Anaplastic Thyroid Carcinoma

Endocrine

Clinicals - History

Fact Explanation
Rapidly growing anterior neck mass. Anaplastic carcinoma grows very rapidly. It accounts for about 1.6% of all thyroid cancers. Rapidly growing anterior neck mass.
Anaplastic carcinoma grows very rapidly. It accounts for about 1.6% of all thyroid cancers.
Hoarseness This is one of the most common presentation. Hoarseness is due to the involvement of the recurrent laryngeal nerve. Hoarseness
This is one of the most common presentation. Hoarseness is due to the involvement of the recurrent laryngeal nerve.
Dysphagia Compression of the esophagus produces dysphagia. This is the second most common symptom of presentation. Dysphagia
Compression of the esophagus produces dysphagia. This is the second most common symptom of presentation.
Cough Tracheal compression produces cough. Cough
Tracheal compression produces cough.
Dyspnea Due to the pulmonary metastases. Dyspnea
Due to the pulmonary metastases.
Stridor Due to tracheal compression. Stridor
Due to tracheal compression.
Cervical pain Invasion of cervical plexus produces neck pain. Cervical pain
Invasion of cervical plexus produces neck pain.
Bone pain Metastasis in the bone produce bone pain. Most patients with anaplastic carcinoma of the thyroid will have metastasis at the time of presentation. Bone pain
Metastasis in the bone produce bone pain. Most patients with anaplastic carcinoma of the thyroid will have metastasis at the time of presentation.
Neurologic deficits Due to cerebral metastasis and involvement of the vertebral column. Neurologic deficits
Due to cerebral metastasis and involvement of the vertebral column.
Symptoms of increased intracranial pressure Anaplastic carcinoma metastasizes to the brain and increase the intra-cranial pressure. Patients have early morning headache and nausea which is relieved by vomiting. Symptoms of increased intracranial pressure
Anaplastic carcinoma metastasizes to the brain and increase the intra-cranial pressure. Patients have early morning headache and nausea which is relieved by vomiting.
Palpable cervical lymph nodes Cervical lymph nodes enlarge due to local metastasis. Palpable cervical lymph nodes
Cervical lymph nodes enlarge due to local metastasis.
Long history of anterior neck mass with recent rapid enlargement Previously undetected long-standing thyroid carcinoma and goiters (eg, papillary, follicular) are known to progress to anaplastic carcinoma. Long history of anterior neck mass with recent rapid enlargement
Previously undetected long-standing thyroid carcinoma and goiters (eg, papillary, follicular) are known to progress to anaplastic carcinoma.
Anorexia and weight loss Systemic spread of the tumor to the liver produce anorexia and weight loss. Anorexia and weight loss
Systemic spread of the tumor to the liver produce anorexia and weight loss.

Clinicals - Examination

Fact Explanation
Anterior neck mass The thyroid gland may contain a single nodule (58%), or multiple nodules (36%), involving a single lobe or both lobes. The gland is firm to hard in consistency and fixed to the surrounding structures. Anterior neck mass
The thyroid gland may contain a single nodule (58%), or multiple nodules (36%), involving a single lobe or both lobes. The gland is firm to hard in consistency and fixed to the surrounding structures.
Cervical lymph nodes Some patients have lymph node enlargement. Cervical lymph nodes
Some patients have lymph node enlargement.
Signs of pleural effusions Lungs are the most common site of metastasis. Malinant pleural effusions produce reduced chest expansion, stony dull percussion note, and absent air entry over the affected segment. Signs of pleural effusions
Lungs are the most common site of metastasis. Malinant pleural effusions produce reduced chest expansion, stony dull percussion note, and absent air entry over the affected segment.
Neurologic deficits Due to the cerebral metastasis. Neurologic deficits
Due to the cerebral metastasis.
Evidence of bone metastasis Bone metastasis of the spine produces tender points. Vertebral collapse is detected by palpation of the vertebral column. Evidence of bone metastasis
Bone metastasis of the spine produces tender points. Vertebral collapse is detected by palpation of the vertebral column.
Laryngoscopic examination of vocal cords This will detect the vocal cord paralysis. Laryngoscopic examination of vocal cords
This will detect the vocal cord paralysis.

