Incidental extensive thyroid malignancy in a laryngectomy for squamous carcinoma: a case report

Introduction Laryngectomy specimens for extensive squamous cell carcinoma (SCC) often include thyroid for both access and staging. Occasionally, incidental pathology is discovered within this tissue or the associated neck structures. We present a case of unexpected extensive thyroid malignancy, concurrent with squamous carcinoma. Clinical Presentation A 56-year-old man presented to Ear, Nose, and Throat with a 4-month history of hoarseness and palpable neck masses. He had previously suffered from follicular non-Hodgkin lymphoma, treated with bendamustine and rituximab. Following a past assault, he sustained brain damage and required tracheostomy. He was a previous smoker. A computed tomography scan revealed a supraglottic mass, subsequently confirmed as moderately differentiated SCC on microlaryngoscopic biopsy. Histopathology A total laryngectomy with bilateral modified neck dissections was performed. On sectioning, a bilateral tumor was present within the anterior supraglottis and glottis, destroying the anterior thyroid cartilage and involving the strap muscles. The included right thyroid lobectomy contained a number of pale nodules, which were sampled extensively. Histology confirmed the laryngeal tumor to be moderately differentiated SCC. The thyroid gland contained numerous foci of invasive papillary thyroid carcinoma that, at one point, collided with the SCC. The selective neck dissections contained numerous bilateral deposits of both squamous and papillary thyroid carcinoma with extracapsular extension. Conclusions Laryngeal resection specimens include numerous adjacent anatomical structures, removed both for surgical and staging purposes. Our case report highlights that these adjacent structures can include additional incidental primary disease, making careful macroscopic dissection and description vital to ensure both correct staging and to avoid second pathologies being overlooked.