Primary leiomyosarcoma of the thyroid gland with prior malignancy and radiotherapy:A case report and review of literature
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摘要
BACKGROUND Leiomyosarcoma(LMS) of the thyroid gland is a rarely presented tumor that offers poor prognosis. To the best of the authors' knowledge, there currently exist only 28 known cases described in the literature(limited to English).CASE SUMMARY Herein a case is reported of a 60-year-old female patient who had an LMS of the thyroid, which was accompanied by periodic dysphonia and breathing disorder as well as the feeling of pressure in the chest and neck. At the time the disease was diagnosed, no metastases were detected. Prior to the diagnosis, the patient experienced a uterine adenocarcinoma that had been treated by surgical procedure and radiotherapy. For the LMS, a total thyroidectomy was performed,followed by radiotherapy. Since metastases were also discovered in the lungs,sternum, and femur, chemotherapy was administered as well.Immunohistochemically, the tumor cells in the thyroid indicated positively for alpha smooth muscle actin, calponin, and H-caldesmon, but were negative for CD34, p63, estrogen receptor, progesterone receptor, and Epstein-Barr virus.CONCLUSION Although the etiology of the LMS is as of yet unknown, prior malignancy and radiation should be considered as risk factors.
BACKGROUND Leiomyosarcoma(LMS) of the thyroid gland is a rarely presented tumor that offers poor prognosis. To the best of the authors' knowledge, there currently exist only 28 known cases described in the literature(limited to English).CASE SUMMARY Herein a case is reported of a 60-year-old female patient who had an LMS of the thyroid, which was accompanied by periodic dysphonia and breathing disorder as well as the feeling of pressure in the chest and neck. At the time the disease was diagnosed, no metastases were detected. Prior to the diagnosis, the patient experienced a uterine adenocarcinoma that had been treated by surgical procedure and radiotherapy. For the LMS, a total thyroidectomy was performed,followed by radiotherapy. Since metastases were also discovered in the lungs,sternum, and femur, chemotherapy was administered as well.Immunohistochemically, the tumor cells in the thyroid indicated positively for alpha smooth muscle actin, calponin, and H-caldesmon, but were negative for CD34, p63, estrogen receptor, progesterone receptor, and Epstein-Barr virus.CONCLUSION Although the etiology of the LMS is as of yet unknown, prior malignancy and radiation should be considered as risk factors.
BACKGROUND Leiomyosarcoma(LMS) of the thyroid gland is a rarely presented tumor that offers poor prognosis. To the best of the authors' knowledge, there currently exist only 28 known cases described in the literature(limited to English).CASE SUMMARY Herein a case is reported of a 60-year-old female patient who had an LMS of the thyroid, which was accompanied by periodic dysphonia and breathing disorder as well as the feeling of pressure in the chest and neck. At the time the disease was diagnosed, no metastases were detected. Prior to the diagnosis, the patient experienced a uterine adenocarcinoma that had been treated by surgical procedure and radiotherapy. For the LMS, a total thyroidectomy was performed,followed by radiotherapy. Since metastases were also discovered in the lungs,sternum, and femur, chemotherapy was administered as well.Immunohistochemically, the tumor cells in the thyroid indicated positively for alpha smooth muscle actin, calponin, and H-caldesmon, but were negative for CD34, p63, estrogen receptor, progesterone receptor, and Epstein-Barr virus.CONCLUSION Although the etiology of the LMS is as of yet unknown, prior malignancy and radiation should be considered as risk factors.