Investigations - Diagnosis

Fact Explanation
Fine-needle aspiration and cytology (FNAC) FNAC will provide a cytological diagnosis of anaplastic carcinoma. Fine-needle aspiration and cytology (FNAC)
FNAC will provide a cytological diagnosis of anaplastic carcinoma.
Open surgical biopsy When FNAC is inconclusive open surgical biopsy is done to make the definitive diagnosis of anaplastic carcinoma. Open surgical biopsy
When FNAC is inconclusive open surgical biopsy is done to make the definitive diagnosis of anaplastic carcinoma.

Investigations - Management

Fact Explanation
Serum calcium levels Permanent hypoparathyroidism is a known complication of radical surgery. Serum calcium levels
Permanent hypoparathyroidism is a known complication of radical surgery.
Indirect laryngoscopy Detects post-operative recurrent laryngeal nerve palsy. Indirect laryngoscopy
Detects post-operative recurrent laryngeal nerve palsy.
Complete blood count Enables detection of anemia and infection before the surgery. Complete blood count
Enables detection of anemia and infection before the surgery.
Serum electrolytes and creatinine Renal function should be evaluated prior to the surgery. Serum electrolytes and creatinine
Renal function should be evaluated prior to the surgery.
Chest radiography If there is a history of lung disease. Detection of the anatomical variations of the structures in the neck is also important. Chest radiography
If there is a history of lung disease. Detection of the anatomical variations of the structures in the neck is also important.
ECG Asses the cardiovascular fitness of the patient. ECG
Asses the cardiovascular fitness of the patient.
Chest radiography Canon ball appearance is suggestive of lung metastasis. Detects malignant pulmonary effusions. Chest radiography
Canon ball appearance is suggestive of lung metastasis. Detects malignant pulmonary effusions.
Ultra sound scan of the neck Detects cervical lymph node metastasis. Ultra sound scan of the neck
Detects cervical lymph node metastasis.
CT scan CT scan of the neck detects the local spread of disease (stage IVA). Other than that CT can detect pleural effusions and metastasis in lung, liver, bone, and brain. If distant metastasis are present the tumor stage is IVC. CT scan
CT scan of the neck detects the local spread of disease (stage IVA). Other than that CT can detect pleural effusions and metastasis in lung, liver, bone, and brain. If distant metastasis are present the tumor stage is IVC.
MRI Detects similar information like the CT scan. MRI
Detects similar information like the CT scan.
Bone scanning Detects bone metastasis. Bone scanning
Detects bone metastasis.
Positron emission tomography (PET) Uses 18F-fluorodeoxyglucose (18F-FDG). This visualizes the primary tumor, and metastases in the lymph nodes, lungs, and other distant sites. Positron emission tomography (PET)
Uses 18F-fluorodeoxyglucose (18F-FDG). This visualizes the primary tumor, and metastases in the lymph nodes, lungs, and other distant sites.
Indirect laryngoscopy Detects recurrent vocal cord paralysis. Indirect laryngoscopy
Detects recurrent vocal cord paralysis.

Management - Supportive

Fact Explanation
Tracheostomy The major cause of mortality in patients with anaplastic carcinoma of the thyroid is the airway obstruction. Tracheostomy is a conservative measure to prevent this and prolong the life. Tracheostomy
The major cause of mortality in patients with anaplastic carcinoma of the thyroid is the airway obstruction. Tracheostomy is a conservative measure to prevent this and prolong the life.
Interventional bronchoscopy Provides access to deliver laser therapy to tracheal metastases. Also enables stenting the narrowed airway. Interventional bronchoscopy
Provides access to deliver laser therapy to tracheal metastases. Also enables stenting the narrowed airway.
Patient education Anaplastic carcinoma of the thyroid is a rapidly growing and early metastasizing carcinoma and have median survival of about 4 to 6 months. Patient education and psychological support is mandatory. Patient education
Anaplastic carcinoma of the thyroid is a rapidly growing and early metastasizing carcinoma and have median survival of about 4 to 6 months. Patient education and psychological support is mandatory.

