Category: Thyroid

Monitor: 18

18 - A RARE CASE OF LEIOMYOSARCOMA METASTASIS TO THE THYROID

Friday, Apr 26
11:00 AM – 11:30 AM

Objective : This is the case of a 47-year-old, nonsmoker female with history of myomatous uterus and anemia secondary to abnormal uterine bleeding; on which the preoperative workup revealed bilateral lung nodules and a 2.4 cm mass at the left thyroid lobe. Patient denied family history of thyroid or pelvic malignancies, radiation exposure, constitutional symptoms as well as neck obstructive symptoms such as shortness of breath, dysphagia, hoarseness, pain or masses. An ultrasound guided fine needle aspiration biopsy was performed and the diagnosis of anaplastic thyroid carcinoma was reported based mainly on cytologic parameters. A lung biopsy was also performed and revealed a different tumor consistent with a leiomyosarcoma, with the characteristic immmunohistochemical staining pattern (Desmin +, SMA +, Cytokeratin- and SMA +) of sarcomatous differentiation. Supporting the possibility of a metastatic sarcoma to the thyroid instead of a primary anaplastic carcinoma with sarcomatous features, the total hysterectomy confirmed the uterine corpus as primary site.


Methods : N/A


Results : N/A


Discussion : Mesenchymal tumors of the thyroid are extremely rare.  Uterine leiomyosarcoma is an aggressive tumor that has the propensity for distant metastasis.  The most common sites of distant spread include the lung, liver, brain and bone.  The thyroid gland is a known but unusual site for metastasis from soft tissue sarcoma.   Ten cases of metastatic leiomyosarcoma to the thyroid have been described in the literature and five are from primary uterine leiomyosarcomas.  Leiomyosarcomas of the thyroid gland whether of primary or metastatic origin should be distinguished from anaplastic carcinoma.  Some authors believed that thyroid sarcomas are anaplastic carcinomas with sarcomatous features. Cytologic evaluation alone can be ineffective for differentiating a leiomyosarcoma from an anaplastic carcinoma and we want to emphasize the utility of immunihistochemical testing in these cases. In terms of treatment prognosis, and therapeutic interventions, these tumors are lethal. Especially when thyroid metastasis occurs, the long-term survival has been reported to be dismal.


Conclusion : We wanted to review the differential diagnosis of sarcomatous tumor in thyroid and discuss the best approach to diagnose this tumor specially during the fine needle aspiration procedure triage evaluation for ancillary studies.

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Gabriel I. Irizarry Villafañe

Endocrinology Fellow
San Juan City Hospital
San Juan, Puerto Rico

I am currently a first year endocrinology fellow. Worked as chief resident of internal medicine at San Juan City Hospital last year. Board Certified in Internal Medicine and graduated from Internal Medicine Residency at Hospital Universitario Ramon Ruiz Arnau

Rafael Trinidad-Hernandez

Endocrinology Services
Pavia Hospital Santurce
Carolina, Not Applicable, Puerto Rico

Education
January 2013 Endocrinology Fellowship
to December 2014 San Juan City Hospital

July 2011 to Geriatric Fellowship
June 2012 University of Puerto Rico Medical Sciences, Department of Medicine

July 2007 to Internal Medicine
June 2010 Damas Hospital/ Ponce School of Medicine Consortium; Ponce, Puerto Rico

August 2005 Fifth Pathway Program
to June 2006 New York Medical College, Valhalla, New York

July 1999 to Medical School
June 2004 Universidad Xochicalco; Baja California, México

August 1995 to Pre- Medicine
June 1999 Universidad de Puerto Rico, Carolina, Puerto Rico

Miosotis Garcia

Faculty Member
Endocrinology Department , Hospital Municipal de San Juan
San Juan, Not Applicable, Puerto Rico

Certified by the American Academy of Pathology since May 2012, Dr. García studied medicine at the Central University of the Caribbean School of Medicine between 1999 and 2004. She began her residency in Pathology on January 1, 2004 and culminated on June 30 June 2008.

