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Saoud C, Lam H, Callegari F, Faquin WC, Nakadaira KS, Wakely PE, Ali SZ. Cytopathology of mesenchymal tumors of the thyroid gland: analysis of 12 cases from multinational institutions with review of the literature. J Am Soc Cytopathol 2023; 12:436-450. [PMID: 37806808 DOI: 10.1016/j.jasc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/12/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Mesenchymal tumors of the thyroid gland are extremely rare. We report the cytomorphologic characteristics of 12 mesenchymal tumors occurring in the thyroid gland and highlight the diagnostic difficulties encountered in their cytologic evaluation. MATERIALS AND METHODS The cytopathology and surgical pathology archives from 5 large institutions were searched for thyroid mesenchymal tumors that had an FNA available for review. Clinicopathologic and cytomorphologic characteristics for each case were evaluated. RESULTS Twelve cases of mesenchymal tumors occurring in the thyroid were identified in our search. Patient age ranged from 28 to 84 years (median, 60 years). The cases occurred in 7 women and 5 men. The tumor size ranged from 1.4 to 14 cm (median, 3.3 cm). The tumors were as follows: hemangioma (n = 4; 33.3%), angiosarcoma (n = 2; 16.7%), schwannoma (n = 2; 16.7%), solitary fibrous tumor (n = 2, 16.7%), metastatic synovial sarcoma (n = 1, 8.3%) and metastatic pleomorphic rhabdomyosarcoma (n = 1, 8.3%). The cytomorphologic features of the tumors were similar to those of their counterparts occurring in different sites. An accurate diagnosis was achieved in six primary thyroid mesenchymal cases (60%). Five patients (41.7%) underwent total thyroidectomy, and 3 patients received partial thyroidectomy (25%). Three patients (25%) did not receive a thyroidectomy and subsequent surgical information was not available in 1 case (8.3%). CONCLUSIONS Mesenchymal tumors of the thyroid are extremely uncommon. Cytologic diagnosis of these tumors is often challenging due to the morphologic overlap with diverse epithelial and non-epithelial thyroid lesions. Ancillary studies such as immunohistochemistry and molecular studies are essential for accurate diagnosis.
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Affiliation(s)
- Carla Saoud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hansen Lam
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fabiano Callegari
- Sao Paulo Federal University (UNIFESP), Sao Paulo, Brazil; Cytolog Laboratory, Sao Paulo, Brazil
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Gambardella C, Docimo L, Candela G, Cozzolino G, Mongardini F, Serilli F, Nesta G, Filograna Pignatelli M, Ferrandes S, Gambardella A, Docimo G. Thyroid-Bed Schwannoma Mimicking a Thyroid Neoplasm: A Challenging Diagnosis: Report of a Case and Literature Review. Medicina (B Aires) 2022; 58:medicina58101345. [PMID: 36295506 PMCID: PMC9611195 DOI: 10.3390/medicina58101345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Schwannomas, also called neurinomas, are rare benign tumors of the neural cells that can develop from the sheaths of nervous structures of several districts, although the most frequent sites are the cranial nerves (25%–45%). Rarely, cases show neck schwannomas in the thyroid parenchyma, while the cases of thyroid-bed schwannomas mimicking a thyroid-gland lesions are anecdotal. Methods: We report the case of a 70-year-old man with a preoperative-imaging diagnosis of a thyroid neoplasm, confirmed as Thyr 4 by fine-needle cytology. Results: During surgery, an extra-thyroidal lesion was discovered, determined to be a neck schwannoma through definitive pathology. A literature review of cases of thyroid-bed-lesion schwannomas misinterpreted as thyroid neoplasms was carried out. Conclusions: In the case of suspicious extra-thyroidal lesions, we advocate for a close routine cooperation between the cytologist, the radiologist, and the surgeon in the attempt to reach an accurate preoperative diagnosis.
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Zhao HN, Ma BY, Yan F, Peng YL. Multimodal ultrasound imaging of primary thyroid schwannoma: A case report. Medicine (Baltimore) 2021; 100:e25517. [PMID: 33879689 PMCID: PMC8078360 DOI: 10.1097/md.0000000000025517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/25/2021] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Primary schwannoma of the thyroid gland is very rare, and its preoperative diagnosis is difficult. PATIENT CONCERNS We report the case of a thyroid nodule in an 18-year-old woman, who presented with a mass in her left neck with stiffness and normal thyroid function. However, the patient complained of numbness in her left upper extremity, and ultrasound (US) features were suspicious of malignancy. DIAGNOSES Multimodal US imaging was performed using B-mode, color doppler, ultrasonic elastography (UE), and contrast-enhanced ultrasound (CEUS). CEUS revealed heterogeneous enhancement and "target sign" within the tumor. The nodule was suspicious for malignancy and classified as TI-RADS 4b, while the elasticity values measured by UE indicated a benign lesion. Fine needle aspiration (FNA) was subsequently performed in the markedly contrast-enhanced area for biopsy. Cytological results revealed a benign schwannoma. INTERVENTION The patient underwent left lobe resection. Postoperative pathology confirmed it to be a primary benign schwannoma of the thyroid. OUTCOMES After thyroidectomy, the patient was followed-up with US. At present, all laboratory tests and thyroid imaging are normal, and the numbness of the left upper limb has disappeared. LESSONS The combination of different US modalities is useful for the diagnosis of thyroid lesions. FNA performed under CEUS guidance improves the accuracy of biopsy sampling.