Management - Specific

Fact Explanation
Total thyroidectomy About one third of the patients with anaplastic carcinoma have small, resectable carcinoma at the time of diagnosis (stage IVA). These patients are suitable candidates for the total thyroidectomy. The patients are given radiotherapy after the surgical resection for better outcome. Often multimodal approach with surgery, radiotherapy, and chemotherapy is used. Total thyroidectomy
About one third of the patients with anaplastic carcinoma have small, resectable carcinoma at the time of diagnosis (stage IVA). These patients are suitable candidates for the total thyroidectomy. The patients are given radiotherapy after the surgical resection for better outcome. Often multimodal approach with surgery, radiotherapy, and chemotherapy is used.
Doxorubicin Doxorubicin is an antineoplastic agent which inhibits topoisomerase II and produces free radicals. These free radicals damage the DNA of the rapidly growing cells. This is the most effective therapy in metastatic disease. Mono-therapy with doxorubicin is inferior than the combined therapy with doxorubicin and cisplatin. Doxorubicin is often combined with external beam radiotherapy for more effective tumor suppression. Doxorubicin
Doxorubicin is an antineoplastic agent which inhibits topoisomerase II and produces free radicals. These free radicals damage the DNA of the rapidly growing cells. This is the most effective therapy in metastatic disease. Mono-therapy with doxorubicin is inferior than the combined therapy with doxorubicin and cisplatin. Doxorubicin is often combined with external beam radiotherapy for more effective tumor suppression.
Cisplatin Cisplatin is a chemotherapeutic agent which forms DNA crosslinks and denature the DNA double helix. These actions will inhibit the cell proliferation. Cisplatin
Cisplatin is a chemotherapeutic agent which forms DNA crosslinks and denature the DNA double helix. These actions will inhibit the cell proliferation.
Valproic acid Valporic acid induces apoptosis of the cancer cells. It enhances the action of doxorubicin by increasing the sensitivity of anaplastic cancer cell lines to doxorubicin. Valproic acid
Valporic acid induces apoptosis of the cancer cells. It enhances the action of doxorubicin by increasing the sensitivity of anaplastic cancer cell lines to doxorubicin.
External beam radiotherapy Radiotherapy with larger doses will improve the survival. It is a very effective method of limiting the loco regional spread of the tumor. For patients who are less than or 70 years old with tumor size of 5 cm or less with no distant disease benefit from post-operative radiotherapy. Often larges doses are used in the treatment. External beam radiotherapy
Radiotherapy with larger doses will improve the survival. It is a very effective method of limiting the loco regional spread of the tumor. For patients who are less than or 70 years old with tumor size of 5 cm or less with no distant disease benefit from post-operative radiotherapy. Often larges doses are used in the treatment.
BRAF and EGFR inhibitors BRAF mutations and EGFR overexpression are known associated genetic changes in anaplastic thyroid carcinoma. Inhibition of the activity of these two genes will inhibit the proliferation of malignant cells. Erlotinib is an EGFR inhibitor. BRAF and EGFR inhibitors
BRAF mutations and EGFR overexpression are known associated genetic changes in anaplastic thyroid carcinoma. Inhibition of the activity of these two genes will inhibit the proliferation of malignant cells. Erlotinib is an EGFR inhibitor.
Imatinib This is an inhibitor of C-kit, platelet-derived growth factor receptor. Imatinib
This is an inhibitor of C-kit, platelet-derived growth factor receptor.

