Thyroid & parathyroid
Other thyroid malignancies
Sarcoma
Author: Sheren Younes, M.D., Ph.D.
Last author update: 1 June 2015
Last staff update: 12 February 2021
Copyright: 2015-2024, PathologyOutlines.com, Inc.
PubMed Search: sarcoma thyroid
Related Topics: angiosarcoma
Table of Contents
Definition / general | Case reports | Clinical images | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Cytology images | Positive stains | Negative stains | Electron microscopy images | Molecular / cytogenetics images | Differential diagnosisCite this page: Younes S. Sarcoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/thyroidsarcoma.html. Accessed April 16th, 2024.
Definition / general
- Primary thyroid sarcomas are rare, usually reported only as case reports
- Chondrosarcoma: primary thyroid tumors are very rare
- Kaposi sarcoma: rare site for this tumor, even in HIV patients (0.9%, J Thyroid Res 2014;2014:364146)
- Leiomyosarcoma: malignant mesenchymal tumor of smooth muscle origin; very rare as primary thyroid tumor; has very aggressive clinical course
- Synovial sarcoma: distinctive soft tissue neoplasm, 5 - 10% of all soft tissue sarcomas, but very rare in thyroid (Goldblum: Enzinger and Weiss's Soft Tissue Tumors, 6th ed, 2013); presents as rapidly enlarging thyroid mass with normal thyroid function tests
- Undifferentiated pleomorphic sarcoma (MFH): extremely rare thyroid tumor with median survival of only 9 months (Eur J Surg Oncol 2009;35:649)
Case reports
- 15 year old boy with primary thyroid synovial sarcoma (J Korean Med Sci 2007;22:S154)
- 30 year old man with Kaposi sarcoma (Clin Nucl Med 1987;12:848)
- 30 year old woman with MFH metastasizing to thyroid (Acta Cytol 2008;52:729)
- 41 year old HIV+ woman with thyroid Kaposi sarcoma (Acta Cytol 2003;47:645)
- 41 year old patient with hypothyroidism due to Kaposi sarcoma of thyroid (Rev Infect Dis 1991;13:826)
- 45 year old HIV- Haitian woman with thyroid Kaposi sarcoma (Acta Cytol 2007;51:421)
- 49 year old woman and 71 year old man with thyryoid liposarcoma (Sarcoma 2004;8:91)
- 55 year old man with rapidly growing 7 cm neck mass - synovial sarcoma (Case Rep Oncol 2014;7:6)
- 56 year old woman with thyryoid liposarcoma (Am J Clin Pathol 1991;95:675)
- 59 year old woman with primary thyroid myxoid liposarcoma (J Clin Pathol 2009;62:1037)
- 60 year old man and 72 year old woman with primary thyroid synovial sarcoma (Acta Cytol 2003;47:495, Clin Exp Otorhinolaryngol 2011;4:204)
- 60 and 75 year old women with primary thyroid osteosarcoma (Diagn Cytopathol 2008;36:589, Contemp Oncol (Pozn) 2013;17:97)
- 64 and 65 year old women with thyroid leiomyosarcoma (Endocr Pathol 2013;24:136, Thyroid 2008;18:425)
- 65 year old man with thyroid leiomyosarcoma (Updates Surg 2014;66:165)
- 65 year old man with thyroid MFH mimicking Riedel thyroiditis (J Clin Pathol 2001;54:570)
- 67 and 70 year old women with primary thyroid MFH (Thyroid 2008;18:51)
- 68 year old man with primary myxoid chondrosarcoma (Arch Pathol Lab Med 1988;112:94)
- 72 year old woman and 77 year old man with thyroid leiomyosarcoma (Diagn Pathol 2013;8:36, Oncol Lett 2014;7:1011
- 83 year old woman with thyroid leiomyosarcoma (Ann Diagn Pathol 2008;12:50)
- Metastasis of uterine leiomyosarcoma to thyroid gland (Thyroid 2007;17:1295)
- Mesenchymal chondrosarcoma of thyroid (APMIS 2004;112:384)
- Thyroid liposarcoma mimicking retrosternal goiter (Ann Thorac Surg 2003;75:566)
Clinical images
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Leiomyosarcoma: nodule with heterogeneous uptake
