Primary angiosarcoma of the thyroid gland with recurrence diagnosed by fine needle aspiration: a case report

Primary Angiosarcoma of the Thyroid in an Asian Woman: A Case Report with Review of the Literature

Primary thyroid angiosarcoma is a rare malignant tumor and characterized by its prevalence in Alpine regions of Central Europe, close relation to longstanding goiter, and aggressive clinical course with dismal prognosis. We describe the case of an 83-year-old Chinese female who lives in the coastal area of Taiwan. She came to our hospital due to a progressively enlarged mass at her anterior neck. The sonography of the thyroid revealed a well-circumscribed mass in the left lobe. She underwent left hemithyroidectomy. The diagnosis of angiosarcoma of the thyroid was made and further confirmed at a different institution. To the best of our knowledge, this is the first case of primary thyroid angiosarcoma reported from Taiwan and the sixth Asian afflicted with primary thyroid angiosarcomas in the English literatures. The literature search in the PubMed database identified 58 cases who had histologically proven primary thyroid angiosarcomas. A preliminary analysis of epidemiological presentation, clinical features, immunohistochemical characters, and prognosis of primary thyroid angiosarcoma was proposed. The prognosis of this rare neoplasm is surprisingly favorable in comparison with that of its morphological similar, the anaplastic thyroid carcinoma. The use of a comprehensive panel of immunohistochemical stains, including at least two endothelial markers (especially CD31 and ERG) and PAX-8, in combination with thorough light microscopic examination may assist in the discrimination between these two tumors.

Primary Thyroid Angiosarcoma with Tracheal Invasion

A 48-year-old woman was referred to our clinic because she had been experiencing hemoptysis for 1 month. Chest computed tomography revealed a small portion of a thyroid mass was penetrating the trachea. Bronchoscopy revealed a blood vessel covered mass located in her trachea. The presence of a malignant tumor was confirmed by a biopsy. The patient was referred to the otolaryngology department for tumor resection and a pathological evaluation identified the thyroid angiosarcoma with tracheal invasion. Angiosarcomas have a poor prognosis, but the patient has not experienced any recurrence two years after surgery. A very rare case of primary thyroid angiosarcoma with tracheal invasion was cured successfully.

Invasive thyroid angiosarcoma with a favorable outcome

INTRODUCTION

Thyroid angiosarcoma is a malignant neoplasm, which usually shows local aggressive behavior and associated with a high recurrence rate. It was originally described in the Alpine region and extremely rare in other parts of the world.

CASE PRESENTATION

An asymptomatic 61-year-old woman presented with a right lobe thyroid nodule with fine needle aspiration cytology indicating "suspicious for malignancy" was reported in our study. Histological examination revealed a vascular 35mm neoplasm with areas of necrosis. Immunohistochemistry staining had negative results for MNF, CAM5.2, CD34, thyroglobulin, and positive for CD31. The findings described were compatible with angiosarcoma diagnosis. Besides, a 4mm papillary microcarcinoma was found in the left lobe. Computerized tomography (CT) scan performed about two months after the operation, showed a right neck nodular lesion, conditioning tracheal deviation. At our institution, the study performed was consistent with local recurrence (angiosarcoma). Tumor excision was performed and invasion to larynx, trachea and esophagus was detected intraoperatively. Histopathologic examination confirmed tumor recurrence and the patient was submitted to radiotherapy (60 Gy), completed four years ago. There is not, so far, any evidence of tumor recurrence.

CONCLUSIONS

We described a rare case of a usually aggressive thyroid angiosarcoma in a patient living in a non-Alpine region, with an unusual favorable outcome after the operation and radiotherapy.

Angiosarcoma of the thyroid: a case report with review of the literature

Angiosarcoma is a rare and aggressive tumor of the thyroid gland, mainly seen in the Alpine regions. We present such a case with literature review. We present the case of a 60-year-old man with cough, dyspnea, and hemoptysis along with slow increase in the size of his long-standing goiter. Computed tomography of the neck showed a large thyroid mass and chest imaging revealed multiple pulmonary nodules. Fine needle aspiration cytology and tru-cut biopsy of the thyroid were notable for poorly differentiated malignant cells. Diagnosis of angiosarcoma of the thyroid was made after total thyroidectomy. Patient died of continued hemoptysis and respiratory failure 3 weeks after admission. We searched the literature for previous case reports using Pubmed and Ovid. Forty-seven reported cases were identified and our case was added to make a database of 48 cases. Demographic and tumor characteristics were analyzed. Angiosarcoma was found to be more common in females and at age of 60 or above. Results were consistent with previously reported series of 14 and 17 cases from Austria. This review provides information on various characteristics angiosarcoma of the thyroid which can be used as baseline data for future reference and research studies for this cancer.

Primary thyroid angiosarcoma: an unusual localization

The finding of thyroid nodules is a very common occurrence in routine clinical practice. Approximately 5% to 7% of the entire population have thyroid nodules. Vascular lesions are one of the most controversial issues in thyroid pathology. These include benign lesions such as hemangiomas and, rarely, malignant tumors such as angiosarcomas or undifferentiated angiosarcomatoid carcinomas. In particular, angiosarcoma of the thyroid gland is a rare, highly aggressive malignant vascular tumor and in Italy the greatest geographical incidence of this lesion is witnessed near the Alps. Here, a case of thyroid angiosarcoma in a 71-year-old man with a history of goiter for about 20 years is described. The unusual localization of this lesion, the difficulties in reaching a definitive diagnosis for this particular histological type of primary tumor and a history of long-standing multinodular goiter in thyroid of an older man from outside the Alpine region prompted us to report this case of thyroid angiosarcoma mainly to discuss surgical, histopathological and immunohistochemical features.

High grade angiosarcoma arising in fibroadenoma

Primary angiosarcoma of the breast is a rare tumour that account for fewer than 0.05% of all malignant mammary tumours. Angiosarcoma may have an perfidious clinical onset. Radiologic findings are often nonspecific and may appear completely normal in one-third of cases with primary angiosarcoma. The prognosis is usually poor because of the high rates of local recurrence and early development of metastases. Aggressive surgical resection is the mainstay of treatment. The role of adjuvant therapy has not yet been well established.

Here we present a case of a 53 year old, postmenopausal women with primary angiosarcoma arising in fibroadenoma. To our knowledge, this is the first case described in the literature to date.