Case report: a grievous tale of a rare primary thyroid leiomyosarcoma

Abstract

Background Primary thyroid leiomysosarcoma is a rare and aggressive disease which represents 0.014% of primary thyroid cancers. It confers a diagnostic conundrum, due to difficulty to make a preoperative diagnosis of thyroid leiomyosarcoma and to differentiate it from anaplastic thyroid carcinoma. Case presentation We herein report a rare case of primary thyroid leiomyosarcoma. A 48-year-old male presented with history of anterior neck swelling for the past 2 months. Computed tomography (CT) neck showed hypodense nodule at the right thyroid lobe with calcification causing tracheal deviation, with intratracheal extension at 1st and 2nd tracheal rings and presence of lung metastases. The histopathology analysis yield high grade spindle cell neoplasm suggestive of sarcoma. Immunohistochemistry showed that neoplastic spindle cells were positive for smooth muscle actin, vimentin, caldesmon while no reactivity was reported for thyroglobulin, calcitonin, thyroid transcription factor-1, S-100, CD45, CD 5, and cytokeratins. Patient had undergone tracheostomy and chemotherapy but he succumbed to death 1 month after completion of chemotherapy. Conclusion Primary thyroid leiomyoarcoma is a very rare and aggressive disease. The treatment ranging from surgery, adjuvant radiotherapy and chemotherapy, with high recurrence rates.