Gross description
- Chondrosarcoma: well defined, greyish white, with cartilaginous consistency
- Leiomyosarcoma: solid, unencapsulated tumor with hemorrhage and necrosis
- Synovial sarcoma: encapsulated mass with lobulated cut surface, grayish tan solid mass with rubbery consistency (J Korean Med Sci 2007;22:S154)
Gross images
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Synovial sarcoma:
well demarcated
lobulated, tan
solid mass
Microscopic (histologic) description
- Chondrosarcoma: lobular appearance with pleomorphic chondrocytes and infiltration of surrounding thyroid tissue; variable calcification
- Leiomyosarcoma: spindled cells in fascicular pattern, infiltrating normal thyroid tissue; cells are pleomorphic with abundant eosinophilic fibrillary cytoplasm and irregular intracytoplasmic vacuoles; commonly hemorrhage, necrosis, mitotic figures, atypical mitoses
- Liposarcoma: invasive tumor composed of spindle to pleomorphic cells, with variable pleomorphism; may have myxoid stroma with arborizing capillaries
- Osteosarcoma: spindled to epithelioid cells invading and destroying adjacent thyroid; pleomorphic with coarse chromatin and multinucleated cells with foci of lace-like osteoid
- Synovial sarcoma: biphasic growth pattern with admixture of spindled and epithelial cell components; spindle cell component has fascicles of atypical fibroblast-like cells; epithelial component has solid nests of plump epithelioid cells with well formed glandular structures; cells are pleomorphic and mitotically active
Microscopic (histologic) images
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Leiomyosarcoma:
Compactly cellular
Cigar shaped nuclei
Invades thyroid parenchyma
CK-
h-Caldesmon
Desmin
ER-
TTF1-
Chromogranin-, synaptophysin-
Liposarcoma
Synovial sarcoma: biphasic growth; cytokeratin & vimentin
UPS / MFH: residual thyroid follicles; intersecting bundles of atypical spindle cells
Cytology description
- Kaposi sarcoma: spindled and plasmacytoid cells
- Leiomyosarcoma: spindled and plump pleomorphic cells with acidophilic fibrillary cytoplasm in a necrotic / proteinaceous background
- Osteosarcoma: hypercellular smears of loosely cohesive cells; spindled to epithelioid cells with scant to moderate amphophilic-basophilic cytoplasm, with occasional small cytoplasmic vacuoles; cells may be multinucleated; nuclei are elongated ovals with coarse chromatin and prominent nucleoli; fibrillar, metachromatic extracellular matrix
- Synovial sarcoma: clusters of pleomorphic spindled and epithelioid cells
Cytology images
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Synovial sarcoma:
spindled and
epithelioid cells
Positive stains
Negative stains
- Leiomyosarcoma: Cytokeratin, EMA, TTF1; also CD31, Factor VIII, thyroglobuin
- Liposarcoma: cytokeratin
- Osteosarcoma: thyroglobulin, calcitonin, cytokeratin, TTF1; also synaptophysin, chromogranin, HMB45
- Synovial sarcoma: TTF1, thyroglobulin, synaptophysin, chromogranin, S100
Electron microscopy images
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Synovial sarcoma:
solid nests of
epithelial cells
Molecular / cytogenetics images
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Synovial sarcoma:
SYT-SSX fusion
gene transcript
Differential diagnosis
- Chondrosarcoma: anaplastic carcinoma with chondrosarcomatous component (Cesk Patol 2005;41:34)
- Follicular or papillary neoplasms with spindle cell metaplasia
- Medullary carcinoma
- Riedel thyroiditis
- SETTLE