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  1. ASARI R, PASSLER C, KACZIREK K, SCHEUBA C, NIEDERLE B. Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg. [online] 2008 Feb;143(2):132-7. [viewed 6 April 2014] Available from: doi: 10.1001/archsurg.2007.55.
  2. AUGUSTO T, FRANCESCA S, MARCO B. Anaplastic Thyroid Carcinoma. Front Endocrinol (Lausanne). [online] 2012; 3: 84. [viewed 6 April 2014] Available from: doi: 10.3389/fendo.2012.00084
  3. B. JEREB, J. STJERNSWARD, AND T. LOWHAGEN, “Anaplastic giant cell carcinoma of the thyroid. A study of treatment and prognosis,” Cancer, [online] 1975. 35 (5), 1293–1295, [viewed 6 April 2014] Available from: http://www.scopus.com/record/display.url?eid=2-s2.0-0016783987&origin=inward&txGid=913BC837E6F75251CA21D16E00A154F8.aqHV0EoE4xlIF3hgVWgA%3a2
  4. BHATIA A, RAO A, ANG KK, GARDEN AS, MORRISON WH, ROSENTHAL DI, et al. Anaplastic thyroid cancer: Clinical outcomes with conformal radiotherapy. Head Neck. [online] Nov 2 2009 [viewed 6 April 2014] Available from: doi: 10.1002/hed.21257.
  5. BOGSRUD TV, KARANTANIS D, NATHAN MA, MULLAN BP, WISEMAN GA, KASPERBAUER JL, et al. 18F-FDG PET in the management of patients with anaplastic thyroid carcinoma. Thyroid. [online] Jul 2008;18(7):713-9. [viewed 6 April 2014]
  6. CHIACCHIO S, LORENZONI A, BONI G, RUBELLO D, ELISEI R, MARIANI G. Anaplastic thyroid cancer: prevalence, diagnosis and treatment. Minerva Endocrinol. [online] Dec 2008;33(4):341-57. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18923370
  7. CHUANZHENG S. QIULI LI, ZEDONG HU, JIEHUA HE, CHAO LI, GUOJUN LI, XIAOFENG T., ANKUI YANG. Treatment and Prognosis of Anaplastic Thyroid Carcinoma: Experience from a Single Institution in China. [online] [viewed 8 April 2014] Available from: DOI: 10.1371/journal.pone.0080011
  8. CHUANZHENG SUN, QIULI LI, ZEDONG HU, JIEHUA HE, CHAO LI, GUOJUN LI, XIAOFENG TAO, ANKUI YANG. Treatment and Prognosis of Anaplastic Thyroid Carcinoma: Experience from a Single Institution in China. PLoS ONE [online] 8(11): e80011. [viewed 6 April 2014] Available from: doi:10.1371/journal.pone.0080011
  9. DAVID F. SCHNEIDER, HERBERT C. New developments in the diagnosis and treatment of thyroid cancer. [online] [viewed 6 April 2014] Available from: DOI: 10.3322/caac.21195
  10. DE CREVOISIER R, BAUDIN E, BACHELOT A, et al.: Combined treatment of anaplastic thyroid carcinoma with surgery, chemotherapy, and hyperfractionated accelerated external radiotherapy. Int J Radiat Oncol Biol Phys [online] 60 (4): 1137-43, 2004. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15519785?dopt=Abstract
  11. GILLILAND FD, HUNT WC, MORRIS DM, KEY CR. Prognostic factors for thyroid carcinoma. A population-based study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973-1991. Cancer. [online] 1997;79:564–573. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9028369
  12. GIUFFRIDA D, GHARIB H. Anaplastic thyroid carcinoma: Current diagnosis and treatment. Annals of Oncology[online] 2000: 11: 1083-1089. [viewed 6 April 2014] Available from: http://annonc.oxfordjournals.org/content/11/9/1083.full.pdf?origin=publication_detail
  13. GOLDMAN JM, GOREN EN, COHEN MH, et al.: Anaplastic thyroid carcinoma: long-term survival after radical surgery. J Surg Oncol [online] 14 (4): 389-94, 1980. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/7442263?dopt=Abstract
  14. HA HT, LEE JS, URBA S, KOENIG RJ, SISSON J, GIORDANO T, WORDEN FP. A phase II study of imatinib in patients with advanced anaplastic thyroid cancer. Thyroid [online] 2010. 20:975–980. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20718683
