after the diagnosis. They showed a very good quality of life, including continuation of normal activities such as jogging.