A case report of thyroid sarcomatoid carcinoma.
Lei Zhang, Lijing Ran, Lulu Zhao et al.
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Case in brief
A 65-year-old man presented with fever and left-sided neck pain; examination found a hard mass in the left thyroid lobe. Ultrasound showed a hypoechoic nodule with an anterior-posterior-to-transverse diameter ratio >1, circumferential calcification, and intranodular blood flow, alongside enlarged, fused left cervical nodes. CT showed tracheal compression by the thyroid mass. Fine-needle aspiration with immunohistochemistry, positive for cytokeratin and vimentin, confirmed sarcomatoid carcinoma. After multidisciplinary review, he received four cycles of sintilimab, paclitaxel, and anlotinib, with remission followed by disease progression and death 9 months after diagnosis.
What made this case unusual
The diagnosis was established by fine-needle aspiration combined with immunohistochemistry demonstrating both cytokeratin and vimentin positivity, in a thyroid malignancy described as extremely uncommon.
Diagnostic / clinical pearl
In a suspected thyroid sarcomatoid carcinoma, pathological assessment with immunohistochemistry can help establish the diagnosis; this case used cytokeratin and vimentin positivity.
Why it matters
The reported combination regimen achieved temporary disease control, but the patient died of progression 9 months after diagnosis, underscoring the aggressive course described in this case.