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LETTER TO THE EDITOR
Year : 2014  |  Volume : 51  |  Issue : 4  |  Page : 548-549
 

Liposarcoma of thyroid gland: A review of the gained experience


Departments of Otolaryngology and Head Neck surgery, Maulana Azad Medical College and LokNayak Hospital, New Delhi, India

Date of Web Publication1-Feb-2016

Correspondence Address:
Dr. Virad Kumar
Departments of Otolaryngology and Head Neck surgery, Maulana Azad Medical College and LokNayak Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175296

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How to cite this article:
Kumar V, Raj A, Rathore PK. Liposarcoma of thyroid gland: A review of the gained experience. Indian J Cancer 2014;51:548-9

How to cite this URL:
Kumar V, Raj A, Rathore PK. Liposarcoma of thyroid gland: A review of the gained experience. Indian J Cancer [serial online] 2014 [cited 2019 Aug 21];51:548-9. Available from: http://www.indianjcancer.com/text.asp?2014/51/4/548/175296


Sir,

Malignancy of the thyroid gland is uncommon, contributing to 1% of all malignancies.[1] Only 1% of these thyroid malignancies are sarcomas. Primary liposarcoma of thyroid is exceedingly rare. We found only six cases [Table 1] in the English literature,[1–5] of which one was not even primary and rather radiation induced.[3] A 72 year old female presented with progressive neck swelling for one year. There was no pain, dysphagia or respiratory difficulty. The swelling was non-tender, firm, with well defined margins [Figure 1]. Fine needle cytology revealed a high grade thyroid malignancy of mesenchymal origin. During the surgical removal, it was not possible to excise the whole gland as the tumor was encasing the right common carotid artery and the pre-vertebral soft tissues. Thus, a wide resection was done. The histopathology revealed a cellular stroma containing spindle shaped cells with prominent nucleoli and focal pleomorphism. There were intermingled immature lipoblasts, tumour giant cells with occasional histiocytes[Figure 2]. Immuno-histochemistry showed vimentin positivity, while being negative cytokeratin, thyroglobulin and calcitonin. A diagnosis of liposarcoma of the thyroid was made. After the neck wound healed the patient was immediately subjected to external beam radiotherapy. The second case was a 65 year old female who presented with respiratory distress, following a neck swelling for last two years. Of note, both the cases had no history of previous neck irradiation or surgery. There were signs of inflammation, with engorged neck veins over the swelling [Figure 3]. Tracheostomy was done as mediastinal enlargement was ruled out. The contrast CT of neck showed a hypodense mass inside the right lobe of the thyroid which was pushing the trachea to the left [Figure 4]. Fine needle aspiration showed a high grade malignancy of thyroid. The patient then underwent a total thyroidectomy. Tumour specimen showed a cellular spindle cell tumor with a background of immature lipoblasts. The tumor cells were positive for vimentin and desmin. Post operatively, external radiotherapy was administered. Both cases were aymptomatic and under regular follow up for more than two years.
Table 1: Review of clinical presentations

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Figure 1: The first patient showing the thyroid mass, involving both the lobes with predominant affection of the left side

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Figure 2: A histological section of the resected tumor showing large vacuolated lipoblasts. The surrounding stroma shows spindle cells with eosinophilic cytoplasm and promoinent nucleoli, suggestive of liposarcoma (×250)

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Figure 3: The second patient showing the large, inflamed and tender thyroid enlargement predominantly of the right side. The patient had stridor and underwent emergency tracheostomy

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Figure 4: Contrast enhanced CT scan (axial section) of the neck, showing the heterogenoushypodense lesion of the right lobe of thyroid gland. The trachea is pushed to the left sideswelling

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Surgical extirpation of the tumor should be the mainstay of treatment for thyroid liposarcomas. Radiotherapy should be recommended in all cases after surgery for maximum survival benefit, as evident in some earlier reports also, where simultaneous postoperative radiotherapy was administered.[3],[5]

In conclusion, thyroid sarcomas are clinically difficult to distinguish from undifferentiated carcinomas and the diagnosis largely rests on the post operativehistopathological confirmation. More such cases are needed to evaluate the role of chemotherapy and thus define the single best treatment protocol. Although for this, the disease is very rare and thus we recommend that a wide surgical resection possible, followed by early high dose radiotherapy can offer chances of best possible outcome, in the present scenario.

 
  References Top

1.
MitraA, FisherC, Rhys-EvansP, HarmerC. Liposarcoma of the thyroid. Sarcoma 2004;8:91-6.  Back to cited text no. 1
    
2.
NielsenVT, KnudsenN, HolmIE. Liposarcoma of the thyroid gland. Tumori 1986;72:499-502.  Back to cited text no. 2
    
3.
GriemKL, RobbPK, CaldarelliDD, TempletonAC. Radiation induced sarcoma of the thyroid. Arch Otolaryngol Head Neck Surg 1989;115:991-3.  Back to cited text no. 3
    
4.
AndrionA, GaglioA, DoglianiA, BoscoE, MazzuccoG. Liposarcoma of the thyroid gland. Fine-needle aspiration cytology, immunohistology, and ultrastructure. Am J ClinPathol 1991;95:675-9.  Back to cited text no. 4
    
5.
KilicM, KeskekM, AlbayrakL, ErtanT, GocmenE, KocM. Liposarcoma of the thyroid gland: A case report. ActaChirBelg 2007;107:73-4.  Back to cited text no. 5
    


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