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Histiocytic sarcoma localised in the thyroid - A case report

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LETTER TO THE EDITOR Histiocytic sarcoma localised in the thyroid—a case report Filip Y. F. L. De Vos & Martin N. Gerding & Jan W. Arends & Jurgen J. Wegman Received: 5 November 2007 /Accepted: 26 February 2008 /Published online: 3 April 2008 # The Author(s) 2008 Dear Editor, “Histiocytic sarcoma” is a rare haematological neoplasm with immunohistochemical and morphological diagnostic criteria per exclusionem. In this case report, our patient illustrates that this rare tumour with its unique location and diagnostic morphologic criteria is sensitive to a combina- tion of anthracycline-based chemotherapy and radiotherapy, resulting in complete response for 2 years. A 64-year-old Caucasian woman presented with an asymptomatic, gradually enlarging neck mass at the Outpatient Department of Internal Medicine. Laboratory results showed subclinical hypothyroidism. Thyroid scin- tigraphy revealed a cold nodule in the left lower thyroid lobe. Results of aspiration cytology were compatible with an infected cyst. Based on the presence of a goitre, subclinical hypothyroidism and auto-antithyroid peroxidase antibodies >600 kU/L, a diagnosis of Hashimoto’s thyroid- itis was suspected and treated with levothyroxin. Five months later she developed neck pain. Pre-operative tru-cut biopsy showed a cell-rich tumour proliferation, possibly histiocytic. Further histological biopsies by open surgery incision showed diffuse proliferation of cells made up of large, bizarre, lobulated, vesicular nuclei with one or more conspicuous nucleoli and ample eosinophilic cytoplasm. Between these cells scattered plasma cells and occasional lymphocytes were seen. No thyroid tissue was present. Immunohistochemical staining revealed strong cytoplasmic expression for CD68 (clones KP-1 and PGM-1) (Fig. 1), lysozym and α1-antitrypsin, whereas lymphoid and mye- loid markers (CD43, myeloperoxidase) were all negative as well as keratins, thyreoglobulin, calcitonin and S100. Melan-A, thyrosinase and HMB45 (melanocytic markers)

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