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  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 3  |  Page : 349-350
 

Spindle cell hemangioma of thyroid


Department of Pathology, Surat Municipal Institute of Medical Education and Research Surat, Gujarat, India

Date of Web Publication18-Feb-2016

Correspondence Address:
B J Sapariya
Department of Pathology, Surat Municipal Institute of Medical Education and Research Surat, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.176716

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How to cite this article:
Sapariya B J, Udhreja P R. Spindle cell hemangioma of thyroid. Indian J Cancer 2015;52:349-50

How to cite this URL:
Sapariya B J, Udhreja P R. Spindle cell hemangioma of thyroid. Indian J Cancer [serial online] 2015 [cited 2019 Sep 20];52:349-50. Available from: http://www.indianjcancer.com/text.asp?2015/52/3/349/176716


Sir,

Spindle cell hemangioma (SCH) (hemangioendothelioma, SCH) lesions are uncommon, affect a wide age range in both sexes, and usually located at skin and subcutaneous tissue of the extremities. In recent years it has been suggested that SCH is probably a vascular malformation or results from abnormalities of local blood flow. SCH in thyroid is very uncommon. One such interesting case of SCH of thyroid, which was treated by hemithyroidectomy and histopathological diagnosis confirmed by immunohistochemistry is presented.

A 30 years-old female patient presented with history of swelling in front of neck for three years duration. The swelling moved with deglutition. The thyroid hormone profile was normal. The patient was non-reactive to HIV.

Ultrasound examination showed approximately 4.3 × 2.8 cm 2 sized, well defined cystic lesion in right lobe of thyroid. The remaining thyroid gland was normal.

Fine needle aspiration showed few benign thyroid follicular cells against extensive hemorrhagic background. Right hemithyroidectomy was performed.

On gross examination, a soft to firm, well circumscribed, dark brown nodule measuring 4 × 2.5 × 2 cm 3 embedded in normal appearing thyroid gland was identified. [Figure 1]a Microscopic findings showed an encapsulated nodule. The tumor was consisting of innumerable small and medium sized vascular channels separated by plump spindly stroma lined by many bland plump nucleated cells without pleomorphism or mitotic Figures. There were also cystically dilated colloid filled and few small thyroid acini mixed with tumor. [Figure 1]b Immunohistochemistry showed thyroid follicles with thyroglobuline positivity [Figure 2]a, endothelial cells with strong positivity for CD 34 and factor-VIII associated antigen. [Figure 2]b, c] and spindle cells were positive for vimentin and negative for thyroglobuline, CD 34 and Factor-VIII associated antigen [Figure 2]a, [Figure 2]b, [Figure 2]c.
Figure 1: Spindle cell hemangioma of thyroid (a) Gross findings, thick arrow shows brown black nodule and thin arrow shows normal thyroid gland, (b) Microscopic findings (H and E, ×40)

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Figure 2: Immunohistochemistry ×40: (a) Thyroglobulin positive in thyroid follicular cells, (b) factor VIII associated antigen positive in vascular endothelial cells and (c) CD34 positive in vascular endothelial cells

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In 1986 “Spindle cell hemangioendothelioma”[1] was first describe by Weiss and Enzinger. SCH occurs at all ages (8-78 years; median, 32 years; mean, 34 years). Males and females were equally affected.[2] This lesion is usually located in the dermis or subcutaneous tissue of the distal extremities (particularly the hands). It can also occur in the proximal extremities, trunk, axilla, ear, vulva, penis, spleen, and pancreas.

Histologically, the lesions consist of alternating areas of dilated, thin walled cavernous vascular spaces and solid areas composed predominantly of spindle cells and clusters of epithelioid endothelial cells with intracytoplasmic vacuoles.[3] Immunohistochemistry reveals that the cells lining the cavernous spaces and the epithelioid cells in the solid area stain positively for endothelial markers CD31 and factor-VIII associated antigen. The spindle cells are immunonegative for endothelial marker CD34. Most of these spindle cells stain positively for vimentin. SCH exhibits the ultrastructural features of reactive vascular proliferation rather than of angiosarcoma.[4],[5]

The main differential diagnosis is with Kaposi's sarcoma in which cavernous spaces and epithelioid vacuolated cells are not present. Unlike SCH the spindle cells in Kaposi's sarcoma stain positively for CD34.

There is no evidence that SCH have the ability to metastasize either distally or regionally. There have been considerable debates as to whether these lesions are reactive or neoplatic.

 
  References Top

1.
Weiss SW, Enzinger FM. Spindle cell hemangioendothelioma: A low grade Angiosarcoma resembling a cavernous Hemangioma and Kaposi's sarcoma. Am J Surg Pathol 1986;10:521-30.  Back to cited text no. 1
    
2.
Perkins P, Weiss SW. Spindle cell hemangioendothelioma. An analysis of 78 cases with reassessment of its pathogenesis and biologic behavior. Am J Surg Pathol 1996;20:1196-204.  Back to cited text no. 2
    
3.
Fukunaga M, Ushigome S, Nikaido T, Ishikawa E, Nakamori K. Spindle cell hemangioendothelioma: An immunohistochemical and flow cytometric study of six cases. Pathol Int 1995;45: 589-95.  Back to cited text no. 3
    
4.
Imayama S, Murakamai Y, Hashimoto H, Hori Y. Spindle cell hemangioendothelioma exhibits the ultrastructural features of reactive vascular proliferation rather than of angiosarcoma. Am J Clin Pathol 1992;97:279-87.  Back to cited text no. 4
    
5.
Ding J, Hashimoto H, Imayama S, Tsuneyoshi M, Enjoji M. Spindle cell haemangioendothelioma: Probably a benign vascular lesion not a low-grade angiosarcoma. A clinicopathological, ultrastructural and immunohistochemical study. Virchows Arch A Pathol Anat Histopathol 1992;420:77-85.  Back to cited text no. 5
    


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