Unusual Manifestation of Anaplastic Thyroid Cancer

Introduction: The authors present a rare case of a patient with symptoms consistent with retropharyngeal abscess. The diagnosis of anaplastic thyroid cancer was made after surgery and subsequent histological examination. Case report: An 80-year-old woman was referred to Dpt. of Otolaryngology, Head and Neck Surgery, Charles University Medicine Faculty, Teaching Hospital in Hradec Králové with odynophagia and pain in the left side of the neck. The patient had pronounced swelling of the left side of her neck. We could also see swelling of the posterior pharyngeal wall, more pronounced on the left side. Inflammation markers were markedly elevated. Administration of antibiotics intravenously (amoxicillin combined with clavulan acid and gentamicin) was started. A computer tomography investigation (CT) was performed and a retropharyngeal abscess was found. The existence of a tumour was considered as well. An acute endoscopic examination and a puncture of the retropharyngeal space at the site of the swelling were performed, but no pus or any other liquid was found. On the sixth day of hospitalization a second CT scan was performed. As the retropharyngeal mass was still present along with continually elevated inflammatory markers, surgical revision of the retropharyngeal space from an external approach was performed. No abscess formation was found. During the surgery, retropharyngeal lymph nodes were removed for histological examination. The histological examination of the lymph nodes identified metastasis of anaplastic thyroid cancer. Conclusions: The differential diagnosis of diseases affecting deep neck structures can be very difficult. Symptoms of inflammation dominating in the clinical picture do not exclude the possibility of malignancy. The most relevant imaging examination seems to be contrast enhanced computer tomography or magnetic resonance imaging