Department of Surgery, Korea University College of Medicine Guro Hospital, 97, Guro-dong gil, Guro-gu, Seoul, Republic of Korea.
Department of Pathology, Korea University College of Medicine Guro Hospital, 97, Guro-dong gil, Guro-gu, Seoul, Republic of Korea.
Ann Endocrinol (Paris). 2011 Sep;72(4):314-316. doi: 10.1016/j.ando.2011.06.001. Epub 2011 Jul 23.
Leiomyosarcoma metastatic to the thyroid is extremely rare. Especially, metastasis of pulmonary leiomyosarcoma to the thyroid is extremely rare-only one such case has been previously reported.
A 55-year-old woman presented with a chief complaint of a cough of 1.5 months duration. Chest radiography (PA view) and chest computed tomography revealed 1cm sized subpleural nodule in left apical lung and a 8.3×4cm sized, lobulated mass in anterior segment of left upper lobe of the lung. We decided on left upper lobectomy and excision by video-assisted thoracoscopic surgery (VATS). They were leiomyosarcomas. During follow-up chest computed tomography at 23 months after first surgery, we noticed that a nodule on the left lobe of the thyroid gland had increased in size over 3 months. The patient underwent total thyroidectomy and central lymph node dissection. Immunohistochemical staining showed that tumor cells were positive for smooth muscle actin, focal positive for desmin and positive for vimentin, but negative for CD34 and S-100 protein. C-kit staining showed focal, weak positivity. The Ki-67 proliferation index was around 30-40%.
Our case represents the first report of pulmonary leiomyosarcoma metastatic to the thyroid, although extrapulmonary leiomyosarcomas metastatic to the thyroid is encountered infrequently.
转移至甲状腺的平滑肌肉瘤极为罕见。特别是，肺平滑肌肉瘤转移至甲状腺的情况极其罕见——此前仅报告过一例。
一名 55 岁女性因咳嗽 1.5 个月就诊。胸部 X 线摄影（PA 视图）和胸部计算机断层扫描显示左肺尖部 1cm 大小的胸膜下结节和左肺上叶前段 8.3×4cm 大小的分叶状肿块。我们决定行左肺上叶切除术和电视辅助胸腔镜手术（VATS）切除。这些肿瘤为平滑肌肉瘤。第一次手术后 23 个月随访胸部计算机断层扫描时，我们注意到左甲状腺叶的一个结节在 3 个月内增大。患者接受了全甲状腺切除术和中央淋巴结清扫术。免疫组织化学染色显示肿瘤细胞平滑肌肌动蛋白阳性，结蛋白局灶阳性，波形蛋白阳性，但 CD34 和 S-100 蛋白阴性。C-kit 染色显示局灶弱阳性。Ki-67 增殖指数约为 30-40%。
尽管肺外平滑肌肉瘤转移至甲状腺并不常见，但我们的病例代表了首例肺平滑肌肉瘤转移至甲状腺的报告。
