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Ren H, Cui X, Zhang L. Primary schwannoma of the thyroid gland: analysis of case characteristics and review of the literature. BMC Surg 2024; 24:234. [PMID: 39154012 PMCID: PMC11330010 DOI: 10.1186/s12893-024-02523-y] [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: 03/13/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND To improve the characteristics of primary thyroid schwannomas (PTS) and to provide reference basis for clinical diagnosis and treatment. METHODS PubMed was searched for case reports of PTS up to December 2022 using the search terms "Thyroid nerve sheath tumor" or "Thyroid schwannoma" or "Thyroid Neurilemmoma", respectively. 34 cases were screened. RESULTS PTS can occur at any age, nodules averaged 3.9 cm. The most common symptoms were voice change and dysphagia. Fine needle aspiration cytology showing spindle-shaped cells should be considered for schwannoma. Most cases underwent thyroid lobectomy or nodule removal with a good prognosis. Tissue types with both Antoni A and Antoni B features are common. Positive immunohistochemical staining for S-100 protein, CD34 and waveform proteins helped confirm the diagnosis. CONCLUSIONS Positive immunohistochemistry for S-100 and wave proteins helps confirm the diagnosis. Preoperative diagnosis is challenging, but pathology and immunohistochemical staining are the gold standard for diagnosis. The first choice of treatment is surgical resection of the nodules, the prognosis is good.
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Affiliation(s)
- Hangjun Ren
- Department of General Surgery, The First People's Hospital of Yuhang District, Hangzhou, Zhejiang, 311100, China
| | - Xingguo Cui
- Department of Thyroid Breast Surgery, Yanbian University Hospital, Yanbian, Jilin, 133000, China
| | - Lianmei Zhang
- Department of Thyroid Breast Surgery, Yanbian University Hospital, Yanbian, Jilin, 133000, China.
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López F, Al Ghuzlan A, Zafereo M, Vander Poorten V, Robbins KT, Hamoir M, Nixon IJ, Tufano RP, Randolph G, Pace-Asciak P, Angelos P, Coca-Pelaz A, Khafif A, Ronen O, Rodrigo JP, Sanabria Á, Palme CE, Mäkitie AA, Kowalski LP, Rinaldo A, Ferlito A. Neck Surgery for Non-Well Differentiated Thyroid Malignancies: Variations in Strategy According to Histopathology. Cancers (Basel) 2023; 15:cancers15041255. [PMID: 36831604 PMCID: PMC9954150 DOI: 10.3390/cancers15041255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer.
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Affiliation(s)
- Fernando López
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
- Correspondence: ; Tel.: +34-985108000
| | - Abir Al Ghuzlan
- Department of Biology and Pathology, Gustave Roussy Cancer Campus, University Paris-Saclay, 91190 Villejuif, France
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, 3000 Leuven, Belgium
- European Reference Network for Rare Adult Solid Cancers (EURACAN), 69008 Lyon, France
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 62702, USA
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium
| | - Iain J. Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh EH1 3EG, UK
| | - Ralph P. Tufano
- FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, FL 34239, USA
| | - Gregory Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA 02138, USA
| | - Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON M5S, Canada
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL 60637, USA
| | - Andrés Coca-Pelaz
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
| | - Avi Khafif
- A.R.M. Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv 8410501, Israel
| | - Ohad Ronen
- Department of Otolaryngology—Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
| | - Juan Pablo Rodrigo
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
| | - Álvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín 050021, Colombia
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health Sciences, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo 01246-903, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo 01509-001, Brazil
| | | | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, 35125 Padua, Italy
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Zhang L, Lubin D, Sinard JH, Dickson BC, Antonescu CR, Wu H, Panni RZ, Dogan S, Untch BR, Ghossein RA, Xu B. Primary Mesenchymal Tumors of the Thyroid Gland: A Modern Retrospective Cohort Including the First Case of TFE3-Translocated Malignant Perivascular Epithelioid Cell Tumor (PEComa). Head Neck Pathol 2022; 16:716-727. [PMID: 35218514 PMCID: PMC9424363 DOI: 10.1007/s12105-022-01428-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 12/19/2022]
Abstract
Primary mesenchymal tumors of the thyroid gland are extremely rare, with only case reports and small case series documented in the English literature, many of which were published prior to the era of molecular pathology. In the current study, we aim to present a contemporary multi-centric cohort of thyroid mesenchymal tumors. Nineteen primary thyroid mesenchymal tumors were collected from three tertiary centers. Their clinicopathologic features, immunoprofile, molecular alterations, and outcome were described. Eight cases were classified as benign or intermediate with solitary fibrous tumor being the most common histotype (n = 3). The remaining 11 cases were malignant, including three angiosarcomas, one epithelioid hemangioendothelioma, one adamantinoma-like Ewing sarcoma, one biphasic synovial sarcoma, one malignant melanocytic peripheral nerve sheath tumor (melanotic schwannoma), one myxofibrosarcoma, and two undifferentiated pleomorphic/spindle sarcomas (one of which was radiation-induced). Six tumors showed characteristic diagnostic translocations. We herein also described the first case of thyroid malignant perivascular epithelioid cell tumor (PEComa) with RBM10-TFE3 fusion in a 35-year-old female patient. Thyroid mesenchymal tumors, benign or malignant, are rare with a broad spectrum of possible diagnoses. A comprehensive examination to include histology, immunohistochemistry, and molecular testing is essential for the correct diagnosis and to distinguish them from anaplastic thyroid carcinoma. PEComa may occur as a primary tumor of the thyroid gland, expanding the histologic spectrum of thyroid mesenchymal tumors.
