Undifferentiated (anaplastic) thyroid carcinoma (UTC), also called “giant and spindle cell carcinoma,” is an extremely aggressive thyroid malignancy. Accounting for less than 5% of malignant thyroid tumors, it carries the poorest prognosis as compared to well differentiated and poorly differentiated thyroid carcinomas. Most patients succumb to their disease within six months to one year of their initial diagnosis, typically as a result of tumor involvement of vital structures within the neck. Characteristic clinical features are associated with UTCs. These tumors are rarely seen in individuals below the age of 50 (<10% of cases). There is a female predominance (2–4:1). Patients present with a hard, nodular thyroid gland, and most have a rapidly growing mass. Neck enlargement is due to marked tumor growth, with or without reactive fibrosis, which infiltrates into surrounding extrathyroidal soft tissues of the neck, e.g., muscle, trachea, esophagus, and adjacent skin, cartilage, and bone. Half of the patients with UTC report significant neck compression that can result in dyspnea, dysphasia, hoarseness, and/or pain. One-quarter to one-half of patients present with lymphadenopathy and/or distant metastases, most commonly to the lungs. Finally, a history of long standing goiter and thyroid function tests indicating euthyroidism (despite extensive thyroid gland destruction) are common.
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