Anaplastic thyroid carcinoma with cutaneous extension

A 76-yr-old woman presented with an 8-month history of a rapidly enlarging neck mass. She denied hoarseness of voice, dysphagia, or dyspnea but did report a 10-pound weight loss. Serum TSH was 1.24 IU/ ml. Computed tomography of the neck showed a 7.9-cm solid and cystic mass (Fig. 1). Fine-needle aspiration revealed papillary thyroid cancer with a poorly differentiated component. Within 1 month, the mass had markedly increased in size and was eroding through the skin (Fig. 2). Thyroglobulin levels were not obtained because we were consulted postoperatively. The patient underwent a total thyroidectomy, central compartment and right radical neck dissection. Pathology showed 4.5-cm papillary and 6-cm anaplastic thyroid carci-