Main squamous cell carcinoma (SCC) from the thyroid gland is normally a very rare entity representing 1% of all primary carcinomas of the thyroid gland with a very poor prognosis. is to report the case of a SCC of the thyroid gland in a 65-year-old woman, emphasizing the postoperative complications and poor prognosis of these patients. CASE REPORT A 65-year-old female patient with a 20-year history of thyroid goiter was admitted to our clinic due to progressive neck enlargement for the past 2 months. Her previous medical history revealed only hypertension. Her weight was stable and she was a smoker for 26 years (19C45 years old). On physical examination, her vital signs were stable. A fixed hard neck mass was palpable in the left thyroid lobe. There was no palpable cervical lymphadenopathy, and examination of chest, heart, nervous system and abdomen was normal. Thyroid ultrasound was performed revealing a mass of the left lobe measuring 4.5 5.2 5.9 cm with retrosternal extension. The ultrasound also showed the presence of enlarged lymph nodes in the left neck. Fine needle aspiration (FNA) cytology was performed which showed no definite signs of malignancy. The patient was scheduled for operation and underwent total thyroidectomy. The recurrent nerves were identified and preserved in both sides. The excision of the thyroid gland (Fig.?1) was accompanied by six enlarged lymph nodes that seemed to be suspicious during the surgical procedure. No LY2109761 price infiltration of adjacent organs (esophagus, trachea and carotid) was noted intraoperatively. The patient’s hospitalization was uneventful and was discharged on the second postoperative day. Open in a separate window Figure?1: Surgical specimen: thyroid gland with an enlarged left lobe (retrosternal SPN extension). Histological examination showed the presence of moderately differentiated SCC which infiltrated primarily the remaining and focally the proper lobe from the thyroid gland (Fig.?2). Huge regions of fibrosis with hyalinization, calcification, bone tissue foci and development of necrosis were observed. Because of the previously described lesions Probably, the cytological aspiration was adverse for malignancy. From the six resected lymph nodes, three demonstrated metastasis from the SCC. Neoplastic cells were seen in the perilymphnodal lipoid tissue also. Sections from additional sites from the thyroid demonstrated goiter-like lesions without indications of Hashimoto’s thyroiditis or any additional neoplasm. On the basis of the above results, the patient was referred for further treatment to an oncology clinic. Open in a separate window Figure?2: H/E 100 section from the left lobe of the thyroid LY2109761 price gland showing infiltrative SCC. A month after surgery the patient was again admitted with painful enlargement in the left neck. EarCnose and throat field examination was performed showing left vocal cord paresis. Esophagogastroduodenoscopy was performed, due to the presence of enlarged lymph nodes in the left supraclavicular fossa, with no significant findings. CT of the neck and thorax revealed a 6.2-cm-diameter mass infiltrating the trachea and the surrounding soft tissue (Fig.?3), as well as the presence of lymph nodes in the mediastinum and metastatic foci in the right lung (Fig.?4). MRI of the head and neck showed the presence of stenosis in the subglottic part of the larynx, the upper part of the trachea and extensive lymphadenopathy in the left neck, with enlargement of isthmus and left lobe areas. Finally, one and a half month after surgery, tracheostomy was performed due to airway compromise. Open in a separate window Figure?3: A CT scan showing a 6.2-cm mass pressuring and infiltrating the trachea and surrounding soft tissue. Open in a separate window Figure?4: A CT scan showing metastasis to the right lung. Patient was submitted to adjuvant chemotherapy as well as radiation therapy. She underwent two cycles of chemotherapy with cisplatin 70 mg/kg once a week with concomitant radiotherapy, which was abruptly terminated because of toxicity. Patient died 5 months after the surgery because of airway bargain (immediate infiltration of tumor to trachea leading to airway blockage). DISCUSSION An initial SCC from the thyroid can be uncommon, representing 1% of most LY2109761 price major thyroid carcinomas [1, 2]. Because of its rarity,.