Thompson L D, Wenig B M, Adair C F, Shmookler B M, Heffess C S
Department of Endocrine and Otorhinolaryngic-Head & Neck Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Cancer. 1997 Feb 1;79(3):579-87. doi: 10.1002/(sici)1097-0142(19970201)79:3<579::aid-cncr22>3.0.co;2-#.
Primary smooth muscle tumors of the thyroid gland are rare. To date, there are few cases reported of primary thyroid leiomyomas and leiomyosarcomas.
One leiomyoma and four leiomyosarcomas arising within the thyroid gland were identified in the files of the Endocrine Tumor Registry of the Armed Forces Institute of Pathology. Histologic and immunohistochemical features were reviewed and follow-up obtained.
The patients included 2 females, ages 56 and 64 years, and 3 males, ages 45, 68, and 83 years. The patients presented with a mass in the thyroid gland that had increased in size over a number of months. All the tumors originated within a single lobe of the thyroid gland and measured from 1.1 to 9 cm in greatest dimension. Histologically, there was a fascicular pattern of growth comprised of spindle-shaped cells with blunt-ended nuclei. The leiomyoma was encapsulated, cytologically bland, and amitotic; the leiomyosarcomas were invasive with increased cellularity, pleomorphism, a high mitotic rate, necrosis, and hemorrhage. Immunohistochemical staining showed reactivity with vimentin, smooth muscle actin, muscle specific actin, and desmin. The patient with the leiomyoma was alive without evidence of disease 11 years after the initial presentation, with surgical resection as the only treatment. Three of the patients with leiomyosarcomas were dead within 2 years of diagnosis, in spite of aggressive therapeutic intervention. The remaining patient was still alive 10 months after initial presentation with multiple lung metastases.
Smooth muscle tumors of the thyroid gland are distinctive tumors. Leiomyosarcomas can be distinguished from anaplastic carcinoma, although patient outcome is uniformly unfavorable.
甲状腺原发性平滑肌肿瘤较为罕见。迄今为止，原发性甲状腺平滑肌瘤和平滑肌肉瘤的报道病例较少。
在武装部队病理研究所内分泌肿瘤登记处的档案中，识别出1例甲状腺平滑肌瘤和4例甲状腺平滑肌肉瘤。回顾了组织学和免疫组化特征并进行了随访。
患者包括2名女性，年龄分别为56岁和64岁，以及3名男性，年龄分别为45岁、68岁和83岁。患者表现为甲状腺肿物，数月内大小增大。所有肿瘤均起源于甲状腺的单个叶，最大直径为1.1至9厘米。组织学上，呈束状生长模式，由核钝圆的梭形细胞组成。平滑肌瘤有包膜，细胞学表现温和，无核分裂；平滑肌肉瘤具有侵袭性，细胞增多、多形性、高核分裂率、坏死和出血。免疫组化染色显示与波形蛋白、平滑肌肌动蛋白、肌肉特异性肌动蛋白和结蛋白反应。平滑肌瘤患者在初次就诊11年后存活，无疾病证据，仅接受了手术切除治疗。3例平滑肌肉瘤患者在诊断后2年内死亡，尽管进行了积极的治疗干预。其余患者在初次就诊10个月后仍存活，有多处肺转移。
甲状腺平滑肌瘤是独特的肿瘤。平滑肌肉瘤可与未分化癌相鉴别，尽管患者的预后普遍不佳。
