Zembala-Nożyńska Ewa, Lange Dariusz
Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Poland.
Contemp Oncol (Pozn). 2013;17(1):97-9. doi: 10.5114/wo.2013.33783. Epub 2013 Mar 15.
A rare localization of primary osteosarcoma is presented. A woman aged 76 years was operated on for rapid growth of thyroid right lobe tumour. Histopathology showed anaplastic cancer with numerous foci of osseous metaplasia, negative with thyroglobulin, calcitonin, synaptophysin and chromogranin. A high proliferative activity of the tumour was observed (MIB-1 reaction) in the form of a positive reaction in approx. 40% of the tumour cell nuclei. The tumour stage was evaluated as pT4aNxMx according to the TNM scale. The reconsultation revealed negative staining with cytokeratin, and positive with vimentin, thereby confirming the mesenchymal origin of the tumour, with the final diagnosis being primary thyroid osteosarcoma. Taking into consideration the histopathological diagnosis, the extremely low radiation sensitivity of the tumour, the patient's age, the radical surgical treatment and persisting respiratory failure, radiotherapy was rejected in favour of further follow-up. The patient remains under oncological and endocrinological care.
本文报告了一例原发性骨肉瘤的罕见定位病例。一名76岁女性因甲状腺右叶肿瘤快速生长接受手术。组织病理学显示为间变性癌,伴有大量骨化生灶,甲状腺球蛋白、降钙素、突触素和嗜铬粒蛋白均为阴性。观察到肿瘤具有较高的增殖活性(MIB-1反应),约40%的肿瘤细胞核呈阳性反应。根据TNM分期系统,肿瘤分期评估为pT4aNxMx。再次会诊显示细胞角蛋白染色阴性,波形蛋白染色阳性,从而证实肿瘤起源于间充质,最终诊断为原发性甲状腺骨肉瘤。考虑到组织病理学诊断、肿瘤极低的放射敏感性、患者年龄、根治性手术治疗以及持续的呼吸衰竭,拒绝放疗,选择进一步随访。患者仍在接受肿瘤学和内分泌学护理。