The sonographic images cannot reproduce reality. The largest diameter
of the thyroid exceeded 15 cm. Moreover, the tumor evolved over 2
months and presented a stone-hard mass. An experienced thyroidologist
has little doubt that only anaplastic cancer and MALT-type lymphoma of
the thyroid may present this pattern.
We aspirated the patient six times. There were only less then 10 cells
which morphology could be judged on the smear samples. They presented
degenerative atypia and extreme enlargement. In a normal situation we
have to categorize the smear as non-diagnostic. Such scanty smear
cannot arise from a MALT-type lymphoma.
Considering the clinical, the sonographic and the cytological
presentation we gave a definitive diagnosis of anaplastic carcinoma of
the thyroid. This is absolutely not a rare example: in around 25-30% of
anaplastic carcinomas, we can gain only a limited number of follicular
cells.
