Jose Ting1, Diana Bell2, Salmaan Ahmed3, Anita Ying4, Steven G Waguespack4, Shi-Ming Tu5, Randal Weber1, Mark Zafereo1. 1. 1 Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas. 2. 2 Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas. 3. 3 Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas. 4. 4 Department of Endocrine Neoplasia and Hormonal Disorders, and University of Texas MD Anderson Cancer Center, Houston, Texas. 5. 5 Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND: Primary malignant thyroid teratomas are very rare tumors (fewer than 35 previously reported cases in the literature) typically affecting young adult women. While prognosis is poor, there have been some reports of successful treatment regimens. Four cases treated successfully are reported, and a review of the existing literature is provided. PATIENT FINDINGS: Medical records of four patients with histopathologically confirmed malignant thyroid teratomas treated at the University of Texas MD Anderson Cancer Center between 1994 and 2017 were reviewed. The patients were treated with variable treatment regimens consisting of surgical excision with or without aggressive combination chemotherapy (bleomycin, etoposide, and cisplatin; cyclophasphamide, adriamycin, and cisplatin; actinomycin-D, cyclophosphamide, and etoposide; bleomycin, vincristine, and cisplatin; or vincristine, methotrexate, bleomycin, and cisplatin). SUMMARY: All four patients were young women <40 years of age. One patient had thyroid surgery alone, another had surgery with postoperative adjuvant chemotherapy, and two patients underwent neoadjuvant chemotherapy with significant tumor regression prior to definitive thyroid surgery. No patients had postoperative radiation therapy. All patients remained alive and disease free a median of 172 months (range 52-282 months) following completion of therapy. CONCLUSIONS: This case series represents the largest and longest follow-up from a single institution in the literature to date on primary malignant thyroid teratomas. Based on the existing literature and the authors' experience with these four patients, it is suggested that neoadjuvant chemotherapy combined with surgical excision is a promising approach for patients with gross extrathyroidal extension, cervical lymph node metastases, and/or distantly metastatic disease.
BACKGROUND:Primary malignant thyroid teratomas are very rare tumors (fewer than 35 previously reported cases in the literature) typically affecting young adult women. While prognosis is poor, there have been some reports of successful treatment regimens. Four cases treated successfully are reported, and a review of the existing literature is provided. PATIENT FINDINGS: Medical records of four patients with histopathologically confirmed malignant thyroid teratomas treated at the University of Texas MD Anderson Cancer Center between 1994 and 2017 were reviewed. The patients were treated with variable treatment regimens consisting of surgical excision with or without aggressive combination chemotherapy (bleomycin, etoposide, and cisplatin; cyclophasphamide, adriamycin, and cisplatin; actinomycin-D, cyclophosphamide, and etoposide; bleomycin, vincristine, and cisplatin; or vincristine, methotrexate, bleomycin, and cisplatin). SUMMARY: All four patients were young women <40 years of age. One patient had thyroid surgery alone, another had surgery with postoperative adjuvant chemotherapy, and two patients underwent neoadjuvant chemotherapy with significant tumor regression prior to definitive thyroid surgery. No patients had postoperative radiation therapy. All patients remained alive and disease free a median of 172 months (range 52-282 months) following completion of therapy. CONCLUSIONS: This case series represents the largest and longest follow-up from a single institution in the literature to date on primary malignant thyroid teratomas. Based on the existing literature and the authors' experience with these four patients, it is suggested that neoadjuvant chemotherapy combined with surgical excision is a promising approach for patients with gross extrathyroidal extension, cervical lymph node metastases, and/or distantly metastatic disease.
Authors: Abbas Agaimy; Leora Witkowski; Robert Stoehr; Joseph Christopher Castillo Cuenca; Carlos Alberto González-Muller; Alfred Brütting; Markus Bährle; Konstantinos Mantsopoulos; Randa M S Amin; Arndt Hartmann; Markus Metzler; Samir S Amr; William D Foulkes; Manuel Sobrinho-Simões; Catarina Eloy Journal: Virchows Arch Date: 2020-06-07 Impact factor: 4.064