1
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Zhang X, Sun Y. Argon-helium cryoablation treatment of undifferentiated pleomorphic sarcoma of the thyroid: A case report and literature review. J Interv Med 2023; 6:194-198. [PMID: 38312125 PMCID: PMC10831362 DOI: 10.1016/j.jimed.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 02/06/2024] Open
Abstract
Undifferentiated pleomorphic sarcoma is an extremely rare malignant thyroid tumor. Thyroid sarcoma differs from common malignant thyroid tumors, such as thyroid follicular cell carcinoma. It is usually highly malignant, progresses rapidly, and is prone to remote metastasis. Currently, there is no standard protocol for the treatment of thyroid sarcomas, and most treatment effects are unsatisfactory. Argon-helium cryoablation is an important method of local treatment that is widely used in patients with unresectable advanced tumors. However, owing to the low incidence of thyroid sarcomas, there are no relevant literature reports on the treatment of thyroid sarcomas using cryoablation in China. This study reports the case of a patient with undifferentiated pleomorphic sarcoma of the thyroid gland who was treated with argon-helium cryoablation, and the immediate outcome was good. Based on a review of relevant literature, we discussed the effectiveness and safety of argon-helium cryoablation treatment to provide clinical guidance and references for the treatment of patients with thyroid sarcoma.
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Affiliation(s)
- Xuyang Zhang
- Department of Oncology, Lijiang Hankang Tumor Hospital, Lijiang, Yunnan, 674100, China
| | - Yan Sun
- Department of Oncology, Lijiang Hankang Tumor Hospital, Lijiang, Yunnan, 674100, China
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2
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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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3
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Fernández-Ferreira R, De la Peña-López IR, Zamudio-Coronado KW, Delgado-Soler LA, Torres-Pérez ME, Bourlón-de Los Ríos C, Cortés-González R. Calcitonin-Negative Neuroendocrine Carcinoma of the Thyroid Gland: Case Report and Literature Review. Case Rep Oncol 2021; 14:112-122. [PMID: 33776692 PMCID: PMC7983544 DOI: 10.1159/000510807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/24/2022] Open
Abstract
Calcitonin-negative neuroendocrine tumor (CNNET) of the thyroid is an extremely rare entity. In some of the previously reported cases within the literature, the terms “atypical medullary thyroid carcinoma,” “calcitonin-free oat cell carcinoma,” and “a distinct clinical entity” were applied to NETs without definitive evidence of calcitonin production. In the English-language literature, not only are there only few reported cases of CNNET, but the criteria for diagnosis in these cases are also controversial. Most of the current published cases were also treated surgically for local disease. We describe a case of NET of the thyroid with calcitonin, chromogranin A and thyroglobulin negativity, synaptophysin and TTF-1 positivity, and a high Ki-67 proliferation index with metastases in the cervical region as well as mediastinal adenopathies. This case was considered an unresectable thyroid carcinoma, and chemotherapy including cisplatin and etoposide was started as neoadjuvant treatment at the department of medical oncology. Total thyroidectomy plus bilateral and central cervical dissection was performed, and the patient underwent 2 cycles of adjuvant radiotherapy. Currently, the patient's <sup>18</sup>F-FDG-PET/CT findings show a complete response 17 months after diagnosis. In conclusion, CNNET of the thyroid is very rare and there is limited evidence regarding treatment in patients with metastases. Chemotherapy including cisplatin and etoposide as well as early aggressive surgical resection appears to positively impact patients' survival.