Dr. García worked as a research assistant in the Department of Biochemistry at the Central University of the Caribbean School of Medicine from 2000 to 2001. From 2006 and until 2007, she worked as an assistant pathologist at Domenech Pathology and Associates. From 2008 to 2010 she worked as Assistant Professor of the Department of Pathology of the Ponce School of Medicine, and works as the pathologist of the tissue Bank , National Cancer Foundation Grant U56. She became a part of the HRPLabs medical faculty in 2010. She directed the Cytology department and work as faculty member of the endocrinology department in the San Juan District Hospital.

She is now head of the Research and Development Division and is also part of the Fine Needle Aspiration medical faculty.

Michelle Mangual- Garcia

Program Director
San Juan City Hospital
SAN JUAN

Program Director at San Juan City Hospital

Guillermo Villarmarzo

Laboratory Director HRP Labs.
HRP Labs.
San Juan, Not Applicable, Puerto Rico

Certified by the American Academy of Pathology since October 1984, Dr. Villarmarzo studied medicine at the University of Santiago de Compostela in Coruña, Spain. He completed his Pathology internship at the University of Puerto Rico School of Medicine from October 1, 1974 to September 30, 1975, continuing his residency in pathology at the same institution from October 1, 1975 to June 30. He participated on a special rotation in cytology at Louisville General Hospital in Kentucky under the supervision of Dr. William Christopherson in September, 1977.

He worked as an Instructor of Pathology at the School of Medicine of the University of Puerto Rico in 1977, and served as an assistant professor at the same institution from 1980 to 1986 when he was promoted as Associate Professor for the years 1986 to 1995. In In 1995, he served as Professor of Pathology until 2001.

During these years he was the Medical Director of the Department of Pathology of the Administration of Medical Services of Puerto Rico (ASEM) and Director of the School of Cytotechnology. He created the “Fine Needle Aspiration” (FNA) program in the Pathology Department of the University of Puerto Rico School of Medicine along with the University Hospital and the Municipal Hospital of San Juan and directs the Tumor Boards Of the University Hospital of Adults.

In 1989 he joined Dr. Rafael Ramírez Weiser as a partner in his private practice creating Hato Rey Pathology Associates. In 2001 he began his duties as Director of Laboratory. In December 2007 he became the owner of Hato Rey Pathology Associates, Inc. which has pathology offices and/or laboratories at Hospital del Maestro, HIMA San Pablo Caguas Hospital, Ashford Presbyterian Community Hospital and Damas Hospital in Ponce.

Maria I. Cardona

Internal Medicine Specialist
Solo practice
San Juan, Not Applicable, Puerto Rico

I am a graduate from University of Puerto Rico on 1981 with a concentration on Biology with honors. Posteriorly I follow doctors Degree in medicine at the University of Puerto Rico from which I graduate in 1986. On june of 1986 I started my intership and residency in Internal medicine at the Veterans Administration Medical Center at San Juan, Puerto Rico from which I graduate in 1989.

I start working at Hanscom Air Force Base Clinic in Massachussets from 1990-1992 as primary physician. Also I worked part-time at Somerville Rehabilitation Hospital in Massachussets in Interal Medicine as admitting physician in 1992. On 1993 I moved back to Puerto Rico and started working on private practice as an internal medicine specialist in Santurce, Puerto Rico. In addition I started working as an assistant proffesor in internal medicine at Bayamón Regional Hospital in Bayamón, Puerto Rico. I worked directly with internal medicine residence, students and family medicine residence. I worked there for a space of two years. After which I focused on growing my internal medicine practice admitting patients at the Hospital Pavia Santurce and posteriorly at San Jorge Childrens Hospital, working with plastic and reconstructive surgery service.

On 1991 I was board certify by the American Board of Internal Medicine and recently re-certified on April 2016. As an internal medicine physician I focus on primary care, preventive medicine, and deal with more complicated patients like diabetic, asthma, hypertension and cardiovascular disorders.

Gabriel I. Irizarry Villafañe

Endocrinology Fellow
San Juan City Hospital
San Juan, Puerto Rico

I am currently a first year endocrinology fellow. Worked as chief resident of internal medicine at San Juan City Hospital last year. Board Certified in Internal Medicine and graduated from Internal Medicine Residency at Hospital Universitario Ramon Ruiz Arnau