Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy.
J Endocrinol Invest. 2022 May;45(5):1059-1063. doi: 10.1007/s40618-021-01722-1. Epub 2022 Jan 5.
Thyroid dysfunctions associated with SARS-CoV-2 are emerging in scientific literature. During the second COVID-19 epidemic spread, we evaluated a patient with the suspect of subacute thyroiditis.
Specimen from fine-needle aspiration of a hypoechoic undefined area was analyzed for cytology and for SARS-CoV-2 detection. SARS-CoV-2 was retrieved by real-time polymerase chain reaction on the cytologic sample, which was then cultured on Vero E6 cells and demonstrated to be cytopathic. Whole-genome sequence was deposited. Histological exam diagnosed a rare case of primary thyroid sarcoma with diffuse and strong expression of mouse double minute 2 homolog (MDM2) oncoprotein. Ultrastructural examination confirmed, in several neoplastic cells, the presence of viral particles in cytoplasmic vacuoles.
In our hypothesis, SARS-CoV-2 and sarcoma coexistence could represent a synergistic interplay, ultimately favoring both viral persistence and tumor proliferation: the overexpression of MDM2 in tumor cells might have generated a favorable immunological niche for SARS-CoV-2 localization and, in turn, SARS-CoV-2 could have favored tumor growth by inducing MDM2-mediated p53 downregulation. Functional studies are needed to confirm this suggestive pathway.
与 SARS-CoV-2 相关的甲状腺功能障碍在科学文献中不断涌现。在第二次 COVID-19 疫情蔓延期间，我们评估了一位疑似亚急性甲状腺炎的患者。
对低回声不明区域的细针抽吸标本进行细胞学分析和 SARS-CoV-2 检测。通过对细胞学样本进行实时聚合酶链反应，成功检测到了 SARS-CoV-2，然后将其在 Vero E6 细胞上培养，并显示出细胞病变效应。全基因组序列已提交。组织学检查诊断为罕见的原发性甲状腺肉瘤，其鼠双微体 2 同源物（MDM2）癌蛋白弥漫且强烈表达。超微结构检查在多个肿瘤细胞中证实了细胞质空泡中存在病毒颗粒。
在我们的假设中，SARS-CoV-2 和肉瘤的共存可能代表一种协同作用，最终有利于病毒的持续存在和肿瘤的增殖：肿瘤细胞中 MDM2 的过表达可能为 SARS-CoV-2 的定位创造了有利的免疫生态位，反过来，SARS-CoV-2 可能通过诱导 MDM2 介导的 p53 下调促进肿瘤生长。需要进行功能研究来证实这一提示性途径。
