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Review
. 2021 Apr 28;14(4):e236399.
doi: 10.1136/bcr-2020-236399.

Primary thyroid leiomyosarcoma: a diagnostic and therapeutic challenge

Mohammed Talha Bashir  1 , Tom Bradish  2 , Usman Rasul  1 , Muhammad Shakeel  3
Affiliations
Review

Primary thyroid leiomyosarcoma: a diagnostic and therapeutic challenge

Mohammed Talha Bashir et al. BMJ Case Rep. .

Abstract

Leiomyosarcoma is a malignant mesenchymal tumour of smooth muscle origin. It is extremely rare as a primary thyroid cancer with only 33 cases previously described in the literature. We present the case of a 69-year-old Caucasian man who presented with a 5-month history of left cervical lymphadenopathy and a suspicious mass in the left thyroid lobe on ultrasound scan. Left hemithyroidectomy confirmed the diagnosis of leiomyosarcoma. A review of current understanding and approaches to management of this rare condition are discussed.

Keywords: ear; nose and throat/otolaryngology; pathology; thyroid disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Ultrasound scan of the neck showing normal right thyroid lobe (A); suspicious nodule in the left thyroid lobe with microcalcifications (B, C); abnormal looking lymph nodes in the submandibular region ((D, E) and in the left upper neck (F).
Figure 2
Figure 2
Fine needle aspiration cytology of the thyroid nodule showed some atypical spindle cells—Thy3a.
Figure 3
Figure 3
(A) The left recurrent laryngeal nerve going through the tumour. (B) The left thyroid lobe is involved by a relatively well-circumscribed malignant spindle cell lesion—32 mm in maximum dimension.
Figure 4
Figure 4
Morphological and immunohistochemical diagnosis: high-grade pleomorphic sarcoma in keeping with leiomyosarcoma. Spindle cells are arranged in whorls and fascicles and have high-grade nuclear features. Numerous mitotic figures are identified. Confluent necrosis is also evident.
Figure 5
Figure 5
Chest X-ray sowing multiple pulmonary nodules (cannon ball appearance) worse affecting the right lower lobe.
See this image and copyright information in PMC

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