  15. HAAS V, CELAKOVSKY P, BRTKOVA J, HORNYCHOVA H. Unusual manifestation of anaplastic thyroid cancer. Acta Medica (Hradec Kralove) [online] 2008: 51:233–236. [viewed 6 April 2014]
  16. HOGAN T, JING JIE YU, WILLIAMS HJ, ALTAHA R, XIAOBING LIANG, QI HE. Oncocytic, focally anaplastic, thyroid cancer responding to erlotinib. J Oncol Pharm Pract [online] 2009. 15:111–117. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19276143
  17. HUNDAHL S. A., CADY B., CUNNINGHAM M. P., et al., “Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study,” Cancer. [online] 2000 89: 202–217,. [viewed 6 April 2014] available at (www.ncbi.nlm.nih.gov/pubmed/10897019)?
  18. KEBEBEW E, GREENSPAN FS, CLARK OH, WOEBER KA, MCMILLAN A. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer. [online] 2005 Apr 1;103(7):1330-5. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15739211
  19. KIM JH, LEEPER RD. Treatment of anaplastic giant and spindle cell carcinoma of the thyroid gland with combination Adriamycin and radiation therapy. A new approach. Cancer. [online] 1983;52:954–957. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6883279
  20. KIM JH, LEEPER RD. Treatment of locally advanced thyroid carcinoma with combination doxorubicin and radiation therapy. Cancer. [online] 1987;60:2372–2375. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3664425
  21. MCIVER B, HAY ID, GIUFFRIDA DF, DVORAK CE, GRANT CS, THOMPSON GB, et al. Anaplastic thyroid carcinoma: a 50-year experience at a single institution. Surgery. [online] 2001;130:1028–1034. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11742333
  22. NAGAIAH G., HOSSAIN A., MOONEY C. J., PARMENTIER J., REMICK S. C., “Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment,” Journal of Oncology, [online] 2011: 2011 (2011). [viewed 6 April 2014] Available from: http://dx.doi.org/10.1155/2011/542358
  23. NGUYEN BD, RAM PC. PET/CT staging and posttherapeutic monitoring of anaplastic thyroid carcinoma. Clin Nucl Med [online] 2007. 32:145–149. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17242574
  24. NOGUCHI H, YAMASHITA H, MURAKAMI T, HIRAI K, NOGUCHI Y, MARUTA J, et al. Successful treatment of anaplastic thyroid carcinoma with a combination of oral valproic acid, chemotherapy, radiation and surgery. Endocr J. [online] Apr 2009;56(2):245-9. [viewed 6 April 2014] Available from: https://www.jstage.jst.go.jp/article/endocrj/56/2/56_K08E-016/_article
  25. NOPPEN M, POPPE K, D'HAESE J, MEYSMAN M, VELKENIERS B et al. Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease. Chest [online] 2004: 125: 723-730. doi:10.1378/chest.125.2.723.
  26. PIERIE JP, Muzikansky A, Gaz RD, Faquin WC, Ott MJ. The effect of surgery and radiotherapy on outcome of anaplastic thyroid carcinoma. Ann Surg Oncol. [online] 2002;9:57–64. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11833496
  27. POISSON T, DEANDREIS D, LEBOULLEUX S, BIDAULT F, BONNIAUD G, et al. 18F-Fluorodeoxyglucose positron emission tomography and computed tomography in anaplastic thyroid cancer. Eur J Nucl Med Mol Imaging [online] 2010. 37:2277–2285. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20694463
  28. PRAHALLAD A, SUN C, HUANG S, DI NICOLANTONIO F, SALAZAR R, et al. 2012. Unresponsiveness of colon cancer to BRAF(V600E) inhibition through feedback activation of EGFR. Nature[online] 483:100–103. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22281684
