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Head and Neck Surgery

(311) Metastatic Papillary Thyroid Carcinoma Masquerading as a Giant Cell Tumor

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Michelle Yu, MD MS

    Resident
    NewYork-Presbyterian Hospital (Columbia and Cornell)
    New York, New York, United States

    • Co-Author(s)

  • Michelle Yu, MD MS

    Resident
    NewYork-Presbyterian Hospital (Columbia and Cornell)
    New York, New York, United States

    • Presenting Author(s)

  • VY

    Victoria X. Yu, MD

    Resident Physician
    Department of Otolaryngology, Head and Neck Surgery, Columbia University
    New York, New York, United States

    • Co-Author(s)

  • VY

    Victoria X. Yu, MD

    Resident Physician
    Department of Otolaryngology, Head and Neck Surgery, Columbia University
    New York, New York, United States

  • Sallie M. Long, MD

    Fellow
    University of Miami
    Miami, Florida, United States

  • AD

    Alexandra Daly, MPAS

    PA-C
    Weill Cornell Medical Center
    New York, NY, USA

    • Senior Author(s)

  • Lucian Sulica, MD

    Professor of Laryngology
    Sean Parker Institute for the Voice, Weill Cornell Medical College
    New York, NY, United States

  • Andrew B. Tassler, MD

    Associate Professor of Otolaryngology - Head and Neck Surgery
    NewYork-Presbyterian Hospital/Weill Cornell Medicine
    New York, New York, United States

    • Co-Author(s)

  • TS

    Theresa Scognamiglio, MD

    Weill Cornell Medical Center, USA

Disclosure(s):
Michelle Yu, MD MS: No relevant relationships to disclose.
Victoria X. Yu, MD: No relevant relationships to disclose.
Sallie M. Long, MD: No relevant relationships to disclose.
Andrew B. Tassler, MD: No relevant relationships to disclose.
Theresa Scognamiglio, MD: No relevant relationships to disclose.


Introduction: Multinucleated giant cells (MNGC) are found in benign and malignant lesions of the head and neck. We report a case of recurrent metastatic papillary thyroid cancer (PTC) with an unusual presentation as a giant cell-rich mass.

Methods: This is a case report with literature review.

Results: An 85 year-old man presented with dyspnea and stridor. History was notable for thyroid cancer managed 8 years ago in China with thyroidectomy and Cyberknife. CT showed a left tracheal mass extending to the thyroid bed. Patient underwent debulking of the mass. Pathology showed abundant MNGC and was negative for markers of thyroid follicular cells, thought to represent a giant cell tumor of soft tissue (GCT-ST). The patient was lost to follow up and returned 8 weeks later with dyspnea, found to have regrowth of the mass. PET CT revealed an FDG-avid tracheal mass, cervical nodes, and distant metastases. The patient underwent biopsies that demonstrated BRAFV600E-positive PTC. Genetic tests on tracheal tissue demonstrated BRAF p.V600E mutation, TP53 frameshift deletion, MYC amplification, and PTEN deletion. This presentation was consistent with metastatic, BRAFV600E-positive PTC with possible anaplastic transformation.

Conclusions: GCT-ST is a rare entity in the neck. The differential for MNGC-containing lesions should include PTC, anaplastic thyroid carcinoma, Langerhans histiocytosis, and thyroiditis. Patient history, genetic analysis, and immunohistochemistry help to guide a final diagnosis.