Fine‐needle aspiration biopsy of primary osteosarcoma of the thyroid: Report of a case and review of the literature

Department of Pathology, Columbia University Medical Center, New York, New York 10032, USA.
Diagnostic Cytopathology (Impact Factor: 1.12). 08/2008; 36(8):589-94. DOI: 10.1002/dc.20840
Source: PubMed


Primary osteosarcoma of the thyroid is an extremely rare tumor, with only 27 well-documented cases reported in the literature, including only one in the cytology literature. We describe here an additional case with fine-needle aspiration biopsy findings. A 60-year-old woman presented with a 1-month history of progressive midline neck swelling. CT and ultrasound demonstrated a large thyroid mass with tracheal compression. Fine-needle aspiration biopsies were performed and showed pleomorphic spindle and epithelioid neoplastic cells, multinucleated giant cells, and scant metachromatic extracellular matrix material. Cell block sections contained minute tissue fragments with neoplastic spindle cells. Immunohistochemical stains showed the tumor cells to be positive for vimentin and negative for cytokeratins, TTF-1, calcitonin, synatophysin, chromogranin, and S-100 protein, suggesting a sarcoma; however, the differential diagnosis also included anaplastic thyroid carcinoma and medullary thyroid carcinoma. Tissue biopsy revealed a high-grade spindle cell neoplasm with osteoid production, consistent with osteosarcoma of the thyroid. The patient developed a large pulmonary embolus and superior vena cava syndrome and no further surgical intervention was performed. She died 5 weeks after the initial diagnosis. Upon retrospective review, the cytologic features resemble osteosarcoma in other areas. Although cytologic features on fine-needle aspiration biopsy may suggest a diagnosis of this rare entity, definitive diagnosis should be deferred to histologic examination.

16 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abnormalities of the thyroid gland are the most common lesions encountered in surgical pathology practice. They include both non-neoplastic and neoplastic disorders. Papillary thyroid carcinoma is the most common thyroid malignancy. While majority of thyroid tumors are sporadic, a small subset can also arise in a familial setting, which may be associated with abnormalities in other organs. Thyroid follicular lesions may sometimes pose diagnostic challenge in surgical pathology, and ancillary studies such as immunohistochemistry may be helpful in this differential diagnosis. The role of intraoperative frozen section evaluation is limited in the management of thyroid nodules especially follicular patterned lesions. These and other related topics in thyroid pathology are discussed in this chapter. KeywordsThyroid carcinoma-Thyroiditis-Follicular patterned lesion-Papillary carcinoma-Follicular carcinoma-Medullary carcinoma-Familial thyroid carcinoma-Poorly differentiated carcinoma-Anaplastic carcinoma
    No preview · Chapter · Jan 2010
  • [Show abstract] [Hide abstract]
    ABSTRACT: Thyroid tumors are one of the most common tumors of the endocrine system encountered in surgical pathology practice. They can arise from the follicular lining epithelial cells that produce the thyroid hormone or the C cells that secrete calcitonin. In this chapter we discuss non-C cell tumors of the thyroid. In this group of tumors papillary carcinoma is the most common malignancy and the conventional type of tumor can be easily diagnosed based on classical cytomorphologic features. However, variants of papillary carcinoma exist, the understanding of which is crucial for accurate diagnoses. The follicular patterned tumors may sometimes pose diagnostic challenge and approach to these thyroid lesions is suggested in this section along with ancillary studies that may help in the diagnosis of these tumors. Finally, thyroid cancer progression from differentiated carcinoma to poorly differentiated and anaplastic carcinoma is well known and is also presented along with clinical and pathological correlations. KeywordsThyroid carcinoma–Follicular adenoma–Follicular variant of papillary carcinoma–Follicular-patterned lesions–Follicular carcinoma–Papillary thyroid carcinoma–Insular carcinoma–Anaplastic carcinoma–Oncocytic carcinoma–Oncocytic adenoma–Hyalanizing trabecular tumor–Papillary thyroid carcinoma variants
    No preview · Chapter · Mar 2010
  • [Show abstract] [Hide abstract]
    ABSTRACT: The most common malignant tumor of the thyroid is papillary carcinoma. Sarcoma of the thyroid is encountered very rarely; its therapy is complex and poses significant problems due to the problematic location of the tumor. A 14-year-old female was diagnosed with undifferentiated sarcoma of the thyroid and received combined therapy comprising surgery, chemo- and radiotherapy without significant side effects. This case underlines the fact that undifferentiated thyroid sarcoma may be a diagnostic possibility in children with malignant masses of the neck and may be successfully treated with modern therapeutic strategies.
    No preview · Article · Jul 2010 · Pediatric Blood & Cancer
Show more