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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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Benbella L, Elouarith I, Ouazzani H, Bernoussi Z, Lahlou M, Zouaidia F. Thyroid angiosarcoma: A case report and review of literature. Int J Surg Case Rep 2022; 97:107358. [PMID: 35870219 PMCID: PMC9403027 DOI: 10.1016/j.ijscr.2022.107358] [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: 05/04/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023] Open
Abstract
Thyroid angiosarcoma is a very rare malignancy that is mostly seen in elderly of Alpine regions, related to high prevalence of iodine deficient goiter. It is a very aggressive tumor that can rapidly spread to the cervical lymph nodes, lungs, and brain or can metastasize to the duodenum, small bowel and large bowel. Metastatic disease is associated with poor prognosis and limits the mean survival time to a few months after diagnosis and surgical treatment. The first diagnostic challenge is to rule out an angiomatoid anaplastic carcinoma, using a large panel of antibodies. The second challenge is to specify whether it is a primary or metastatic angiosarcoma especially when other sites are involved, based on clinical and epidemiological criteria.
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Affiliation(s)
- L. Benbella
- Department of Pathological Anatomy, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco,Corresponding author.
| | - I. Elouarith
- Department of Pathological Anatomy, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - H.E.L. Ouazzani
- Department of Pathological Anatomy, Head and Neck Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Z. Bernoussi
- Department of Pathological Anatomy, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - M.K. Lahlou
- Department of Surgery B, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - F. Zouaidia
- Department of Pathological Anatomy, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Negură I, Bădescu MC, Rezuş C, Dănilă R, Florescu AF, Blaj M, Moroşan E, Apostol DGC. Morphology and one immunohistochemical marker are enough for diagnosis of primary thyroid angiosarcoma. Arch Clin Cases 2021; 8:7-13. [PMID: 34754933 PMCID: PMC8565704 DOI: 10.22551/2021.30.0801.10178] [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] [Indexed: 11/25/2022] Open
Abstract
Primary thyroid angiosarcoma is a very rare and extremely aggressive mesenchymal malignant neoplasm showing morphological and immunophenotypic evidence of endothelial cell differentiation. Early diagnosis of this tumor along with radical thyroidectomy followed by postoperative radiotherapy and chemotherapy are essential for adequate management of the patient. Currently available data on diagnosis and treatment options of this neoplasm are limited because it is a rare disease in endocrine organs. Raising awareness regarding its diagnosis can help to optimize the treatment and to improve the survival of the patient. We present the case of a 72-year-old female patient with multiple comorbidities who addressed to the hospital with obstructive respiratory symptoms: dyspnea, wheezing and hoarseness. The investigations, both clinical and paraclinical, identified a local invasive cervical mass located mainly in the left thyroid lobe, whose immunohistochemical examination confirmed primary thyroid angiosarcoma. Although this type of neoplasm is described mainly in the Alpine regions, it can appear in lower altitude regions and this tumor needs to be differentiated from a high-grade neoplasm (anaplastic thyroid carcinoma).
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Affiliation(s)
- Ion Negură
- Pathology Department, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania
| | - Minerva Codruţa Bădescu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,III Internal Medicine Clinic, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania
| | - Ciprian Rezuş
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,III Internal Medicine Clinic, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania
| | - Radu Dănilă
- 3 Surgical Department, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania
| | | | - Mihaela Blaj
- Department of Anesthesia and Intensive Care, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania
| | - Eugenia Moroşan
- Pathology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Delia Gabriela Ciobanu Apostol
- Pathology Department, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania.,Pathology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Thyroid Angiosarcoma-Rare Case or Hard to Find. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:433-437. [PMID: 33717519 PMCID: PMC7948022 DOI: 10.12865/chsj.46.04.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Thyroid Angiosarcoma is a rare malignant condition of the thyroid gland with higher incidence reported in mountainous Alpine regions (Switzerland, Austria and northern Italy), featured with poor prognosis. CASE PRESENTATION A 76 years old male patient presented in our hospital complaining about difficulty in breathing, altered voice (hoarseness), fatigue and dysphagia. Careful observation of the frontal neck region revealed hemorrhaging petechiae and purpura, while palpation indicated a large nodule movable with deglutition, presumably derived by the thyroid gland. Serum biochemical thyroid function tests were normal. Ultrasound of the thyroid gland showed enlargement of the right lobe with a nodular lesion. FNAC indicated a "suspicious for malignancy" lesion. After patient's consensus, total thyroidectomy took place accompanied by excision of infiltrated infrahyoid muscles. The cytopathologic results were positive for primary thyroid angiosarcoma. Patient's postoperative condition was regular, but he died of disease progression 6 months later. DISCUSSION Angiosarcomas are malignant neoplasms arising from endothelial cells of blood vessels. They are most commonly found in skin, soft tissue, breast, bone, liver and spleen. Angiosarcomas tend to be highly hemorrhaging and invasive. Thyroid gland is a rare location of development. Cytopathologically they are grossly characterized by freely anastomosing vascular channels lined by atypical endothelial cells unusually enlarged, often multinucleated with many nucleoli and vacuoles into the cytoplasm containing fragments of erythrocytes. The immunohistological identity of angiosarcomas are endothelial line markers (CD31, CD34 and vimentin). Surgical excision when feasible is the first line treatment while adjuvant radio-and/or chemo-therapy are ambiguous. Infiltration of surrounding tissues and distant metastasis (lymph nodes and lungs) are negative prognostic factors.