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Affiliation(s)
- Ricardo Fernández-Ferreira
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic & Foundation, Mexico, Mexico
| | - Ildefonso Roberto De la Peña-López
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic & Foundation, Mexico, Mexico
| | - Karla Walkiria Zamudio-Coronado
- Department of Endocrinology, Diabetology and Thyroid, National Institute of Medical Sciences and Nutrition "Salvador Zubiran", Mexico, Mexico
| | | | | | - Christianne Bourlón-de Los Ríos
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic & Foundation, Mexico, Mexico
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4
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Rossi ED, Pantanowitz L, Hornick JL. Cytologic and histological features of rare nonepithelial and nonlymphoid tumors of the thyroid. Cancer Cytopathol 2021; 129:583-602. [PMID: 33493367 DOI: 10.1002/cncy.22404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022]
Abstract
Thyroid tumors can be classified into epithelial, nonepithelial, and nonprimary lesions. Nonepithelial thyroid tumors are rare. They can be of primary origin within the thyroid gland, arise secondary to contiguous growth from adjacent tissues, or represent metastatic disease. The incidence of nonepithelial tumors of the thyroid is only 1% to 2%, most of which are lymphomas; the remainder includes mesenchymal and histiocytic tumors. This review examines the cytohistological features of various nonepithelial and nonlymphoid tumors of the thyroid, including vascular lesions, neural tumors (including granular cell tumor and paraganglioma), smooth muscle tumors, solitary fibrous tumor, histiocytic neoplasms (eg, Langerhans cell histiocytosis and Rosai-Dorfman disease), and follicular dendritic cell sarcoma. Their differential diagnosis is discussed, including recommendations to prevent the pitfall of mistaking these rare tumors for more common epithelial thyroid neoplasms.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Rodrigo-Gómez L, Pardal-Refoyo JL, Batuecas-Caletrío Á. Prevalencia de tumores metastásicos en la glándula tiroides. Revisión sistemática y metanálisis. REVISTA ORL 2020. [DOI: 10.14201/orl.23207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: Los tumores metastásicos en la glándula tiroides complican el diagnóstico, el tratamiento y el pronóstico del paciente. El objetivo es conocer la prevalencia de las metástasis en la glándula tiroides referida en la literatura médica y los tumores primarios que con más frecuencia metastatizan en la glándula tiroides. Método: Se realizó una revisión bibliográfica sistemática en las bases de datos de PubMed, La Biblioteca Cochrane y Scopus. Los artículos seleccionados se dividieron en dos grupos, series clínicas de pacientes en los que se hallaron metástasis en tiroides (grupo A) y series de hallazgos de metástasis en tiroides en autopsias (grupo B). Se realizó metanálisis de prevalencia para cada grupo de artículos siguiendo el modelo de efectos aleatorios. Resultados: La prevalencia en cada grupo con su índice de confianza al 95% fue 0.00479 (0.002-0.007) para el grupo A y 0.0362 (0.014-0.059) para el grupo B. La prevalencia de metástasis halladas en autopsias fue 7,58 veces mayor que en los estudios clínicos. En el grupo A la edad media fue 60.82 y en el grupo B 57.20. En ambos grupos las metástasis halladas en tiroides fueron más frecuentes en el sexo femenino. La localización del tumor primario fue diferente en ambos grupos, en el grupo A fue el cáncer de riñón y en el grupo B el cáncer de mama. La variabilidad de la prevalencia de metástasis en tiroides en los diferentes artículos de ambos grupos hace que este estudio tuviese una alta heterogeneidad (índice I2 y Q). Los funnel plot de ambos grupos indicaron alto sesgo de publicación. Discusión: La diferente prevalencia entre series clínicas y autopsias puede implicar que la detección de metástasis en tiroides en la clínica está infradiagnosticada. La razón de esto podría ser que las metástasis intratiroideas se presentan de forma asintomática siendo diagnosticadas como hallazgo casual en autopsias. En otras ocasiones se presentan como un nódulo tiroideo años después del tumor primario, lo que condiciona el diagnóstico. Conclusiones: La prevalencia de metástasis en tiroides es superior en las series de autopsias que en series clínicas (hasta 6.67 veces más frecuente en nuestro estudio). Las metástasis intratiroideas probablemente están infradiagnosticadas por cursar sin clínica siendo diagnosticadas como hallazgo casual en autopsias. Los tumores primarios más frecuentes fueron el riñón (series clínicas) y la mama (series de autopsias).
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6
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Gay S, Monti E, Trambaiolo Antonelli C, Mora M, Spina B, Ansaldo G, Teliti M, Comina M, Conte L, Minuto M, Varaldo E, Zupo S, Massa B, Morbelli S, Giusti M. Case report: lenvatinib in neoadjuvant setting in a patient affected by invasive poorly differentiated thyroid carcinoma. Future Oncol 2019; 15:13-19. [DOI: 10.2217/fon-2019-0099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report a case of an elderly woman presenting with a huge cervical mass invading the tracheal lumen. Diagnosed as invasive poorly differentiated thyroid cancer, after an endotracheal biopsy, stenting and radiotherapy, it was judged eligible for total thyroidectomy, but surgery was delayed due to pulmonary thromboembolism. The patient was therefore treated with lenvatinib with a neoadjuvant intent until hemodynamic stability was obtained. Thyroidectomy and radioiodine therapy were then performed and the postdose scan revealed an area of modest uptake in the anterior part of the neck. The patient is now in a good clinical status and she continues her follow-up program without any adjuvant therapy.
