Primary malignant glomus tumors of the thyroid gland: A case report

Figures & data

Figure 1. Time course of computed tomography (CT). (a–c) Eight months prior to discovery of the mass, only coarse calcified lesions were detected in the right lobe of the thyroid (arrowheads), with no evidence of metastasis to the lungs or throughout the body. (d) and (e) Neck and chest CT before treatment indicating ∼4-cm hypoechoic mass in the right lobe of the thyroid gland, suggesting infiltration into the trachea and cervical esophagus and multiple nodules in lungs (arrowheads). (f) Positron emission tomography-CT before treatment demonstrating approximate accumulation in the right lobe of the thyroid and lung nodules, with no uptake detected in other organs. Although partial accumulation was noted in the small intestine, it was considered a false positive, as no lesions were identified on CT images. (g) and (h) Enlargement of tumor and infiltration into the trachea after treatment with doxorubicin. Slight shrinkage of pulmonary nodules (arrowheads) was observed. (i) and(j) Further progression of tumor and pulmonary nodules after treatment with pazopanib (arrowheads).

Figure 2. Pathology images. (a) Accumulation of atypical cells with enlarged nuclei, increased amounts of chromatin, and distinct nucleoli with poor binding on aspiration cytology (Papanicolaou staining). (b) Round to polygonal atypical cells with round nuclei and eosinophilic cytoplasm growing in sheet form around vessel (low magnification, hematoxylin & eosin staining). (c) The arrows in the image indicate increased mitotic activity (high magnification, hematoxylin & eosin staining). (d) Tumor cells immunohistochemically positive for smooth muscle actin. (e) Basement membranous material demonstrated by periodic acid-Schiff reaction. (f) Thyroid lesion (largest), forming 8.0 × 5.6 × 3.6-cm mass (yellow arrowheads) in contact with trachea (red arrowheads). (g) White mass which formed (yellow arrowheads) and infiltrated the trachea (red arrowheads).

Table 1. Immunohistochemistry results.

Vimentin	Positive	Calretinin	Negative
SMA	Positive	Chromogranin A	Negative
Desmin	Negative	CD99	Negative
TLE1	Positive	S100	Negative
Calponin	Negative	Synaptophysin	Negative
Caldesmon	Negative	MelanA	Negative
AE1/AE3	Negative	HMB45	Negative
EMA	Negative	CD138	Negative
TTF-1	Negative	CD10	Negative
CEA	Negative	CD31	Negative
CD56	Negative	CD34	Negative

SMA: smooth muscle actin; TLE1: transducing-like enhancer of split 1; AE1/AE3: cytokeratins; EMA: epithelial membrane antigen; TTF-1: thyroid ­transcription factor -1; CEA: carcinoembryonic antigen; HMB45: human melanin black 45

Table 2. Case report of primary malignant glomus tumor of the thyroid gland.

	Age	Sex	Metastases	Treatment	Cause of death	Survival period
Chung et al. [8]	55 years	Male	No	Total thyroidectomy, Adriamycin, Cisplatin	Brain Metastasis	30 months
Liu et al. [9]	68 years	Male	Lung	Ifosfamide, Epirubicin, Cisplatin	Multiple organ Failure	6 months
Present case	80 years	Male	Lung	Doxorubicin, Pazopanib	Lung Metastasis	3 months

Metastases in the table indicate the presence or absence of multiple organ metastases at the time of primary tumor discovery.

Chung DH, Kim NR, Kim T, et al. Malignant glomus tumor of the thyroid gland where is heretofore an unreported organ: a case report and literature review. Endocr Pathol. 2015;26(1):37–44. doi: 10.1007/s12022-014-9352-5.

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Liu Y, Wu R, Yu T, et al. Malignant glomus tumor of the thyroid grand: a case report. J Int Med Res. 2019;47(6):2723–2727. doi: 10.1177/0300060519844872.

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