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Primary Angiosarcoma of the Thyroid in an Asian Woman: A Case Report with Review of the Literature. Case Rep Pathol 2020; 2020:9068506. [PMID: 32292620 PMCID: PMC7150700 DOI: 10.1155/2020/9068506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023] Open
Abstract
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.
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Abstract
Mesenchymal origin of primary thyroid angiosarcomas (TAS) is extremely rare and comprises less than 1% of primary thyroid cancer worldwide. While TAS are most commonly occurring in the Alpine region, there are multiple reported cases of TAS in non-Alpine regions. Diagnosis of TAS is commonly made after thyroidectomy as cytologic diagnosis can be challenging due to paucity of cells, presence of necrosis and unawareness of the disease due to rarity. We report a case of primary TAS diagnosed by cytology in a 56-year-old man who presented with a sudden onset of left neck pain, swelling and haemoptysis. He was later noted to have suspicious nodules on both lobes of thyroid on ultrasound. Fine needle aspiration of thyroid nodules showed malignant epithelioid cells. The diagnosis of TAS was made based on positive endothelial markers such as thrombomodulin and CD31, with many pertinent negatives, including negative cytokeratins,thyroid transcription factor (TTF1), thyroglobulin, calcitonin and carcinoembryonic antigen (CEA).
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Affiliation(s)
- Ananya Kondapalli
- Department of Medicine, Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lucas Redd
- VA North Texas Health Care System, Dallas, Texas, USA
| | | | - Yin Oo
- VA North Texas Health Care System, Dallas, Texas, USA
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Kuhn E, Ragazzi M, Ciarrocchi A, Torricelli F, de Biase D, Zanetti E, Bisagni A, Corrado S, Uccella S, La Rosa S, Bongiovanni M, Losito S, Piana S. Angiosarcoma and anaplastic carcinoma of the thyroid are two distinct entities: a morphologic, immunohistochemical, and genetic study. Mod Pathol 2019; 32:787-798. [PMID: 30723294 DOI: 10.1038/s41379-018-0199-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Angiosarcoma and anaplastic carcinoma are the most lethal neoplasms of the thyroid worldwide and share some similarities, which have led to a longstanding controversy on their etiopathological relationship. Thyroid angiosarcomas are characterized by vessel formation and an immunophenotype common to endothelial cells, while anaplastic carcinomas are partially or wholly composed of mesenchymal-like cells that have lost the morphologic and functional features of normal thyroid follicular cells. To investigate whether angiosarcomas represent the endothelial extreme of the differentiation spectrum of carcinomas or they are bona fide vascular neoplasms, we studied the clinico-morphologic and genetic characteristics of a series of 10 angiosarcomas and 22 anaplastic carcinomas. Immunohistochemically, among the endothelial markers, CD31 and ERG were the most consistently expressed in angiosarcomas. Among the markers of thyroid origin, PAX8 was the most reliable in anaplastic carcinomas, while TTF-1 reactivity was found in only 5% of anaplastic carcinomas and thyroglobulin was always negative. Pankeratin reacted with most angiosarcomas and anaplastic carcinomas and is therefore not useful in the differential diagnosis. Interestingly a mutated pattern of p53 immunostaining prompted a diagnosis of anaplastic carcinoma. To compare the genetic profile, we used the NGS approach to sequence hotspot regions within a panel of 57 genes. As a result, only a few mutations were found in angiosarcomas and all of them were single events (no TP53 or TERT mutation). On the other hand, anaplastic carcinomas were characterized by a higher number of mutations, and TP53 and TERT promoter mutations were the most frequent genetic alterations. The lack in angiosarcomas of the common mutations identified in anaplastic carcinomas supports a different genetic origin and strongly suggests that, in spite of a shared sarcomatous morphology and a similar clinical aggressiveness, angiosarcomas and anaplastic carcinomas rely on a completely different set of genetic alterations during their evolution.
