Abstract
The patient was a 58-year-old female. Partial thyroidectomy was performed for a benign thyroid adenoma at 27 years old. Total thyroidectomy was conducted for a thyroid adenocarcinoma and wedge resection of the right lung was carried out for a pulmonary metastatic tumor, diagnosed as poorly differentiated adenocarcinoma of an unknown origin, at 47 years old. Bilateral lung resection was also performed for lung metastases at 52 years old. A single nodule of the right upper lobe near the hilum was not resected at this time. Six years later, this nodule enlarged rapidly. A right upper lobectomy with hilar and mediastinal lymph node dissection was perfomed. The tumor transformed to anaplastic carcinoma. One week after hospital discharge, she was readmitted with complaints of pain and dyspnea. Chest CT revealed compression of the trachea, bilateral main bronchi, and superior vena cava, with marked swelling of the upper mediastinal lymph nodes. The white blood cell count increased to 136,000 per microliter, and granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in peripheral blood showed abnormally high levels. Chemoradiation therapy was ineffective, and she died of insufficient systemic venous return 3 weeks after readmission.
