25295501 Visualization

The patient is a 57 Age - year Age - old Age woman Sex who had noted a rapidly Lab_value enlarging Lab_value mass Sign_symptom on the left Biological_structure side Biological_structure of Biological_structure her Biological_structure neck Biological_structure in 2010 Date .
She underwent a total Detailed_description thyroidectomy Therapeutic_procedure and central Biological_structure neck Biological_structure dissection Therapeutic_procedure , which revealed a 3.8 Distance - cm Distance anaplastic Detailed_description thyroid Disease_disorder cancer Disease_disorder arising in a background of an oncocytic Detailed_description variant Detailed_description of poorly Detailed_description differentiated Detailed_description thyroid Disease_disorder cancer Disease_disorder (Fig.1A, and Fig.S1 in Supplementary Appendix 1, available with the full text of this article at NEJM.org).
Resection Diagnostic_procedure margins Diagnostic_procedure were positive Lab_value , and 3 Lab_value of Lab_value 12 Lab_value lymph Biological_structure nodes Biological_structure were involved Sign_symptom .
At 3 Date weeks Date after Date surgery, the serum Detailed_description thyroglobulin Diagnostic_procedure level was 17.2 Lab_value ng Lab_value per Lab_value milliliter Lab_value , with undetectable Lab_value thyroglobulin Diagnostic_procedure antibodies Diagnostic_procedure .
The patient received concurrent radiation Therapeutic_procedure therapy Therapeutic_procedure and weekly carboplatin Medication and paclitaxel Medication chemotherapy Medication .
The serum Detailed_description thyroglobulin Diagnostic_procedure level at 4 Date weeks Date after Date the completion of chemotherapy and radiation therapy was 12.0 Lab_value ng Lab_value per Lab_value milliliter Lab_value .
Restaging scans Diagnostic_procedure obtained 3 Date months Date later Date revealed a new, right Biological_structure - sided Biological_structure hilar Biological_structure mass Sign_symptom (Fig.1C), and the patient enrolled in a phase Detailed_description 2 Detailed_description clinical Clinical_event trial Clinical_event of everolimus Medication , which was administered at a dose of 10 Dosage mg Dosage daily Dosage .
Within Date 6 Date months Date , follow Clinical_event - up Clinical_event scans Diagnostic_procedure showed that the lesion Coreference had greatly diminished Sign_symptom in Sign_symptom size Sign_symptom (from 3.0 Area by Area 2.6 Area cm Area to 1.1 Area by Area 0.8 Area cm Area ) (Fig.1D).
After 18 Duration months Duration of a sustained response Sign_symptom to everolimus Medication , scans Diagnostic_procedure revealed progressive Disease_disorder disease Disease_disorder (Fig.1E).
The patient underwent a mediastinoscopy Diagnostic_procedure with removal Therapeutic_procedure of an enlarged Sign_symptom lymph Biological_structure node Biological_structure , which contained metastatic Detailed_description anaplastic Detailed_description thyroid Disease_disorder cancer Disease_disorder (Fig.1B, and Fig.S1 in Supplementary Appendix 1).
Whole Detailed_description - exome Detailed_description sequencing Diagnostic_procedure was performed on biopsy Diagnostic_procedure samples of the pretreatment Detailed_description and Detailed_description resistant Detailed_description tumors Detailed_description as well as on a blood Detailed_description sample Detailed_description .