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Affiliation(s)
- Elisabetta Kuhn
- Pathology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Moira Ragazzi
- Pathology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Federica Torricelli
- Laboratory of Translational Research, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie) - Molecular Pathology Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy
| | - Eleonora Zanetti
- Pathology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Alessandra Bisagni
- Pathology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Stefania Corrado
- Department of Anatomic Pathology, Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Silvia Uccella
- Department of Medicine and Surgery, University of Insumbria, Varese, Italy
| | - Stefano La Rosa
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| | | | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy.
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De Felice F, Moscatelli E, Orelli S, Bulzonetti N, Musio D, Tombolini V. Primary thyroid angiosarcoma: A systematic review. Oral Oncol 2018; 82:48-52. [DOI: 10.1016/j.oraloncology.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
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10
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Shi H, Wang C, Wei L, Lu S, Cao D. Malignant Mesenchymoma of the Thyroid: Case Report and Literature Review. TUMORI JOURNAL 2018; 96:345-8. [DOI: 10.1177/030089161009600227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Malignant mesenchymoma of the thyroid is extremely rare. We report such a tumor involving the bilateral lobes of the thyroid which showed simultaneous chondrosarcomatous, osteosarcomatous, fibrosarcomatous and rhabdomyosarcomatous differentiation. The patient was a 52-year-old woman admitted with a history of facial swelling, neck thickness and swallowing discomfort of one month's duration. Sonographic examination indicated a thyroid mass involving the bilateral lobes. Macroscopically, the tumors of both lobes were well demarcated, solid, greyish-white, and multinodular on the cut surface. Some nodules were translucent in appearance and hard in texture. Microscopically, the tumor was composed of small primitive mesenchymal cells with osteoid formation resembling the small cell variant of osteosarcoma interspersed with multiple cartilaginous nodules that indicated chondrosarcomatous differentiation. Some tumor cells showed prominent rhabdomyoblastic differentiation with eosinophilic cytoplasm and eccentric nuclei. Fibrosarcomatous areas were also observed. Immunohistochemically, the small primitive mesenchymal cells were positive for vimentin and CD99 and negative for CD56, Syn, CgA, CK, TG, TTF-1, calcitonin, and S-100. The tumor cells in the rhabdomyosarcomatous area were MyoD1 and muscle-specific actin positive. Molecular analysis for BRAF and RAS gene alterations showed no point mutation. The tumor recurred four months after surgery and tumor thrombi were suspected in the bilateral internal carotid arteries on ultrasonography. Primary malignant mesenchymoma of the thyroid is a high-grade malignant tumor with a poor prognosis. Its differerential diagnosis includes anaplastic carcinoma and other rare sarcomas with chondroid, osteoid, and other mesenchymal metaplasia.
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Affiliation(s)
- Huaiyin Shi
- Department of Pathology, Chinese PLA General Hospital, Beijing
| | - Chunyan Wang
- Department of Pathology, Daxing District Hospital, Beijing, China
| | - Lixin Wei
- Department of Pathology, Chinese PLA General Hospital, Beijing
| | - Sun Lu
- Department of Pathology, Chinese PLA General Hospital, Beijing
| | - Dengfeng Cao
- Division of Anatomic and Molecular Pathology, Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
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11
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Marina M, Corcione L, Serra MF, Ferri T, Silini EM, Ceresini G. Primary Epithelioid Angiosarcoma of the Thyroid in a Patient Occupationally Exposed to Radiations. Front Endocrinol (Lausanne) 2018; 9:577. [PMID: 30327639 PMCID: PMC6174197 DOI: 10.3389/fendo.2018.00577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Angiosarcoma (AS) of the thyroid is a rare and aggressive tumor. Its incidence is higher in iodine-deficient areas but cases unrelated to endemic goiter have been reported. Case Presentation: We describe a case of a 63-year-old Italian man living in a non-iodine-deficient area, with no previous diagnosis of thyroid disease with a history of radiation exposure. The patient-an interventional cardiologist who had worked for 15 years in an angiographic room- came to the clinical observation because of the rapid onset of dyspnea and dysphonia. Computed tomography (CT) showed a 13-cm inhomogeneous neck mass, originating from the left thyroid lobe which caused displacement and stenosis of the trachea. The patient underwent diagnostic fine-needle aspiration that was followed by total thyroidectomy and lymphadenectomy of central and left lateral cervical nodes. The final pathological diagnosis was epithelioid angiosarcoma (EAS), high grade. The preoperative staging by CT of the head, neck, abdomen, chest and pelvis was negative. At pathological staging, the tumor was angionvasive but it was limited to the thyroid; no lymphnode metastases were detected. Chemotherapy with Epirubicin and Ifosfamide was administered for 4 cycles and, then, it was discontinued due to significant bone marrow toxicity. Conclusion: One year after diagnosis, the CT of neck, abdomen, chest, and pelvis were negative. At 2 years after diagnosis, the FDG-PET was negative with no evidence of the disease at CT Due to the known association between the occurrence of angiosarcoma after radiation therapy it is tempting to speculate that in this patient the presence of thyroid EAS may be linked to radiation exposure.The patient is still alive at 62 months after diagnosis. He is on a follow-up program by a 6-month /1-year neck, chest, abdomen, and pelvis CT evaluation with no signs of metastases.