引文
1 DeLellis RA,Loyd RV,Heitz PU.Pathology and Genetics of Tumours of Endocrine Organs.World health Organization Classification of Tumours.3rd ed.IARC Press,Lyon.2004;49-135
2 Goldblum JR,Folpe AV,Weiss SW,Enzinger FM.Enzinger and Weiss's soft tissue tumors.9th ed.Mosby Elsevier,Philadelphia Hardcover.2008;249-269
3 Thompson LD,Wenig BM,Adair CF,Shmookler BM,Heffess CS.Primary smooth muscle tumors of the thyroid gland.Cancer 1997;79:579-587[PMID:9028371]
4 Adachi M,Wellmann KF,Garcia R.Metastatic leiomyosarcoma in brain and heart.J Pathol 1969;98:294-296[PMID:5358278 DOI:10.1002/path.1710980411]
5 Kawahara E,Nakanishi I,Terahata S,Ikegaki S.Leiomyosarcoma of the thyroid gland.A case report with a comparative study of five cases of anaplastic carcinoma.Cancer 1988;62:2558-2563[PMID:3056606]
6 Kawaguchi Y,Kanazawa M,Nakayama K,Urazumi K,Takeuchi S,Abe R.A case of leiomyosarcoma of the thyroid gland showing fatal outcome with rapid course.Nihon Rinshou Gekai Gakkai Zasshi(Jpn JClinSurg)1990;51:1217-1221[DOI:10.3919/ringe1963.51.1217]
7 Kaur A,Jayaram G.Thyroid tumors:cytomorphology of medullary,clinically anaplastic,and miscellaneous thyroid neoplasms.Diagn Cytopathol 1990;6:383-389[PMID:2292224 DOI:10.1002/dc.2840060603]
8 Chetty R,Clark SP,Dowling JP.Leiomyosarcoma of the thyroid:immunohistochemical and ultrastructural study.Pathology 1993;25:203-205[PMID:8367205 DOI:10.3109/00313029309084801]
9 Iida Y,Katoh R,Yoshioka M,Oyama T,Kawaoi A.Primary leiomyosarcoma of the thyroid gland.Acta Pathol Jpn 1993;43:71-75[PMID:8465659]
10 Ozaki O,Sugino K,Mimura T,Ito K,Tamai S,Hosoda Y.Primary leiomyosarcoma of the thyroid gland.Surg Today 1997;27:177-180[PMID:9018000 DOI:10.1007/BF02385912]
11 Tulbah A,Al-Dayel F,Fawaz I,Rosai J.Epstein-Barr virus-associated leiomyosarcoma of the thyroid in a child with congenital immunodeficiency:a case report.Am J Surg Pathol 1999;23:473-476[PMID:10199478 DOI:10.1097/00000478-199904000-00013]
12 Tsugawa K,Koyanagi N,Nakanishi K,Wada H,Tanoue K,Hashizume M,Sugimachi K.Leiomyosarcoma of the thyroid gland with rapid growth and tracheal obstruction:A partial thyroidectomy and tracheostomy using an ultrasonically activated scalpel can be safely performed with less bleeding.Eur J Med Res 1999;4:483-487[PMID:10585304]
13 Takayama F,Takashima S,Matsuba H,Kobayashi S,Ito N,Sone S.MR imaging of primary leiomyosarcoma of the thyroid gland.Eur J Radiol 2001;37:36-41[PMID:11274837 DOI:10.1016/S0720-048X(00)00217-5]
14 Day AS,Lou PJ,Lin WC,Chou CC.Over-expression of c-kit in a primary leiomyosarcoma of the thyroid gland.Eur Arch Otorhinolaryngol 2007;264:705-708[PMID:17256123]
15 Just PA,Guillevin R,Capron F,Le Charpentier M,Le Naour G,Menegaux F,Leenhardt L,Simon JM,Hoang C.An unusual clinical presentation of a rare tumor of the thyroid gland:report on one case of leiomyosarcoma and review of literature.Ann Diagn Pathol 2008;12:50-56[PMID:18164417 DOI:10.1016/j.anndiagpath.2006.06.006]
