Vijaya Ganta, MD*; Gail Nunlee- Bland, MD; Robert L. Copeland Jr., Ph.D

Division of Endocrinology, Diabetes and Metabolism; Howard University Hospital, Washington, United States of America

*Corresponding Author: Vijaya Ganta MD, Division of Endocrinology, Diabetes and Metabolism; Howard University Hospital, Washington, United States of America.

Received: August 21, 2021; Published: September 06, 2021

Citation: Vijaya Ganta MD., et al. “Angiosarcoma of the Thyroid Gland with Bilateral Malignant Pleural Effusion: A Case Report with Review of the Literature". Acta Scientific Microbiology 5.10 (2021): 27-30.

Abstract

Objective: Our objective is to report a case of angiosarcoma of the thyroid gland with bilateral malignant pleural effusion.

Case Report:  A 70-year-old African American woman with a medical history significant for Grave’s disease status post radioactive iodine ablation, and postablative hypothyroidism for 39 years, presented with progressive hoarseness of voice and dysphagia for one year. Physical exam revealed diffuse enlargement of the thyroid, no thyroid bruit or cervical lymphadenopathy. Thyroid function tests TSH, FT3, and FT4 are normal and the thyroid peroxidase antibody was negative. The ultrasound of thyroid reported as a large thyroid gland with diffuse heterogeneity of the parenchyma with no clear-cut margins. The CT scan of the neck and chest with contrast reported as 7.5 x 5.1 cm thyroid mass with ill-defined margins surrounding the trachea, moderate bilateral pleural effusion, pulmonary vascular congestion, bibasilar atelectasis, and/or infiltrates.

The fine needle aspiration of the thyroid under ultrasound guidance reported as angiosarcoma. Immunomarkers were positive for CD34 and CD31, and PAX-8, P53, and thyroglobulin reported as negative. Ultrasound guided pleural fluid aspiration analysis reported as angiosarcoma. Our Patient had total thyroidectomy with wide local excision. Pathology findings reported as high grade epithelioid angiosarcoma of the thyroid with tumor extension at surgical margins. The tumor cells showed strong CD31 immunopositivity, confirming the diagnosis of angiosarcoma. TTF-1 immunostain highlights an entrapped thyroid follicle within the tumor. Our patient was started on radiation therapy 4 weeks after surgery followed by chemotherapy-Taxol. Unfortunately, our patient passed away within 4 months of diagnosis.

Discussion:  Angiosarcoma of the thyroid gland is mainly diagnosed by characteristic immunohistochemical features supported by immunopositivity for vascular endothelial markers such as CD31, CD34, factor VIII-related antigen, and immunonegativity for epithelial markers such as endothelial membrane antigen, pancytokeratin, and thyroglobulin. It has a relatively poor prognosis because it typically metastasizes to local lymph nodes and the lungs, and in later stages to the bone marrow. Treatment is wide local surgical excision. Radiation therapy may be effective in some patients and can be completed using chemotherapy.

Conclusion: Thyroid angiosarcoma can be highly aggressive with a poor prognosis.

Keywords: COVID-19; Sars-Cov-2; Herpes Zoster, Herpes Zoster Ophthalmicus, Covid-19 Vaccines

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Copyright: © 2021 Vijaya Ganta MD., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.