Boudin Laurys, Fakhry Nicolas, Chetaille Bruno, Perrot Delphine, Nguyen Anh Tuan, Daidj Nassima, Guiramand Jérôme, Sarran Anthony, Moureau-Zabotto Laurence, Bertucci François
Department of Medical Oncology, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France ; Department of Medical Oncology, Marseille, France.
Department of Otorhinolaryngology - Head and Neck Surgery, la Timone Universitary Hospital, Marseille, France.
Case Rep Oncol. 2014 Jan 11;7(1):6-13. doi: 10.1159/000357913. eCollection 2014 Jan.
Synovial sarcoma (SVS) of the thyroid gland is exceedingly rare. We report the case of a 55-year-old man with a rapidly growing 7-cm neck mass. Because of suspicion of anaplastic thyroid carcinoma, a total thyroidectomy was planned, without preoperative cytology. During surgery, the tumor ruptured, leading to fragmented and incomplete resection. The morphological and immunohistochemical aspects suggested thyroid SVS, which was confirmed by fluorescent in situ hybridization (SYT gene rearrangement). The patient experienced immediate local relapse in close contact with large vessels and the thyroid cartilage and was referred to our institution. Doxorubicin-ifosfamide chemotherapy led to a minor response that authorized secondary conservative surgery. Because of microscopically incomplete resection, adjuvant radiotherapy was chosen and is ongoing 10 months after initial surgery. The prognosis of thyroid SVS is associated with a high risk for local and metastatic relapses. Pretreatment diagnosis is fundamental and may benefit from molecular analysis. Margin-free monobloc surgical excision is the best chance for cure, but adjuvant chemotherapy and radiotherapy deserve to be discussed.
甲状腺滑膜肉瘤（SVS）极为罕见。我们报告一例55岁男性患者，其颈部有一个迅速增大的7厘米肿物。由于怀疑为间变性甲状腺癌，计划行全甲状腺切除术，未进行术前细胞学检查。手术过程中，肿瘤破裂，导致切除破碎且不完整。形态学和免疫组化结果提示为甲状腺SVS，荧光原位杂交（SYT基因重排）证实了这一诊断。患者在与大血管和甲状腺软骨紧密接触处立即出现局部复发，并转诊至我院。多柔比星-异环磷酰胺化疗仅产生轻微反应，因此进行了二次保守手术。由于显微镜下切除不完全，选择了辅助放疗，目前在初次手术后10个月仍在进行。甲状腺SVS的预后与局部和转移性复发的高风险相关。术前诊断至关重要，分子分析可能有助于诊断。无瘤整块手术切除是治愈的最佳机会，但辅助化疗和放疗也值得探讨。