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Affiliation(s)
- Stefano Gay
- Endocrinology Unit, Policlinico San Martino, Genoa, 16132, Italy
| | - Eleonora Monti
- Endocrinology Unit, Policlinico San Martino, Genoa, 16132, Italy
| | - Chiara Trambaiolo Antonelli
- Pathology, Department of Integrated Surgical & Diagnostic Sciences, University of Genoa, Genoa, 16132, Italy
| | - Marco Mora
- Pathology Unit, Policlinico San Martino, Genoa, 16132, Italy
| | - Bruno Spina
- Pathology Unit, Policlinico San Martino, Genoa, 16132, Italy
| | - Gianluca Ansaldo
- Endocrine Surgery Unit, Policlinico San Martino, Genoa, 16132, Italy
| | - Marsida Teliti
- Endocrine Unit, Thyroid GIP at the Policlinico Hospital San Martino, Genoa, 16132, Italy
| | - Martina Comina
- Endocrine Unit, Thyroid GIP at the Policlinico Hospital San Martino, Genoa, 16132, Italy
| | - Lucia Conte
- Endocrine Unit, Thyroid GIP at the Policlinico Hospital San Martino, Genoa, 16132, Italy
| | - Michele Minuto
- Endocrine Surgery Unit, Thyroid GIP at the Policlinico Hospital San Martino, Genoa, 16132, Italy
| | - Elisabetta Varaldo
- Endocrine Surgery Unit, Thyroid GIP at the Policlinico Hospital San Martino, Genoa, 16132, Italy
| | - Simonetta Zupo
- Cyto-Histopathological Unit and Pathology Unit, Thyroid GIP at the Policlinico Hospital San Martino, Genoa, 16132, Italy
| | - Barbara Massa
- Cyto-Histopathological Unit and Pathology Unit, Thyroid GIP at the Policlinico Hospital San Martino, Genoa, 16132, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, Thyroid GIP at the Policlinico Hospital San Martino, Genoa, 16132, Italy
| | - Massimo Giusti
- Endocrinology Unit, Policlinico San Martino, Genoa, 16132, Italy
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7
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Lastra RR, Newman JG, Brooks JS, Huang JH. Ossifying Fibromyxoid Tumor Metastatic to the Thyroid: A Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556131409300608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ricardo R. Lastra
- Department of Pathology and Laboratory Medicine,
Hospital of the University of Pennsylvania, Philadelphia
| | - Jason G. Newman
- Department of Otorhinolaryngology, Center of Head and
Neck Surgery, Pennsylvania Hospital, Philadelphia
| | - John S. Brooks
- Department of Pathology and Laboratory Medicine,
Pennsylvania Hospital, Philadelphia
| | - Jui-Han Huang
- Department of Pathology and Laboratory Medicine,
Pennsylvania Hospital, Philadelphia
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8
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Zhang Y, Tang H, Hu H, Yong X. A Rare Primary Tumor of the Thyroid Gland: A New Case of Leiomyoma and Literature Review. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2018; 12:1179554918813535. [PMID: 30505153 PMCID: PMC6256313 DOI: 10.1177/1179554918813535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/22/2018] [Indexed: 11/15/2022]
Abstract
Primary leiomyomas of the thyroid are very rare. We here report a case of a
53-year-old woman with a painless mass at the right thyroid, revealed by
physical examination. The patient underwent a lobectomy. Frozen sections showed
a spindle cell tumor of the thyroid gland. The nuclei of some of the tumor cells
were obviously enlarged and deeply stained. Pseudocapsule invasion was observed
in small foci. Samples showed neither mitosis nor necrosis and the nature of the
tumor was difficult to determine. Paraffin sections showed a well-circumscribed
nodular composed of intersecting fascicles of spindled to slightly epithelioid
cells with eosinophilic cytoplasm and blunt-ended, cigar-shaped nuclei. We
observed no significant nuclear atypia, mitotsis, or necrosis.
Immunohistochemical staining showed the tumor cells to be positive for α-smooth
muscle actin and h-caldesmon but negative for TG, TTF1, PAX8, S-100, CT, CK, and
CD34. The ki-67 index was very low (<1%). Primary thyroid leiomyoma is rare
and difficult to diagnose using frozen sections. Diagnosis requires
immunohistochemical staining. Leiomyoma may be mistaken for other thyroid tumors
also characterized by spindle cells.