16 Mansouri H,Gaye M,Errihani H,Kettani F,Gueddari BE.Leiomyosarcoma of the thyroid gland.Acta Otolaryngol 2008;128:335-336[PMID:18274920 DOI:10.1080/00016480500527193]
17 Wang TS,Ocal IT,Oxley K,Sosa JA.Primary leiomyosarcoma of the thyroid gland.Thyroid 2008;18:425-428[PMID:18346004 DOI:10.1089/thy.2007.0276]
18 Qin Q,Liang ZH,Li AH.[Thyroid leiomyosarcoma:report of one cases].Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012;47:75-76[PMID:22455785]
19 Mouaqit O,Belkacem Z,Ifrine L,Mohsine R,Belkouchi A.A rare tumor of the thyroid gland:report on one case of leiomyosarcoma and review of literature.Updates Surg 2014;66:165-167[PMID:23335096DOI:10.1007/s13304-013-0196-1]
20 Amal B,El Fatemi H,Souaf I,Moumna K,Affaf A.A rare primary tumor of the thyroid gland:report a new case of leiomyosarcoma and literature review.Diagn Pathol 2013;8:36[PMID:23445571 DOI:10.1186/1746-1596-8-36]
21 Tanboon J,Keskool P.Leiomyosarcoma:a rare tumor of the thyroid.Endocr Pathol 2013;24:136-143[PMID:23729187 DOI:10.1007/s12022-013-9251-1]
22 Ege B,Levento?lu S.Primary leiomyosarcoma of the thyroid.J Korean Surg Soc 2013;85:43-46[PMID:23833760 DOI:10.4174/jkss.2013.85.1.43]
23?ahin M?,Vural A,Yüce?,?a?l?S,Deniz K,Güney E.Thyroid leiomyosarcoma:presentation of two cases and review of the literature.Braz J Otorhinolaryngol 2016;82:715-721[PMID:27080750 DOI:10.1016/j.bjorl.2015.11.020]
24 Gupta AJ,Singh M,Rani P,Khurana N,Mishra A.Primary Sarcomas of Thyroid Gland-Series of Three Cases with Brief Review of Spindle Cell Lesions of Thyroid.J Clin Diagn Res 2017;11:ER01-ER04[PMID:28384879 DOI:10.7860/JCDR/2017/22907.9164]
25 Zou ZY,Ning N,Li SY,Li J,DU XH,Li R.Primary thyroid leiomyosarcoma:A case report and literature review.Oncol Lett 2016;11:3982-3986[PMID:27313727 DOI:10.3892/ol.2016.4496]
26 Ayadi M,Gabsi A,Meddeb K,Mokrani A,Yahiaoui Y,Letaief F,Chraiet N,Rais H,Mezlini A.Primary leiomyosarcoma of thyroid gland:the youngest case.Pan Afr Med J 2017;26:113[PMID:28533836DOI:10.11604/pamj.2017.26.113.11472]
27 Ordó?ez NG,El-Naggar AK,Hickey RC,Samaan NA.Anaplastic thyroid carcinoma.Immunocytochemical study of 32 cases.Am J Clin Pathol 1991;96:15-24[PMID:1712540 DOI:10.1093/ajcp/96.1.15]
28 Hurlimann J,Gardiol D,Scazziga B.Immunohistology of anaplastic thyroid carcinoma.A study of 43cases.Histopathology 1987;11:567-580[PMID:2442086 DOI:10.1111/j.1365-2559.1987.tb02667.x]
29 Miettinen M,Franssila KO.Variable expression of keratins and nearly uniform lack of thyroid transcription factor 1 in thyroid anaplastic carcinoma.Hum Pathol 2000;31:1139-1145[PMID:11014583DOI:10.1053/hupa.2000.16667]
