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Primary Malignant Teratoma with a Primitive Neuroectodermal Tumor Component in Thyroid Gland : A Case Report

Kim E, Bae TS, Kwon Y, Kim TH, Chung KW, Kim SW, Ro J, Lee ES - J. Korean Med. Sci. (2007)

Bottom Line: However, the adult cases reported are mostly malignant and commonly arise in the thyroid.Pathologic examination revealed it to be malignant teratoma composed of primitive neuroepithelial tissue with primitive neural tubes and loose myxoid to fibrous immature mesenchymal stroma.At 22-months of follow-up, the patient has remained euthyroid and showed no evidence of recurrence.

Affiliation: Research Institute and Hospital, National Cancer Center, 809 Madu-1-dong, Ilsan-gu, Goyang, Korea.

ABSTRACT

Teratomas comprise the most common extragonadal germ cell tumors in childhood. Most teratomas involving the thyroid are benign and occur in children. However, the adult cases reported are mostly malignant and commonly arise in the thyroid. We report a case of a 31-yr-old female with a huge neck mass. Pathologic examination revealed it to be malignant teratoma composed of primitive neuroepithelial tissue with primitive neural tubes and loose myxoid to fibrous immature mesenchymal stroma. The patient underwent extensive evaluation of the thyroid gland with computed tomography (CT) scan and positron emission tomography (PET) scan, which revealed no evidence of metastatic disease. She underwent total thyroidectomy with bilateral modified radical neck dissection, intensive chemotherapy and radiotherapy. At 22-months of follow-up, the patient has remained euthyroid and showed no evidence of recurrence. This is the first case, to our knowledge, of malignant thyroid teratoma with a exuberant primitive neuroectodermal tumor component in Korea.

Microscopic findings of malignant teratoma. The tumor is mainly composed of primitive neuroepithelial cells and neural tubules (H&E stain, ×100).
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Figure 3: Microscopic findings of malignant teratoma. The tumor is mainly composed of primitive neuroepithelial cells and neural tubules (H&E stain, ×100).

Mentions: On gross examination, the mass was occupying most of the right lobe of thyroid gland with a ill-defined border, measuring 7.5×5.0×4.7 cm. The cut surface was grayish white, hemorrhagic, and necrotic with focal cystic changes. Many lymph nodes were grossly involved by the tumor (Fig. 2). The microscopic examination showed that the tumor was mainly composed of primitive neuroepithelial tissue with primitive neural tubes and loose myxoid to fibrous immature mesenchymal stroma (Fig. 3). The normal thyroid follicles were intermingled or adjacent to the tumor. The tumor cells were pleomorphic and partly necrotic with hyperchromatism and frequent mitotic figures (4-6/10 high power fields). A multitude of small cystic spaces was lined by mature squamous or glandular epithelium. Islands of mature cartilage were noted within the primitive neuroepithelial tissue (Fig. 4). Metastases were present in 25 of total 58 lymph nodes, where metastatic components were only composed of a primitive neuroepithelial component. The tumor cells were positive for synaptophysin, focally positive for cytokeratin, neurofilament, desmin, and CD99 on immunohistochemical staining. The primitive neuroepithelial component comprised more than 4 in low power magnification fields (×4 objective with a ×10 ocular, using bvx.), which thus was categorized as malignant teratoma according to the Thompson et al.'s criteria (3).

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Primary Malignant Teratoma with a Primitive Neuroectodermal Tumor Component in Thyroid Gland : A Case Report

Kim E, Bae TS, Kwon Y, Kim TH, Chung KW, Kim SW, Ro J, Lee ES - J. Korean Med. Sci. (2007)

Microscopic findings of malignant teratoma. The tumor is mainly composed of primitive neuroepithelial cells and neural tubules (H&E stain, ×100).
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Figure 3: Microscopic findings of malignant teratoma. The tumor is mainly composed of primitive neuroepithelial cells and neural tubules (H&E stain, ×100).
Mentions: On gross examination, the mass was occupying most of the right lobe of thyroid gland with a ill-defined border, measuring 7.5×5.0×4.7 cm. The cut surface was grayish white, hemorrhagic, and necrotic with focal cystic changes. Many lymph nodes were grossly involved by the tumor (Fig. 2). The microscopic examination showed that the tumor was mainly composed of primitive neuroepithelial tissue with primitive neural tubes and loose myxoid to fibrous immature mesenchymal stroma (Fig. 3). The normal thyroid follicles were intermingled or adjacent to the tumor. The tumor cells were pleomorphic and partly necrotic with hyperchromatism and frequent mitotic figures (4-6/10 high power fields). A multitude of small cystic spaces was lined by mature squamous or glandular epithelium. Islands of mature cartilage were noted within the primitive neuroepithelial tissue (Fig. 4). Metastases were present in 25 of total 58 lymph nodes, where metastatic components were only composed of a primitive neuroepithelial component. The tumor cells were positive for synaptophysin, focally positive for cytokeratin, neurofilament, desmin, and CD99 on immunohistochemical staining. The primitive neuroepithelial component comprised more than 4 in low power magnification fields (×4 objective with a ×10 ocular, using bvx.), which thus was categorized as malignant teratoma according to the Thompson et al.'s criteria (3).

Bottom Line: However, the adult cases reported are mostly malignant and commonly arise in the thyroid.Pathologic examination revealed it to be malignant teratoma composed of primitive neuroepithelial tissue with primitive neural tubes and loose myxoid to fibrous immature mesenchymal stroma.At 22-months of follow-up, the patient has remained euthyroid and showed no evidence of recurrence.

Affiliation: Research Institute and Hospital, National Cancer Center, 809 Madu-1-dong, Ilsan-gu, Goyang, Korea.

ABSTRACT

Background: Teratomas comprise the most common extragonadal germ cell tumors in childhood. Most teratomas involving the thyroid are benign and occur in children. However, the adult cases reported are mostly malignant and commonly arise in the thyroid. We report a case of a 31-yr-old female with a huge neck mass. Pathologic examination revealed it to be malignant teratoma composed of primitive neuroepithelial tissue with primitive neural tubes and loose myxoid to fibrous immature mesenchymal stroma. The patient underwent extensive evaluation of the thyroid gland with computed tomography (CT) scan and positron emission tomography (PET) scan, which revealed no evidence of metastatic disease. She underwent total thyroidectomy with bilateral modified radical neck dissection, intensive chemotherapy and radiotherapy. At 22-months of follow-up, the patient has remained euthyroid and showed no evidence of recurrence. This is the first case, to our knowledge, of malignant thyroid teratoma with a exuberant primitive neuroectodermal tumor component in Korea.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2693658&rFormat=json&query=null&req=5