J Pathol Transl Med.  2021 Sep;55(5):360-365. 10.4132/jptm.2021.06.23.

Metastatic leiomyosarcoma of the thyroid gland: cytologic findings and differential diagnosis

• Lee J
• Cho Y
• Choi KH
• Hwang I
• Oh YL

• KMID: 2520176
• DOI: http://doi.org/10.4132/jptm.2021.06.23

Abstract

Metastatic leiomyosarcoma to the thyroid is an extremely rare occurrence, and only 18 cases have been reported. Here, we report a case of a 37-year-old woman who presented with multiple masses on the scalp. Excisional biopsy was done and the mass revealed fascicles of smooth muscle fibers which showed positive staining for smooth muscle actin, thus confirming the diagnosis of leiomyosarcoma. The patient was also found to have a 0.9 cm mass within the left thyroid. Fine-needle aspiration was done and the cytological smear showed hypercellular spindle cell clusters with hyperchromatic and large nuclei. Normal thyroid follicular cells were found within or around tumor cells. In this report, we present the cytologic findings of metastatic leiomyosarcoma to the thyroid and offer differential diagnoses of the aspirated spindle cells.

Keyword

Leiomyosarcoma; secondary; Cytology; Leiomyosarcoma; Thyroid neoplasms

Figure

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  Fig. 1 Radiologic findings of metastatic leiomyosarcoma. (A) Computed tomography scan reveals 1 cm sized poorly enhancing space occupying lesion (arrow) in left thyroid. (B) Ultrasound shows marked hypoechoic nodule in the inferior pole of left thyroid.

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  Fig. 2 Cytologic features of metastatic leiomyosarcoma. (A) Hypercellular spindle cell clusters are arranged in a fascicular pattern. (B) The cells show indistinct cell borders, eosinophilic cytoplasm, and hyperchromatic, large, elongated nuclei with blunt ends. (C, D) Normal follicular cells are admixed with pleomorphic tumor cells (C) or discovered around tumor cell clusters (D).

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  Fig. 3 Histologic features of the scalp mass. (A) Excisional biopsy specimen from the scalp mass shows bundles or fascicles of smooth muscle fibers. The tumor cells are highly pleomorphic and have a centrally located, blunted, cigar-shaped nucleus adjacent to perinuclear cytoplasmic vacuoles. (B, C) Smooth muscle actin (B) and desmin (C) immunostaining shows positivity. (D) c-Kit immunostaining shows negativity.

Reference

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