30 LiVolsi VA,Brooks JJ,Arendash-Durand B.Anaplastic thyroid tumors.Immunohistology.Am J Clin Pathol 1987;87:434-442[PMID:2435145]
2 Goldblum JR,Folpe AV,Weiss SW,Enzinger FM.Enzinger and Weiss's soft tissue tumors.9th ed.Mosby Elsevier,Philadelphia Hardcover.2008;249-269
3 Thompson LD,Wenig BM,Adair CF,Shmookler BM,Heffess CS.Primary smooth muscle tumors of the thyroid gland.Cancer 1997;79:579-587[PMID:9028371]
4 Adachi M,Wellmann KF,Garcia R.Metastatic leiomyosarcoma in brain and heart.J Pathol 1969;98:294-296[PMID:5358278 DOI:10.1002/path.1710980411]
5 Kawahara E,Nakanishi I,Terahata S,Ikegaki S.Leiomyosarcoma of the thyroid gland.A case report with a comparative study of five cases of anaplastic carcinoma.Cancer 1988;62:2558-2563[PMID:3056606]
6 Kawaguchi Y,Kanazawa M,Nakayama K,Urazumi K,Takeuchi S,Abe R.A case of leiomyosarcoma of the thyroid gland showing fatal outcome with rapid course.Nihon Rinshou Gekai Gakkai Zasshi(Jpn JClinSurg)1990;51:1217-1221[DOI:10.3919/ringe1963.51.1217]
7 Kaur A,Jayaram G.Thyroid tumors:cytomorphology of medullary,clinically anaplastic,and miscellaneous thyroid neoplasms.Diagn Cytopathol 1990;6:383-389[PMID:2292224 DOI:10.1002/dc.2840060603]
8 Chetty R,Clark SP,Dowling JP.Leiomyosarcoma of the thyroid:immunohistochemical and ultrastructural study.Pathology 1993;25:203-205[PMID:8367205 DOI:10.3109/00313029309084801]
9 Iida Y,Katoh R,Yoshioka M,Oyama T,Kawaoi A.Primary leiomyosarcoma of the thyroid gland.Acta Pathol Jpn 1993;43:71-75[PMID:8465659]
10 Ozaki O,Sugino K,Mimura T,Ito K,Tamai S,Hosoda Y.Primary leiomyosarcoma of the thyroid gland.Surg Today 1997;27:177-180[PMID:9018000 DOI:10.1007/BF02385912]
11 Tulbah A,Al-Dayel F,Fawaz I,Rosai J.Epstein-Barr virus-associated leiomyosarcoma of the thyroid in a child with congenital immunodeficiency:a case report.Am J Surg Pathol 1999;23:473-476[PMID:10199478 DOI:10.1097/00000478-199904000-00013]
12 Tsugawa K,Koyanagi N,Nakanishi K,Wada H,Tanoue K,Hashizume M,Sugimachi K.Leiomyosarcoma of the thyroid gland with rapid growth and tracheal obstruction:A partial thyroidectomy and tracheostomy using an ultrasonically activated scalpel can be safely performed with less bleeding.Eur J Med Res 1999;4:483-487[PMID:10585304]
13 Takayama F,Takashima S,Matsuba H,Kobayashi S,Ito N,Sone S.MR imaging of primary leiomyosarcoma of the thyroid gland.Eur J Radiol 2001;37:36-41[PMID:11274837 DOI:10.1016/S0720-048X(00)00217-5]
14 Day AS,Lou PJ,Lin WC,Chou CC.Over-expression of c-kit in a primary leiomyosarcoma of the thyroid gland.Eur Arch Otorhinolaryngol 2007;264:705-708[PMID:17256123]
15 Just PA,Guillevin R,Capron F,Le Charpentier M,Le Naour G,Menegaux F,Leenhardt L,Simon JM,Hoang C.An unusual clinical presentation of a rare tumor of the thyroid gland:report on one case of leiomyosarcoma and review of literature.Ann Diagn Pathol 2008;12:50-56[PMID:18164417 DOI:10.1016/j.anndiagpath.2006.06.006]