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Affiliation(s)
- Michela Marina
- Endocrinology of Aging Unit, Department of Medicine and Surgery, University of Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luigi Corcione
- Pathology Unit, Department of Medicine and Surgery, University of Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Maria Francesca Serra
- Endocrinology of Aging Unit, Department of Medicine and Surgery, University of Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Teore Ferri
- Otolaryngology Unit, Department of Medicine and Surgery, University of Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrico Maria Silini
- Pathology Unit, Department of Medicine and Surgery, University of Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Graziano Ceresini
- Endocrinology of Aging Unit, Department of Medicine and Surgery, University of Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- *Correspondence: Graziano Ceresini
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12
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Primary diagnosis of angiosarcoma by fine needle aspiration: Lessons learned from 3 cases. Diagn Cytopathol 2017; 46:349-354. [DOI: 10.1002/dc.23853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 12/27/2022]
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13
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Collini P, Barisella M, Renne SL, Pizzi N, Mattavelli D, Stacchiotti S, Mattavelli F. Epithelioid angiosarcoma of the thyroid gland without distant metastases at diagnosis: report of six cases with a long follow-up. Virchows Arch 2016; 469:223-32. [PMID: 27229516 DOI: 10.1007/s00428-016-1964-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/19/2016] [Accepted: 05/17/2016] [Indexed: 01/17/2023]
Abstract
We present six cases of epithelioid angiosarcomas (EAS) of the thyroid gland without distant metastases at diagnosis and with a long follow-up. We retrieved the six consecutive cases of thyroid EAS between 2005 and 2011. Gender was equally represented; median age was 60 years (range 53-68). One case was post-irradiation and another post-exposure to vinyl chloride. Median diameter was 6 cm (range 5-13). Regional nodal metastases were present at onset in two cases. All the cases expressed CD31 in a membranous pattern. CD34 was always negative. All the patients underwent complete surgical resection. Neoadjuvant chemotherapy was applied in one case and adjuvant chemotherapy in four cases with adjuvant radiation therapy in one case. Follow-up until June 2015 was available in five cases. Median follow-up was 59 months (range 9-82). Three patients relapsed. Two patients (the post-irradiation and post vinyl chloride exposure cases) died of disease after 36 and 9 months, after a local relapse soon followed by distant metastases. Three patients are alive and well after 59, 70, and 82 months, including a patient with a relapse treated with neoadjuvant chemotherapy and surgery. In conclusion, thyroid EAS without distant metastases at diagnosis are very rare tumors. They all expressed CD31, while CD34 was always negative. Distant metastases developed together with local relapse, rapidly followed by death. Inadequate surgery contributed to poor outcome. Cases with previous exposure to irradiation and vinyl chloride showed a particularly poor behavior.
