Europ. J. Canter Vol. 13, pp. 381-383. Pergamon Press 1977. Printed in Great Britain Anaplastic Carcinoma of the Thyroid Gland P. SCHOUMACHER, R. METZ, P. BEY and A. M. CHESNEAU C, eare Alexis Vatarin, Brabois-R.N. 74-54500 Vandoeuvre-les-Naney, France Abstract--Thirty cases of anaplastic thyroid carcinoma are reviewed. Clinical and lOathological charavteristics are briefly reported. Prognosis is very bad: only 1 patient survived more than 2 years and treatment (surgery and radiotherapy) is rarely e~dent ; Adriamycin, used in 5 more recent cases, gave one good remission and has to be used in all cases in association with other treatments. INTRODUCTION ANAPLASTIC carcinomas of the thyroid gland appearing in old people grow rapidly and are fatal. They are opposed to well differentiated carcinomas of younger people, which have a slower evolution and well defined treatment. The frequency of the anaplastic type is about 20-25% of all thyroid carcinomas. MATERIAL AND METHODS We present observations of anaplastic carcin- omas collected at the Centre Regional de Lutte contre le Cancer de NANCY: 30 between 1957 and 1973 and 5 more recent but which concern patients having received adria- mycin. During this period, 144 thyroid carcin- omas were observed, anaplastic type represent- ing 20%. All these cases have been reviewed by the same pathologist (Dr. Parache). Pathological aspect These carcinomas were classified in 2 groups: (1) Small cell carcinoma (9 cases) with round ceils of the same size as lymphocytes, acidophylic cytoplasm, well delimited. There are many mitoses and frequent nuclear ab- normalities: the nucleus is round or oval, rich in chromatin, with one or more nucleols. These are either grouped, in dense accumulation, divided by fibrous septa or spread without order, diffusely. The distinction with malignant lymphomas is often difficult. (2) Giant cell carcinoma (20 cases) They have a pleomorphic appearance and we can see: spindle-shaped ceils, giant ceils with several nuclei, polygonal or round great ceils, with abun- dant cytoplasm and hyperchromatic nuclei. 381 (3) Other aspects In one observation, the carcinoma was mixed with small and spindle-shaped cells. In another case, we noted the association of a well differentiated carcinoma with an ana- plastic one. One time the metastases were well- differentiated (vesicular in the liver) and the primary was a giant cell anaplastic type. Clinical data The extreme ages at time of diagnosis were 30 and 87 (average 66). Sex ratio showed 27 women for 3 men. The small cell type was observed only in women. Pre-existent goitre was found in 16 cases for at least 4 years (maximum ]9 years). One patient, a 72-year-old woman, was irradiated 35 years before diagnosis for a simple goitre by external radiotherapy. None of our patients received I131 before diagnosis. Seven patients received iodine or antithyroid drugs many years before diagnosis. The beginning of the symptoms is usually sudden. Time between the first symptom and the diagnosis is 3 months in average. The first symptoms are: appearance of a goitre or modification of an old one (2 cases) cervical or mediastinal compression: dysp- nea, dysphagia, dysphonia, pain asthenia, loss of weight cervical lymph node involvement (17 cases) metastatic disease (7 cases, essentially pul- monary). We never observed dysthyroidism: biological and isotopic examinations were normal or sub- normal. Inflammatory signs were often present. Anti-thyroid anti-bodies were found in 3 cases on 6 studied. Thyroid scan showed no fixation on the tumoral region. Metastases never fixed I131.