Primary Diagnosis of an Anaplastic Thyroid Carcinoma by the Dentist: Case Report

Abstract

Za primarnu procjenu i vođenje slučaja u stomatološkim ordinacijama najvažnija je detaljna sustavna anamneza te ekstra/intraoralni pregled pacijenata s bilo kakvom cervikalnom i facijalnom patologijom. Taj je pristup ključan u inicijalnoj procjeni i zbrinjavanju bolesnika s nekoliko kliničkih stanja u cervikalnoj regiji koja se često mogu primarno dijagnosticirati kod stomatologa. Na taj se način sprječavaju nepotrebne terapijske intervencije u klinikama. U ovom prikazu opisujemo slučaj 85-godišnjakinje kojoj je u našoj klinici postavljena dijagnoza anaplastičnog karcinoma štitne žlijezde nakon inicijalne procjene zbog bola u srednjem dijelu mandibularne regije. Povijest bolesti bila je bez osobitosti, osim zabilježene hipertenzije. Tijekom temeljitoga intraoralnog pregleda nije uočena nikakva patologija koja bi objasnila bolove. Maksila je bila bezuba. Ekstraoralnim pregledom otkrivena je cervikalna asimetrija nastala zbog neprepoznate mase u lijevom lobusu štitnjače, zajedno s oteklinom lijevoga inferiornog cervikalnog limfnog čvora. Nije bila planirana nikakva stomatološka terapijska intervencija u ordinaciji. Nakon dijagnostičke obrade pacijentica je bila podvrgnuta operaciji totalne tiroidektomije, bez cervikalne disekcije. Histopatološkom diferencijacijom bio je potvrđen anaplastični karcinom štitnjače. Slučaj je zanimljiv zato što podsjeća na to koliko je važno imati detaljnu sustavnu anamnezu i obaviti ekstra-/intraoralni pregled tijekom inicijalne procjene pacijenata u stomatološkoj ordinaciji, što se ne bi smjelo zanemarivati ako se u klinikama žele izbjeći nepotrebne intervencije.A thorough/systematic medical history taking and extra-/intraoral examination is essential in the primary evaluation and in the management of the patients with any neck and facial pathology in the dental clinics. This approach is crucial in the initial evaluation and the management of the patients with several clinical conditions which may be frequently diagnosed primarily by the dentist in the neck and prevent unnecessary therapeutic interventions in the dental clinics. In this case report, an 85 years old female, who was primarily diagnosed with anaplastic carcinoma of the thyroid gland after initial evaluation for pain in the middle mandibular region in our dental clinic, was presented. Medical history was not specific except hypertension. In thorough intraoral examination no pathology was observed to explain the pain. Maxillary jaw was edentulous. In extra oral examination cervical asymmetry due to an unrecognized mass in the left thyroidal lobe with the enlargement of the left inferior cervical lymph nodes was noted. No dental therapeutic intervention was planned in the dental clinic. After diagnostic workup the patient was treated with total thyroidectomy without cervical dissection. Anaplastic thyroid carcinoma was confirmed with histopathological examination. This case was interesting to recall the importance of the thorough/systemic medical history taking and extra-/intraoral examination in the initial evaluation of the patients in the dental clinic, which should not be ignored to prevent unnecessary interventions in the dental clinics

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