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Affiliation(s)
- Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Soft Tissue and Bone Pathology, Histopathology and Pediatric Pathology Unit, IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
| | - Marta Barisella
- Department of Diagnostic Pathology and Laboratory Medicine, IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Salvatore L Renne
- Department of Diagnostic Pathology and Laboratory Medicine, IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.,Health Sciences Department, University of Milan, Milan, Italy
| | - Natalia Pizzi
- Department of Surgery, IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Davide Mattavelli
- Department of Surgery, IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.,Spedali Civili, Brescia, Italy
| | - Silvia Stacchiotti
- Sarcoma Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Franco Mattavelli
- Department of Surgery, Thyroid Surgery Unit, IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.,Policlinico di Monza, Monza, Italy
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14
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Rotellini M, Vezzosi V, Bianchi S. Epithelioid angiosarcoma of the thyroid: report of a case from an italian non-alpine area and review of the literature. Endocr Pathol 2015; 26:152-6. [PMID: 25935446 DOI: 10.1007/s12022-015-9372-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Epithelioid angiosarcoma of the thyroid is a rare mesenchymal neoplasm, mainly described in the Alpine area. This lesion was initially considered an anaplastic carcinoma, but immunohistochemical and ultrastructural features have proven the endothelial differentiation of tumor cells. In fact, the peculiarity of this tumor concerns the expression of low-molecular weight cytokeratins by neoplastic cells of endothelial origin. We describe a case of epithelioid angiosarcoma of the thyroid occurred in a 73-year-old woman from an Italian non-Alpine area, and a review of non-Alpine primary thyroid epitheliod angiosarcoma is presented.
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Affiliation(s)
- Matteo Rotellini
- Pathological Anatomy Unit, Department of Surgery and Translational Medicine, University of Florence, L.go Brambilla 3, 50134, Florence, Italy,
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15
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A case of rapidly progressing primary thyroid angiosarcoma in a Japanese man. Int Cancer Conf J 2015. [DOI: 10.1007/s13691-014-0170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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16
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Couto J, Martins RG, Santos AP, Matos J, Torres I. Invasive thyroid angiosarcoma with a favorable outcome. Int J Endocrinol Metab 2014; 12:e15806. [PMID: 25745482 PMCID: PMC4338647 DOI: 10.5812/ijem.15806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 05/31/2014] [Accepted: 06/13/2014] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Joana Couto
- Endocrinology Department, Portuguese Institute of Oncology FG, Porto, Portugal
- Corresponding author: Joana Couto, Endocrinology Department, Portuguese Institute of Oncology FG, Porto, Portugal. Tel: + 351-969014901, Fax: + 351-225084001, E-mail:
| | - Raquel G Martins
- Endocrinology Department, Portuguese Institute of Oncology FG, Porto, Portugal
| | - Ana Paula Santos
- Endocrinology Department, Portuguese Institute of Oncology FG, Porto, Portugal
| | - Joana Matos
- Pathology Department, Portuguese Institute of Oncology FG, Porto, Portugal
| | - Isabel Torres
- Endocrinology Department, Portuguese Institute of Oncology FG, Porto, Portugal
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17
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Ragazzi M, Ciarrocchi A, Sancisi V, Gandolfi G, Bisagni A, Piana S. Update on anaplastic thyroid carcinoma: morphological, molecular, and genetic features of the most aggressive thyroid cancer. Int J Endocrinol 2014; 2014:790834. [PMID: 25214840 PMCID: PMC4158294 DOI: 10.1155/2014/790834] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/08/2014] [Indexed: 12/19/2022] Open
Abstract
Anaplastic thyroid carcinoma (ATC) is the most aggressive form of thyroid cancer. It shows a wide spectrum of morphological presentations and the diagnosis could be challenging due to its high degree of dedifferentiation. Molecular and genetic features of ATC are widely heterogeneous as well and many efforts have been made to find a common profile in order to clarify its cancerogenetic process. A comprehensive review of the current literature is here performed, focusing on histopathological and genetic features.
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Affiliation(s)
- Moira Ragazzi
- Pathology Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Research and Statistic Infrastructure, Arcispedale S. Maria Nuova-IRCCS, 42123 Reggio Emilia, Italy
| | - Valentina Sancisi
- Laboratory of Translational Research, Research and Statistic Infrastructure, Arcispedale S. Maria Nuova-IRCCS, 42123 Reggio Emilia, Italy
| | - Greta Gandolfi
- Laboratory of Translational Research, Research and Statistic Infrastructure, Arcispedale S. Maria Nuova-IRCCS, 42123 Reggio Emilia, Italy
| | - Alessandra Bisagni
- Pathology Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
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18
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Nonalpine thyroid angiosarcoma in a patient with hashimoto thyroiditis. Case Rep Oncol Med 2013; 2013:901246. [PMID: 24349811 PMCID: PMC3855954 DOI: 10.1155/2013/901246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/09/2013] [Indexed: 01/21/2023] Open
Abstract
Thyroid angiosarcoma is an uncommon thyroid carcinoma and its incidence is the highest in the European Alpine regions. Thyroid angiosarcoma is also a very aggressive tumor that can rapidly spread to the cervical lymph nodes, lungs, and brain or can metastasize to the duodenum, small boewl, and large bowel. Although it is histologically well defined, clear-cut separation between the angiosarcoma and anaplastic thyroid carcinoma is difficult. A 49-year-old Caucasian female patient, born and resident in Southern Italy (Calabria), in an iodine-sufficient area, was admitted to the Surgery Department because she presented with a painless mass in the anterior region of neck enlarged rapidly in the last three months. After total thyroidectomy and right cervical lymphadenectomy, postoperative histological examination revealed the presence of a thyroid angiosarcoma with positive staining for CD31 and for both Factor VIII-related antigen and Vimentin and only partially positive for staining pancytokeratin and presence of metastasis in cervical, supraclavicular, mediastinal and paratracheal lymph nodes. The patient started adjuvant chemotherapy and she was treated for 6 cycles with Doxorubicin, Dacarbazine, Ifosfamide, and Mesna (MAID). After 22 months from surgery, the patient is still alive without both local and systemic recurrence of the disease.