16 Mansouri H,Gaye M,Errihani H,Kettani F,Gueddari BE.Leiomyosarcoma of the thyroid gland.Acta Otolaryngol 2008;128:335-336[PMID:18274920 DOI:10.1080/00016480500527193]
17 Wang TS,Ocal IT,Oxley K,Sosa JA.Primary leiomyosarcoma of the thyroid gland.Thyroid 2008;18:425-428[PMID:18346004 DOI:10.1089/thy.2007.0276]
18 Qin Q,Liang ZH,Li AH.[Thyroid leiomyosarcoma:report of one cases].Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012;47:75-76[PMID:22455785]
19 Mouaqit O,Belkacem Z,Ifrine L,Mohsine R,Belkouchi A.A rare tumor of the thyroid gland:report on one case of leiomyosarcoma and review of literature.Updates Surg 2014;66:165-167[PMID:23335096DOI:10.1007/s13304-013-0196-1]
20 Amal B,El Fatemi H,Souaf I,Moumna K,Affaf A.A rare primary tumor of the thyroid gland:report a new case of leiomyosarcoma and literature review.Diagn Pathol 2013;8:36[PMID:23445571 DOI:10.1186/1746-1596-8-36]
21 Tanboon J,Keskool P.Leiomyosarcoma:a rare tumor of the thyroid.Endocr Pathol 2013;24:136-143[PMID:23729187 DOI:10.1007/s12022-013-9251-1]
22 Ege B,Levento?lu S.Primary leiomyosarcoma of the thyroid.J Korean Surg Soc 2013;85:43-46[PMID:23833760 DOI:10.4174/jkss.2013.85.1.43]
23?ahin M?,Vural A,Yüce?,?a?l?S,Deniz K,Güney E.Thyroid leiomyosarcoma:presentation of two cases and review of the literature.Braz J Otorhinolaryngol 2016;82:715-721[PMID:27080750 DOI:10.1016/j.bjorl.2015.11.020]
24 Gupta AJ,Singh M,Rani P,Khurana N,Mishra A.Primary Sarcomas of Thyroid Gland-Series of Three Cases with Brief Review of Spindle Cell Lesions of Thyroid.J Clin Diagn Res 2017;11:ER01-ER04[PMID:28384879 DOI:10.7860/JCDR/2017/22907.9164]
25 Zou ZY,Ning N,Li SY,Li J,DU XH,Li R.Primary thyroid leiomyosarcoma:A case report and literature review.Oncol Lett 2016;11:3982-3986[PMID:27313727 DOI:10.3892/ol.2016.4496]
26 Ayadi M,Gabsi A,Meddeb K,Mokrani A,Yahiaoui Y,Letaief F,Chraiet N,Rais H,Mezlini A.Primary leiomyosarcoma of thyroid gland:the youngest case.Pan Afr Med J 2017;26:113[PMID:28533836DOI:10.11604/pamj.2017.26.113.11472]
27 Ordó?ez NG,El-Naggar AK,Hickey RC,Samaan NA.Anaplastic thyroid carcinoma.Immunocytochemical study of 32 cases.Am J Clin Pathol 1991;96:15-24[PMID:1712540 DOI:10.1093/ajcp/96.1.15]
28 Hurlimann J,Gardiol D,Scazziga B.Immunohistology of anaplastic thyroid carcinoma.A study of 43cases.Histopathology 1987;11:567-580[PMID:2442086 DOI:10.1111/j.1365-2559.1987.tb02667.x]
29 Miettinen M,Franssila KO.Variable expression of keratins and nearly uniform lack of thyroid transcription factor 1 in thyroid anaplastic carcinoma.Hum Pathol 2000;31:1139-1145[PMID:11014583DOI:10.1053/hupa.2000.16667]
30 LiVolsi VA,Brooks JJ,Arendash-Durand B.Anaplastic thyroid tumors.Immunohistology.Am J Clin Pathol 1987;87:434-442[PMID:2435145]