甲状腺乳头状癌很少发生间变性转化。甲状腺癌间变性转化的一些危险因素是已知的，但这种转化在实践中很难预测。我们报告的一个病例显示，随着时间的推移，中性粒细胞与淋巴细胞比率 (NLR) 和 C 反应蛋白 (CRP) 升高，这是甲状腺癌间变性转化的先兆。该患者是一名 89 岁的女性，有慢性甲状腺癌病史主动脉夹层。在当地医生检测出甲状腺结节后，她被转诊到我们科室。此前，计算机断层扫描发现她患有多结节性甲状腺肿和左侧颈部淋巴结肿大。她的主要症状是颈椎不适和声音嘶哑。血液检查显示：白细胞 (WBC)，4900 /μL； CRP，0.29 毫克/分升；中性粒细胞，64.4%；和淋巴细胞，25.4%。在左上叶发现一个 21 毫米的肿块。超声检查显示左 III（16 毫米）和左 VI（16 毫米）淋巴结增大。细针抽吸细胞学检查诊断为恶性乳头状癌。但由于患者年龄较大且病史较多，因此实施了非手术政策。诊断后9个月，原发肿瘤直径已长至4厘米，血液检查显示：WBC，7700/μL； CRP，0.18 毫克/分升；中性粒细胞，65.3%；和淋巴细胞，22.3%。诊断后10个月，肿瘤直径迅速增大至8厘米，血液检查显示：WBC，6500/μL； CRP，1.01 毫克/分升；中性粒细胞，68.2%；和淋巴细胞，19.3%。诊断出甲状腺乳头状癌未变性转化，患者接受最佳支持治疗政策下的治疗。确诊11个月后出现多发性肺转移，血液检查结果显示：WBC，13,300/μL； CRP，11.28 毫克/分升；中性粒细胞，93.6%；和淋巴细胞，2.3%。不幸的是，患者在发现未分化转移后 63 天因疾病进展而死亡。看到甲状腺癌间变性转化自然史的机会很少。 NLR 和 CRP 随着时间的推移而升高可能是间变性转化的先兆。© 2024。作者。

Papillary thyroid carcinoma rarely undergoes anaplastic transformation. Some risk factors for anaplastic transformation of thyroid cancer are known, but such transformation is difficult to predict in practice. We report a case demonstrating elevations of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) over time as a precursor to anaplastic transformation of thyroid carcinoma.The patient was an 89 year-old woman with a history of chronic aortic dissection. She was referred to our department after her local doctor detected thyroid nodules. She had previously been found to have multinodular goiter and enlarged left cervical lymph nodes on computed tomography. Her chief complaint was cervical discomfort and hoarseness. Blood tests revealed: white blood cells (WBCs), 4900 /µL; CRP, 0.29 mg/dL; neutrophils, 64.4%; and lymphocytes, 25.4%. A 21 mm mass was identified in the upper left lobe. Left III (16 mm) and left VI (16 mm) lymph node were enlarged on ultrasonography. Fine-needle aspiration cytology diagnosed malignant papillary carcinoma. However, due to the advanced age and medical history of the patient, a non-surgical policy was implemented. The primary tumor grew to 4 cm in diameter by 9 months after diagnosis, and blood tests showed: WBC, 7700 /µL; CRP, 0.18 mg/dL; neutrophils, 65.3%; and lymphocytes, 22.3%. By 10 months after diagnosis, the tumor had increased rapidly in diameter to 8 cm, with blood tests showing: WBC, 6500 /µL; CRP, 1.01 mg/dL; neutrophils, 68.2%; and lymphocytes, 19.3%. Anaplastic transformation of papillary thyroid carcinoma was diagnosed, and the patient was placed on treatment under a policy of best supportive care. Multiple lung metastases appeared 11 months after diagnosis, and blood test results showed: WBC, 13,300 /μL; CRP, 11.28 mg/dL; neutrophils, 93.6%; and lymphocytes, 2.3%. Unfortunately, the patient died of disease progression 63 days after identification of undifferentiated metastasis.Chances to see the natural history of anaplastic transformation of thyroid cancer are rare. Elevations in NLR and CRP over time may be precursors to anaplastic transformation.© 2024. The Author(s).