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19
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Abstract
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.
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Affiliation(s)
- Arshpreet Kaur
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.
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20
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Chen CY, Wu YC, Chou TY, Yang KY. Pleural angiosarcoma mimicking pleural haematoma. Interact Cardiovasc Thorac Surg 2013; 17:886-8. [PMID: 23838336 DOI: 10.1093/icvts/ivt269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pleural angiosarcoma is an extremely rare disease. Although the clinical course could be indolent, the prognosis is very poor once the tumour spreads. Herein, a 69-year old male with a history of thyroid goitre was noted for 5 years before the symptoms of right chest pain and body weight loss developed. His serial chest roenterogram revealed loculated pleural effusion which rapidly progressed to be multiple pleural haematomas. After several sono-guided aspiration/biopsies with undiagnosed pleural haematomas, an exploratory thoracotomy confirmed the diagnosis of pleural angiosarcoma. Whole body image studies did not find other suspicious primary sites except for a thyroid tumour with eccentric calcification extending into the thoracic cage. Aspiration cytology of the thyroid tumour was shown to be morphologically consistent with angiosarcoma. This case reminds clinicians that pleural metastatic angiosarcomas presenting as haematomas have a high risk of massive and refractory haemothorax.
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Affiliation(s)
- Cheng-Yu Chen
- Division of Chest Medicine, Department of Internal Medicine, National Yang-Ming University Hospital, Taiwan
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21
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Gouveia P, Silva C, Magalhães F, Santos C, Guerreiro E, Santos F, Gomes T. Non-Alpine thyroid angiosarcoma. Int J Surg Case Rep 2013; 4:524-7. [PMID: 23570682 DOI: 10.1016/j.ijscr.2013.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Angiosarcoma is a very rare entity of soft tissue neoplasm with an aggressive and destructive biological behavior. Thyroid angiosarcoma is usually reported in Alpine regions, with only exceptionally rare cases arising in non-mountainous areas. In the Alpine regions it constitutes 2-10% of all malignant thyroid tumors. PRESENTATION OF CASE We report a case of a thyroid non-Alpine angiosarcoma in a 71-year-old female with a 10 years old multinodular goiter. The cervical mass underwent rapid growth in the last year, and she was referred for surgical treatment. A 15cm mass was found on the right side of the neck invading adjacent tissues and displacing the trachea without obvious invasion of this organ. Fine needle aspiration cytology showed "carcinoma". Lung metastasis were present. Although difficult, total thyroidectomy was possible with resection of an esophageal implant. Post-operatively, she had respiratory failure that eventually recovered, but, on 39th post-operative day, she died of violent hemoptysis, probably due to invasion by mediastinal metastasis. DISCUSSION A clear distinction between angiosarcoma and anaplastic carcinoma of the thyroid is considerably difficult, despite treatments and prognosis are practically the same. However, in recent years, a thyroid malignancy exhibiting phenotypical features of endothelial differentiation was described. Keratin positivity cannot be reported as necessarily indicative of epithelial differentiation. CONCLUSION Optimal treatment for thyroid angiosarcoma remains unclear, not only because the prognosis is poor, despite multimodal therapeutic efforts, but also because it is a very rare entity.
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Affiliation(s)
- Pedro Gouveia
- Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
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22
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Petronella P, Scorzelli M, Luise R, Iannaci G, Sapere P, Ferretti M, Costanzo RMA, Freda F, Canonico S, Rossiello R. Primary thyroid angiosarcoma: an unusual localization. World J Surg Oncol 2012; 10:73. [PMID: 22553943 PMCID: PMC3490834 DOI: 10.1186/1477-7819-10-73] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 05/03/2012] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Pasquale Petronella
- Department of Gerontology, Geriatry and Metabolic Diseases, UOC of General and Geriatric Surgery, School of Medicine, Second University of the Study of Naples, Naples, Italy.