  29. Practice advisory for preanesthesia evaluation. An updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. [viewed 1 April 2014] Available from: http://www.guideline.gov/content.aspx?id=36197
  30. ROBERT C. S. Approach to the Patient with Anaplastic Thyroid Carcinoma. J Clin Endocrinol Metab. [online] Aug 2012; 97(8): 2566–2572. [viewed 6 April 2014] Available from: doi: 10.1210/jc.2012-1314
  31. ROBERT C. S. Approach to the Patient with Anaplastic Thyroid Carcinoma. J Clin Endocrinol Metab.[online] Aug 2012; 97(8): 2566–2572. [viewed 6 April 2014] Available from: doi: 10.1210/jc.2012-1314
  32. ROBERT C. S., KENNETH B. A., SYLVIA L. A., KEITH C. B. American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer. THYROID. [online] 2012. 22(11) [viewed 6 April 2014] Available from: DOI: 10.1089/thy.2012.0302
  33. ROBERT E. C., Clinical Features of Metastatic Bone Disease and Risk of Skeletal Morbidity. Clin Cancer Res [online] October 15, 2006 12; 6243s [viewed 6 April 2014] Available from: doi: 10.1158/1078-0432.CCR-06-0931
  34. RUCKER L, FRYE EB, STATEN MA. Usefulness of screening chest roentgenograms in preoperative patients. JAMA [online]250(23):3209-11. [viewed 1 April 2014]
  35. SAMAAN NA, ORDONEZ NG. Uncommon types of thyroid cancer. Endocrinol Metab Clin North Am [online] 1990; 19: 637-48[viewed 6 April 2014] available at (http://www.ncbi.nlm.nih.gov/pubmed/2261909)?
  36. SHILLER SM, KONDURI K, HARSHMAN LK, WELCH BJ, O'BRIEN JC. Recurrent thyroid cancer with changing histologic features. Proc (Bayl Univ Med Cent). [online] 2010;23(3):304-310. [viewed 6 April 2014] available at (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900987)?
  37. SHIMAOKA K, SCHOENFELD DA, DEWYS WD, et al.: A randomized trial of doxorubicin versus doxorubicin plus cisplatin in patients with advanced thyroid carcinoma. Cancer [online] 56 (9): 2155-60, 1985. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3902203?dopt=Abstract
  38. SUN M.L., SANG J.S., BYOUNG C.C. Treatment Outcome of Patients with Anaplastic Thyroid Cancer: A Single Center Experience. Yonsei Med J. [online] Mar 1, 2012; 53(2): 352–357. [viewed 6 April 2014] Available from: doi: 10.3349/ymj.2012.53.2.352
  39. SWAAK-KRAGTEN AT, DE WILT JH, SCHMITZ PI, BONTENBAL M, LEVENDAG PC. Multimodality treatment for anaplastic thyroid carcinoma--treatment outcome in 75 patients. Radiother Oncol. [online] Jul 2009;92(1):100-4. [viewed 6 April 2014] Available from: doi: 10.1016/j.radonc.2009.02.016. Epub 2009 Mar 26.
  40. SWAAK-KRAGTEN AT, DE WILT JH, SCHMITZ PI, BONTENBAL M, LEVENDAG PC. Multimodality treatment for anaplastic thyroid carcinoma—treatment outcome in 75 patients. Radiother Oncol [online] 2009. 92:100–104. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19328572
  41. TENNVALL J, LUNDELL G, WAHLBERG P, BERGENFELZ A, GRIMELIUS L, AKERMAN M, HJELM SKOG AL, WALLIN G. 2002. Anaplastic thyroid carcinoma: three protocols combining doxorubicin, hyperfractionated radiotherapy and surgery. Br J Cancer [online] 86:1848–1853. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12085174
  42. US-KRASOVEC M, GOLOUH R, AUERSPERG M, BESIC N, RUPARCIC-O. Anaplastic thyroid carcinoma in fine needle aspirates. Acta Cytol. [online] 1996 Sep-Oct;40(5):953-8. [viewed 6 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8842172
  43. WISEMAN SM, MASOUDI H, NIBLOCK P, TURBIN D, RAJPUT A, HAY J, et al. Anaplastic thyroid carcinoma: expression profile of targets for therapy offers new insights for disease treatment. Ann Surg Oncol. [online] Feb 2007;14(2):719-29. [viewed 6 April 2014] Available from: 10.1245/s10434-006-9178-6