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Affiliation(s)
- Yanling Zhang
- Department of Oncology, Wanbei Coal-Electricity Group General Hospital, Suzhou, China.,Department of Pathology, Wanbei Coal-Electricity Group General Hospital, Suzhou, China
| | - Heng Tang
- Department of Pathology, Wanbei Coal-Electricity Group General Hospital, Suzhou, China
| | - Huaiyuan Hu
- Department of Pathology, Wanbei Coal-Electricity Group General Hospital, Suzhou, China
| | - Xiang Yong
- Department of Pathology, Wanbei Coal-Electricity Group General Hospital, Suzhou, China
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9
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Najafian A, Kahan S, Zeiger MA, Olson MT. Unusual findings in thyroid cytology and histology. Diagn Cytopathol 2017; 45:185-190. [PMID: 28160441 DOI: 10.1002/dc.23655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/24/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Although cytology and histopathology of thyroid lesions generally fall into common, well-defined categories, there are uncommon cases with unusual fine needle aspiration (FNA) findings or histology. Herein, we review the prevalence and characteristics of rare thyroid cytology and histopathology findings at a tertiary hospital. METHODS Institutional data from >31,000 patients with a thyroid pathology from 1995 to 2013 were queried. Both cytology and histology were available in 6,693 patients. After exclusion of the common cytological categories detailed by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and common histopathology categories, 90 patients with either an unusual FNA, histopathology, or both were identified. RESULTS A total of 90 cases were included (19: only unusual FNA; 25: only unusual histology; 46: both unusual cytology and histopathology). The positive predictive value of an unusual FNA for discovering an unusual lesion was 71% (95% CI: 58%-81%). The majority (66%) were females and median age was 59 years. On histopathology, 80 (88%) cases were malignant, 72 (90%) of which were initially diagnosed as malignant on FNA. Of the 10 benign lesions, 8 (80%) also had a benign FNA. Patients with unusual malignant lesions were significantly older than those with unusual benign lesions (62 vs. 44 years; P: 0.004). CONCLUSION Unusual cytopathological and histopathological findings in thyroid comprise a varied group of tumors that are individually rare but collectively common. A preoperative FNA with an unusual cytopathology is likely to lead to an unusual histopathological diagnosis; however, its diagnostic accuracy in differentiating benign from malignant is lower than the accuracy of cytopathology of conventional TBSRTC. Diagn. Cytopathol. 2017;45:185-190. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alireza Najafian
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Stacie Kahan
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Martha A Zeiger
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Matthew T Olson
- Division of Cytopathology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
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Shah AA, Ohori NP, Yip L, Coyne C, Antonescu CR, Seethala RR. Epithelioid Hemangioendothelioma: a Rare Primary Thyroid Tumor with Confirmation of WWTR1 and CAMTA1 Rearrangements. Endocr Pathol 2016; 27:147-52. [PMID: 27026033 DOI: 10.1007/s12022-016-9428-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a rare case of epithelioid hemangioendothelioma as a primary thyroid tumor. To our knowledge, there are only two prior unequivocal cases of primary thyroid epithelioid hemangioendothelioma reported in the English literature. This is the first case in the thyroid with molecular confirmation.
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Affiliation(s)
- Akeesha A Shah
- Department of Pathology, University of Pittsburgh Medical Center, Presbyterian Rm. A609 200 Lothrop St, Pittsburgh, PA, 15213, USA.
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center, Presbyterian Rm. A609 200 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Linwah Yip
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher Coyne
- Division of Endocrinology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Presbyterian Rm. A609 200 Lothrop St, Pittsburgh, PA, 15213, USA
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Kim GY, Park CY, Cho CH, Park JS, Jung ED, Jeon EJ. A Calcitonin-Negative Neuroendocrine Tumor Derived from Follicular Lesions of the Thyroid. Endocrinol Metab (Seoul) 2015; 30:221-5. [PMID: 25491784 PMCID: PMC4508268 DOI: 10.3803/enm.2015.30.2.221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine lesions of the thyroid are rare. The most common types are medullary thyroid carcinomas (MTCs) and C-cell hyperplasia. MTCs originate from thyroid parafollicular cells that secrete calcitonin which serves as a serum marker of MTCs. Here, the rare case of a calcitonin-negative neuroendocrine tumor (NET) derived from follicular lesions of the thyroid is described. A 34-year-old man presented at our hospital for the surgical management of an incidental thyroid nodule that was observed on an ultrasound sonography (USG) of the neck. Initially, USG-guided aspiration cytology was performed, and a MTC was suspected. The expressions of thyroglobulin and thyroid transcription factor-1, which are thyroid follicular cell markers, and synaptophysin and chromogranin A, which are neuroendocrine markers, was confirmed following surgical pathology. However, the staining of calcitonin, a marker of MTCs, was not observed. A nonmedullary NET of the thyroid is uncommon, and the distinction between calcitonin-negative NETs and MTCs of the thyroid may be important due to differences in their clinical courses and management.