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23
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24
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Binesh F, Akhavan A, Navabii H, Dadgarnia MH, Zand V. Primary angiosarcoma of the thyroid gland in an young Iranian woman. BMJ Case Rep 2011; 2011:bcr.03.2011.4042. [PMID: 22693296 DOI: 10.1136/bcr.03.2011.4042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Angiosarcoma of the thyroid gland is a rare and aggressive primary malignant tumour of the thyroid, originally reported in patient from Swiss Alpine region. Here, the authors describe a case of primary angiosarcoma of the thyroid in an 21-year-old Iranian woman who presented with a rapidly enlarging neck mass associated with compressive symptoms.
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Affiliation(s)
- Fariba Binesh
- Department of Pathology, Yazd Shahid Sadoghi University, Yazd, Islamic Republic of Iran.
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25
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Dainese E, Pozzi B, Milani M, Rossi G, Grazia Pezzotta M, Vertemati G, Tricomi P, Sessa F. Primary pleural epithelioid angiosarcoma. A case report and review of the literature. Pathol Res Pract 2010; 206:415-9. [PMID: 20089367 DOI: 10.1016/j.prp.2009.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 09/14/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
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26
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Hoang C, Le Naour G, Ménégaux F, Capron F. [An unusual mutinodular goiter]. Ann Pathol 2009; 29:528-30. [PMID: 20005447 DOI: 10.1016/j.annpat.2009.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Catherine Hoang
- Service d'anatomie et cytologie pathologiques, groupe hospitalier Pitié-Salpêtrière, CHU Paris-Est, 75651 Paris cedex 13, France.
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27
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Isa NM, James DT, Saw TH, Pennisi R, Gough I. Primary angiosarcoma of the thyroid gland with recurrence diagnosed by fine needle aspiration: a case report. Diagn Cytopathol 2009; 37:427-32. [PMID: 19306411 DOI: 10.1002/dc.21065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Angiosarcoma of the thyroid is a rare and aggressive primary malignant tumor of the thyroid originally reported in patients from the Swiss Alpine region. Diagnosis of this tumor rests mainly on characteristic histopathological features of a malignant vascular tumor supported by immunopositivity for vascular markers e.g., CD31, Factor VIII, and CD34. Its cytological features, however, are not well-defined. We describe a case of primary angiosarcoma of the thyroid in a 48-year-old female, who presented with a rapidly enlarging neck mass associated with compressive symptoms. She had a history of hypothyroidism. The initial fine needle aspiration cytology of the neck mass was negative. She then underwent left hemithyroidectomy. Histologically, the tumor showed poorly differentiated malignant cells with eccentrically-placed nuclei, prominent nucleoli, and intracytoplasmic vacuoles admixed with mixed inflammatory cells. These showed immunopositivity for CD31 but were negative for CD34, Factor VIII, CK5/6, EMA, TTF-1, Thyroglobulin, Calcitonin, Melan A, and Calretinin. A diagnosis of poorly differentiated malignant tumor consistent with angiosarcoma was made. The patient was treated with radiation therapy but developed recurrence of the tumor. Second aspiration cytology of the recurrent tumor yielded hypocellular smears containing singularly dispersed atypical cells having eccentrically-placed nuclei with prominent macronucleoli and intracytoplasmic vacuoles within a background of inflammatory cells, consistent with recurrent angiosarcoma. Chemotherapy was started but she succumbed to the disease 7 months after diagnosis. The cytological, histopathological, immunohistochemical findings, and the clinical course are discussed.
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Affiliation(s)
- Nurismah Md Isa
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia.
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28
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Abstract
Hemangiosarcoma of the thyroid gland is a very rare entity. The therapy of this tumor is difficult because of its locally aggressive and destructive behavior with a high recurrence rate. We report a case of 60-year-old man with history of 1 month rapidly enlarging neck mass in the thyroid region. Ultrasound examination and CT scan showed resistance arising from the left thyroid lobe. FNAC revealed necrotic tumor mass without any cytological specification. Because of the clinical findings, a total thyroidectomy was indicated. The surgery was complicated by invasion of the tumor mass into the surrounding tissues. Therefore, only left side hemithyroidectomy was performed. Histopathology including histochemistry proved positive staining for Factor VIII, Fasciin, and CD31 in tumor cells. In this case, adjuvant oncological treatment was planned, but the patient died because of massive bleeding from the tumor mass. The histological diagnosis of thyroid hemangiosarcoma is mostly difficult. The treatment of the first choice is radical surgery. If the tumor cannot be treated by surgery, then radiotherapy, eventually chemotherapy is indicated. The prognosis is not favorable.