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Abstract
Primary thyroid schwannoma is a sporadic non-epithelial tumor of the thyroid gland. Most previous cases reported in the literature presented it as an asymptomatic neck mass. In this report, we describe a rare case of thyroid schwannoma in a 33-year-old female, presented as a left-side neck swelling, accompanied by a change in voice and difficulty swallowing. An ultrasound of the mass showed a large heterogeneous, predominantly cystic, nodule; in contrast to the usual predominantly solid nodule described in the literature. After several pre-operative diagnostic tests, including fine needle aspiration (FNA), the diagnosis remained unclear. In the end, the patient underwent a successful surgical excision of the mass, and the diagnosis of schwannoma was confirmed based on the histopathologic examination which revealed both type A and B Antoni cells as well as positive staining for S-100 protein.
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Affiliation(s)
| | - Shahem Abbarh
- Internal Medicine, Almaarefa University, Riyadh, SAU
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Kang JY, Yi KS, Cha SH, Choi CH, Kim Y, Lee J, Son SM. Schwannoma of the thyroid bed: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e18814. [PMID: 32000383 PMCID: PMC7004672 DOI: 10.1097/md.0000000000018814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Schwannomas involving the thyroid gland are very rare and only a few cases have been reported in the literature. However, previous reports did not distinguish between thyroid bed schwannomas and intrathyroidal schwannomas. Here, we report a thyroid bed schwannoma mimicking a malignant thyroid nodule and review the literature on thyroid bed schwannomas. PATIENT CONCERNS A 33-year-old woman presented at our hospital with mild neck swelling. DIAGNOSIS Thyroid ultrasound revealed a well-defined, oval-shaped, markedly hypoechoic solid nodule with echogenic foci suggesting macro- and microcalcifications in the left thyroid gland. The lesion was considered a "highly suspicious" intrathyroidal nodule, based on the guidelines for the assessment of thyroid nodules. Fine needle aspiration was performed twice, but the cytological results were nondiagnostic. INTERVENTIONS Left thyroidectomy was performed, and schwannoma of the thyroid bed was confirmed on histopathologic analysis. OUTCOMES The patient was in a stable condition after surgery, and the thyroid function test results were within the normal range. LESSONS Diagnosis of a schwannoma of the thyroid bed is challenging because its incidence is extremely low, and it is often misdiagnosed as an intrathyroidal nodule on ultrasonography. Therefore, it is advisable to adopt a diagnostic strategy to perform additional core needle biopsy in cases of thyroid nodules with nondiagnostic fine needle aspiration results and to consider the location of the lesion more carefully to determine the suitable therapy.
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Affiliation(s)
| | | | - Sang-Hoon Cha
- Department of Radiology
- College of Medicine and Medical Research Institute
| | | | | | - Jisun Lee
- Department of Radiology
- College of Medicine and Medical Research Institute
| | - Seung-Myoung Son
- College of Medicine and Medical Research Institute
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Chen G, Liu Z, Su C, Guan Q, Wan F, Dong B, Bao L, Zhang W, Wang Y, Wang G. Primary peripheral nerve sheath tumors of the thyroid gland: A case report and literature review. Mol Clin Oncol 2015; 4:209-210. [PMID: 26893864 DOI: 10.3892/mco.2015.703] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/04/2015] [Indexed: 12/17/2022] Open
Abstract
Primary peripheral nerve sheath tumors (PNSTs) of the thyroid gland are rare, with fewer than 30 cases reported in the medical literature to date. Primary PNSTs of the thyroid gland are classified into malignant and benign PNSTs. The benign PNSTs may be further subclassified into neurofibromas and Schwannomas. This is the case report of a 51-year-old male patient presenting with multiple primary PNSTs involving the left lobe of the thyroid gland. The patient underwent total excision of the thyroid gland and the pathological results indicated a Schwannoma with Antoni type A and B cells. The literature was reviewed briefly and, to the best of our knowledge, this is the first case report of multiple primary PNSTs of the thyroid gland.
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Affiliation(s)
- Guang Chen
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zengguang Liu
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Chang Su
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Qiang Guan
- Department of General Surgery, Changchun Central Hospital, Changchun, Jilin 130051, P.R. China
| | - Fang Wan
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Bingfei Dong
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Liang Bao
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wenxin Zhang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yinping Wang
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Guimin Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Lee YS, Kim JS, Chung AM, Park WC, Kim TJ. Primary Neurilemmoma of the Thyroid Gland Clinically Mimicking Malignant Thyroid Nodule. J Pathol Transl Med 2015; 50:168-71. [PMID: 26498011 PMCID: PMC4804143 DOI: 10.4132/jptm.2015.08.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/11/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Young Sub Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jee Soon Kim
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Arthur Minwoo Chung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Chan Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Jung Kim
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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De Simone B, Del Rio P, Sianesi M. Schwannoma mimicking a neoplastic thyroid nodule. Updates Surg 2012; 66:85-7. [PMID: 23269639 DOI: 10.1007/s13304-012-0189-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022]
Abstract
Schwannoma is a rare benign tumor of nerve fibers that originates from neuronal sheath cells; it is frequently located extramedullary and about 25-45 % of this type of neoplastic lesion is localized in the head and in the neck. Primary schwannoma of the thyroid gland is very uncommon. We report the case of a 50-year-old female patient affected by schwannoma of the thyroid gland underwent total thyroidectomy for nodule of the left lobe suspicious for neoplasm, without complications.
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Affiliation(s)
- B De Simone
- Department of Surgical Science, Unit of General Surgery and Organ Transplantation, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy,
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