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Affiliation(s)
- Ga Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chul Yun Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chang Ho Cho
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - June Sik Park
- Department of Otolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eui Dal Jung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eon Ju Jeon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
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12
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Chung DH, Kim NR, Kim T, Ahn J, Lee S, Lee YD, Cho HY. Malignant glomus tumor of the thyroid gland where is heretofore an unreported organ: a case report and literature review. Endocr Pathol 2015; 26:37-44. [PMID: 25544269 DOI: 10.1007/s12022-014-9352-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Glomus tumors are relatively uncommon clinically benign tumors. Malignant glomus tumors are rare, and only a small number develop metastatic foci. The usual location is deep dermis or subcutis, but it has been reported in various locations. A 55-year-old man presented with an incidentally found thyroid mass. Neck ultrasound showed a mass with a heterogeneous hypoechoic calcific mass in the right lobe. Right lobectomy specimen showed the 3.6-cm-sized calcified mass composed of sheets of uniform round to polygonal cells and intervening staghorn-shaped vessels. Occasional cellular atypism and necrosis with increased mitotic activity (up to 7 per 10 high-power fields) were found. Infiltration to the residual thyroid parenchyma, vessel, thyroidal capsule, and strap muscle was found. These tumor cells were strongly positive for smooth muscle actin, collagen type IV, and vimentin with pericellular reticulin-cuffing. Ultrastructurally, closely packed oval-shaped tumor cells having cytoplasmic mitochondria, rough endoplasmic reticulums with pinocytotic vesicles along the plasmalemmal surface and thin filaments of 6 nm in diameter were surrounded by thick basal lamina. That mass was diagnosed as a malignant glomus tumor. Incidentally, a 0.5-cm-sized papillary carcinoma was found through entire embedding. Complete thyroidectomy with chemotherapy was done. Thirty months later, multiple metastases developed in the brain and lung, and he expired. To our knowledge, neither benign nor malignant thyroid glomus tumor has been previously described. Here, we describe the first case of a malignant glomus tumor in the thyroid gland.
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Affiliation(s)
- Dong Hae Chung
- Department of Pathology, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil Namdong-gu, Incheon, 405-760, Korea
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13
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Dutta D, Mukhopadhyay S, Maisnam I, Ghosh S, Mukhopadhyay P, Chowdhury S. Neuroendocrine carcinoma of the thyroid causing adrenocorticotrophic hormone-dependent Cushing's syndrome. Thyroid 2013; 23:120-3. [PMID: 23140512 DOI: 10.1089/thy.2012.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cushing's syndrome (CS) due to ectopic adrenocorticotrophic hormone (ACTH) and/or ectopic corticotropic releasing hormone (CRH) secretion accounts for <10% of all CS. Neuroendocrine carcinomas rarely cause CS. These carcinomas have been found to secrete either ACTH or rarely CRH. Herein we report a case of neuroendocrine carcinoma originating from the thyroid as the source of ACTH-dependent CS. SUMMARY A 30-year-old woman with features of CS presented with severe respiratory distress. Six months before that, she was diagnosed with primary hypothyroidism and started on levothyroxine (LT4) therapy. Biochemical evaluation was done, and nonsuppressed serum cortisol levels following dexamethasone with high ACTH confirmed a diagnosis of ACTH-dependent CS. Magnetic resonance imaging of the brain showed a bulky pituitary gland. Adrenal imaging showed bilateral adrenal hyperplasia. A computerized tomography scan showed a large anterior mediastinal mass arising from the neck and extending behind the transverse aortic arch. She underwent emergency thoracotomy due to rapidly progressive superior mediastinal syndrome and left vocal cord palsy. At surgery, the mass was seen originating from the thyroid and the thymus was compressed posteriorly. Near total thyroidectomy and thymectomy with removal of pericardial seedlings were done. Histopathology revealed sheets, cords, and nests of round or oval tumor cells with hyperchromatic nuclei and scant cytoplasm with local invasion and lymphovascular embolization suggestive of a neuroendocrine carcinoma arising from thyroid, staining positive for cytokeratin, synaptophysin, and chromogranin-A, and negative for calcitonin and carcinoembryonic antigen. CONCLUSIONS Here we report a case of a neuroendocrine tumor of the thyroid causing ACTH-dependent CS. The tumor was negative for calcitonin staining, indicating that this was not a medullary carcinoma of the thyroid. Neuroendocrine carcinomas originating from the thyroid gland are very rare. A thyroid tumor of neuroendocrine origin causing ACTH-dependent CS has not been reported previously.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