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29
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Njim L, Moussa A, Hadhri R, Gassab I, Ben Yahia N, Mahmoudi H, Zakhama A. [Angiomatoid tumor of the thyroid gland: primitive angiosarcoma or variant of anaplastic carcinoma?]. Ann Pathol 2008; 28:221-4. [PMID: 18706366 DOI: 10.1016/j.annpat.2008.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 10/21/2022]
Abstract
Thyroid gland angiomatoid tumors are an extremely aggressive neoplasms with varied histological patterns and features of endothelial differentiation. The histogenesis of thyroid angiomatoid tumors has been controversial for many years: these tumors may be either a variant of anaplastic carcinoma, or an angiosarcoma. We report a case of thyroid angiomatoid tumor in a 68-year-old woman. We also discuss, through a review of the literature, the pathologic criteria that could be used to distinguish between angiosarcoma and anaplastic carcinoma of the thyroid.
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Affiliation(s)
- Leila Njim
- Service d'anatomie et cytologie pathologiques, hôpital Fattouma-Bourguiba, avenue du 1st-Juin, Monastir 5000, Tunisia.
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30
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Papotti M, Arrondini M, Tavaglione V, Veltri A, Volante M. Diagnostic controversies in vascular proliferations of the thyroid gland. Endocr Pathol 2008; 19:175-83. [PMID: 18766472 DOI: 10.1007/s12022-008-9039-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Vascular lesions are one of the most controversial issues in thyroid pathology. The differential diagnosis includes benign lesions on one side, i.e., endothelial reactive hyperplasia (Masson's "hemangioma") in goiter and hemangioma, and malignant tumors on the other, i.e., angiosarcomas and undifferentiated (angio)sarcomatoid carcinomas. Benign reactive endothelial hyperplasia with atypias mimicking malignant tumors may occur in long-standing nodular goiter, as a result of spontaneous hemorrhage followed by granulation tissue and fibrous organization. Alternatively, it may follow a fine-needle aspiration biopsy (FNAB) procedure. Angiosarcoma is a rare primary malignant thyroid tumor, mainly observed in endemic goiter areas displaying morphologic and phenotypical similar to those typical of angiosarcomas in other locations (including focal cytokeratin expression). The distinction between angiosarcoma and (angio)sarcomatoid anaplastic carcinoma is difficult and the true existence of angiosarcoma has been challenged. Other extremely rare vascular lesions or mimics in the thyroid include benign hemangioma and pseudo-angiosarcomatous variant of medullary carcinoma. The differential diagnosis between benign and malignant vascular conditions in FNAB material is extremely challenging, and the cytopathology report should be remarkably cautious, especially in poorly cellular and highly hemorrhagic cases: atypias in endothelial cells are not per se indicative of malignancy, being a common feature of reactive endothelial hyperplasia in infracted goiter nodules as well.
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Affiliation(s)
- Mauro Papotti
- Department of Pathology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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31
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32
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Yilmazlar T, Kirdak T, Adim S, Ozturk E, Yerci O. A case of hemangiosarcoma in thyroid with severe anemia due to bone marrow metastasis. Endocr J 2005; 52:57-9. [PMID: 15758558 DOI: 10.1507/endocrj.52.57] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 56-year-old woman presented with rapidly enlarging thyroid mass and deep anemia. There was no history of gastrointestinal bleeding, and endoscopic examinations of the gastrointestinal system were normal. Fine needle aspiration cytology from the thyroid nodule was suspicious. After blood transfusion, total thyroidectomy was performed. Postoperative histopathological examination of the specimen revealed hemangiosarcoma of the thyroid. After establishment of the diagnosis chemotherapy was started. But hemoglobin values decreased again and hepatosplenomegaly developed at the second month of surgery. Bone marrow aspiration cytology which was performed demonstrated the same tumoral cells infiltrating bone marrow. The patient died at 12th week after surgery. Thyroid hemangiosarcoma can metastasize to the bone marrow and anemia may be an indicator of the advanced disease. In the differential diagnosis of the anemia, bone marrow metastasis and bone marrow biopsy should be considered in suspected cases.
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Affiliation(s)
- Tuncay Yilmazlar
- Department of General Surgery, Uludag University School of Medicine, Gorukle, Bursa, Turkey
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