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Affiliation(s)
- Lingxin Zhang
- Department of Pathology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Daniel Lubin
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - John H Sinard
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Brendan C Dickson
- Department of Pathology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hao Wu
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Roheena Z Panni
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Brian R Untch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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4
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Danish MH, Wasif M, Ud Din N, Awan MS. Malignant peripheral nerve sheath tumour of thyroid: a diagnostic dilemma. BMJ Case Rep 2020; 13:13/4/e234374. [PMID: 32327463 DOI: 10.1136/bcr-2020-234374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Malignant peripheral nerve sheath tumours of thyroid are rare entities that can present a diagnostic dilemma. We present the case of a patient who presented with neck mass with a history of multiple neck surgeries and airway compression. The patient's previous histopathology was mistaken for Riedel's thyroiditis in an outside hospital, which delayed appropriate treatment leading to suffering on part of the patient and frustration on part of the physician. We emphasise that rare malignancies should be considered in rapidly growing neck masses that are causing airway compression, and histopathology of such tumours should be reported by expert pathologists.
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Affiliation(s)
| | - Muhammad Wasif
- Otolaryngology Head & Neck Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Nasir Ud Din
- Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - Muhammad Sohail Awan
- Otolaryngology Head & Neck Surgery, Aga Khan University, Karachi, Sindh, Pakistan
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Wei J, Yang J, Liang W, Xu C, Wen Y. Clinicopathological features of primary thyroid leiomyosarcoma without Epstein-Barr virus infection: A case report. Oncol Lett 2019; 17:281-287. [PMID: 30655765 PMCID: PMC6313169 DOI: 10.3892/ol.2018.9609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/07/2018] [Indexed: 12/12/2022] Open
Abstract
Primary thyroid leiomyosarcoma (LMS) is a rare tumor type with an unusual location, the diagnosis is based entirely on histological and immunohistochemical evaluations. In the present study, a rare case of a 74-year-old female patient who exhibited a right anterior neck mass for 12 months, which rapidly enlarged for the last 3 months. Ultrasound of the thyroid revealed a 55×42 mm hypoechoic mass with clear margins in the right lobe. Histological examination of the tumor demonstrated malignant spindle cells in interlacing fascicles and whorls. Additionally, nuclear pleomorphism, tumor giant cells, necrosis and abnormal mitotic figures were observed. The immunohistochemistry indicated that the tumor cells were strongly positive for smooth muscle actin, desmin, p53 and vimentin expression, but negative for cytokeratin, epithelial membrane antigen, thyroid transcription factor-1, paired box-8, 34βE12, cytokeratin 5/6, cluster of differentiation (CD)117, myoglobin, S100, p16. The final histopathological diagnosis was primary thyroid LMS.
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Affiliation(s)
- Jianguo Wei
- Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang 312000, P.R. China
| | - Jianfeng Yang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang 312000, P.R. China
| | - Wenqing Liang
- Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang 312000, P.R. China
| | - Chunwei Xu
- Department of Pathology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian 350014, P.R. China
| | - Yuanyuan Wen
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhoushan, Zhejiang 316021, P.R. China
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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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Abstract
Primary leiomyosarcoma of the thyroid gland is uncommon. To date, 20 cases have been reported in English in the literature. The tumors usually present in elderly patients with female predilection and are associated with poor clinical outcome. Herein, we report an additional case of primary thyroid leiomyosarcoma in a 64-year-old woman. She underwent total thyroidectomy and later was discovered to have multiple lung and liver metastases. The patient died 3 months after surgery. The major differential diagnoses including undifferentiated (anaplastic) carcinoma of the thyroid, spindle cell variant of medullary thyroid carcinoma, spindle cell tumor with thymus-like differentiation, uncommon primary tumor of the thyroid and metastatic tumors with predominant spindle cells are discussed.
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Affiliation(s)
- Jantima Tanboon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, 10700, Thailand.
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Kandil E, Abdel Khalek M, Abdullah O, Dali D, Faruqui S, Khan A, Friedlander P, Jaffe BM, Crawford B. Primary peripheral nerve sheath tumors of the thyroid gland. Thyroid 2010; 20:583-6. [PMID: 20553194 DOI: 10.1089/thy.2009.0245] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Primary peripheral nerve sheath tumors (PNSTs) of the thyroid gland are exceptionally rare tumors that usually present as asymptomatic neck nodules in adults. This article presents a literature review of these tumors. SUMMARY PNSTs of the thyroid can be classified into benign and malignant. Only three cases of malignant PNSTs have been reported. Benign PNSTs of the thyroid include neurofibromas and schwannomas. Only two cases of isolated neurofibroma of the thyroid have been reported. Schwannomas are typically benign, slow-growing tumors that originate from neuronal schwann cells, with a clinical picture depending on the anatomic size and site. Pathologically, schwannomas are classified into Antoni A and Antoni B. Only 17 cases of schwannomas of the thyroid exist in literature to date. CONCLUSIONS Schwannomas of the thyroid gland are extremely rare and usually asymptomatic. Complete surgical resection is mandatory for care.
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Affiliation(s)
- Emad Kandil
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
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