THE CONTEXT
Undifferentiated, or anaplastic, thyroid carcinoma is rare and is among the most aggressive human malignancies, with an extremely poor prognosis.
Origin and clinical behaviour
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Anaplastic carcinoma may arise de novo or through dedifferentiation of papillary or poorly differentiated carcinoma.
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The disease is characterised by rapid growth, visceral invasion and distant metastases.
Establishing the diagnosis
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Thyroid lymphoma can be mistaken for anaplastic carcinoma, so biopsy is critical.
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Biopsy can be performed using a core or open technique.
Treatment according to disease extent
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Occasional patients have disease limited to the neck that appears resectable on imaging.
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These selected patients seem to have a slightly better outcome with aggressive surgery followed by radiotherapy with or without chemotherapy.
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Treatment is palliative in most patients.
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Patients developing airway symptoms are generally better managed without tracheostomy, despite the potentially distressing mode of death.