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Smallridge RC, Ain KB, Asa SL, Bible KC, Brierley JD, Burman KD, Kebebew E, Lee NY, Nikiforov YE, Rosenthal MS, Shah MH, Shaha AR, Tuttle RM. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid 2012; 22:1104-39. [PMID: 23130564 DOI: 10.1089/thy.2012.0302] [Citation(s) in RCA: 473] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Rapid evaluation and establishment of treatment goals are imperative for optimum patient management and require a multidisciplinary team approach. Here we present guidelines for the management of ATC. The development of these guidelines was supported by the American Thyroid Association (ATA), which requested the authors, members the ATA Taskforce for ATC, to independently develop guidelines for ATC. METHODS Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The quality and strength of recommendations were adapted from the Clinical Guidelines Committee of the American College of Physicians, which in turn was developed by the Grading of Recommendations Assessment, Development and Evaluation workshop. RESULTS The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues including end of life. The guidelines include 65 recommendations. CONCLUSIONS These are the first comprehensive guidelines for ATC and provide recommendations for management of this extremely aggressive malignancy. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach (surgery, radiation, systemic therapy) is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for a clinical trial or hospice/palliative care, depending upon their preference.
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Fat I, Kulaga M, Dodis R, Carling T, Theoharis C, Rennert NJ. Insular variant of poorly differentiated thyroid carcinoma. Endocr Pract 2011; 17:115-21. [PMID: 20634178 DOI: 10.4158/ep09368.ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a case of an insular variant of poorly differentiated thyroid carcinoma (PDTC) and to review the literature related to diagnosis, natural history, and treatment of this unusual form of thyroid cancer. METHODS We present the clinical, laboratory, and pathologic findings of the study patient and review English-language literature related to PDTC published between 1970 and the present. RESULTS PDTC is a controversial and rare epithelial thyroid cancer, intermediate between differentiated thyroid carcinoma and anaplastic thyroid carcinoma that exhibits increased aggressiveness, propensity to local recurrence, distant metastases, and increased mortality. PDTC warrants aggressive management with total thyroidectomy followed by radioactive iodine ablation and potentially additional therapy for residual or recurrent disease. Some carcinomas do not take up radioactive iodine, and dedifferentiated clones of distant metastases may evolve. It is unclear whether chemotherapy is beneficial. Use of additional imaging modalities, including positron emission tomography, 18-fludeoxyglucose positron emission tomography/computed tomography, 18-fludeoxyglucose positron emission tomography/computed tomography/magnetic resonance imaging, (124)I positron emission tomography/computed tomography, positron emission tomography/magnetic resonance imaging fusion studies, and recombinant human thyrotropin-stimulated radioactive iodine uptake for cancer surveillance are discussed. CONCLUSIONS PDTC is an unusual and aggressive form of thyroid cancer. Fine-needle aspiration cytology may not yield sufficient information to specifically diagnose PDTC. Aggressive management with total thyroidectomy and neck dissection followed by high-dose radioactive iodine remnant ablation is standard. Iodine I 131 whole body scanning is often the initial test for tumor surveillance, with other imaging modalities applied as needed.
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Affiliation(s)
- Ioana Fat
- Department of Internal Medicine, Norwalk Hospital, Norwalk, Connecticut 06856, USA
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Bukhari MH, Niazi S, Anwar M, Nasir A. An audit of local experience, histological classification of primary tumours of the thyroid according to WHO revised criteria with a critical account. Histopathology 2009; 55:120-4. [DOI: 10.1111/j.1365-2559.2009.03338.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Dai CW, Zhang GS, Pei MF, Shen JK. Thyroid diffuse large B cell lymphoma (DLBCL) following thyroid medullary cancer: long-term complete remission with R-CHOP therapy. Ann Hematol 2008; 88:701-2. [DOI: 10.1007/s00277-008-0639-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 10/30/2008] [Indexed: 11/29/2022]
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