A 24 yr
old male presented with a painless slow growing neck swelling on the
left side. FNAC revealed follicular cells arranged in a papillary
fashion. Ultrasound neck showed a multinodular goitre with calcified
areas. Surgery planned on the patient was total thyroidectomy. However,
histopathology of the excised specimen revealed soft tissue malignancy
with normal thyroid tissue.
Case Report
A 24 yr old male presented to the surgical out patient department
with a painless, slow growing swelling on the left side of the anterior
part of the neck since 1 yr. This 9x7 cm swelling showed minimal movement
on deglutition and was hard in consistency. An FNAC revealed the presence
of follicular cells with atypia arranged in a papillary fashion, which
was suggestive of a papillary carcinoma of the thyroid. Ultrasound
of the neck revealed a multinodular goitre with calcified areas.
The patient was subjected to surgery. The intraoperative findings
were a large mass arising from the posterolateral aspect of the left
lobe of the thyroid gland. The carotid sheath was adherent to the
mass posteriorly. On further dissection the internal jugular vein
and the carotid arteries were found to be kinked but free from the
mass. The thyroid appeared normal with no palpable nodules but as
the tumour was attached to the left lobe of thyroid gland and FNAC
had revealed papillary carcinoma, excision of the tumour with total
thyroidectomy was performed. The patient had an uneventful postoperative
recovery. The patient was started on Thyroxine replacement therapy.
The histopathology report of the specimen reveald a partly encapsulated
lowgrade malignant mesenchymoma (lipo-leiomyo-angiosarcoma) with normal
thyroid tissue. There was no evidence of local recurrence on follow
up after 6 months.
|
|
Fig.
1 : Broad interlacing fascicles of neoplastic smooth
muscle cells (leiomyosarcoma). |
|
| |
Fig.
2 : Moderate nuclear hyperchromatism and size variation
in liposarcoma. |
Discussion
Malignant mesenchymoma is an interesting but very rare tumour.1
First described by Stout in 1948, it is defined as a sarcoma composed
of two or more unrelated differentiated malignant forms apart from
fibrosacomatous elements. It is usually found in the retroperitoneum
or thigh. Other sites include upper and lower extremities, anterior
and posterior aspects of the trunk, mediastinum, head and neck, kidney,
spermatic cord, small intestine, peritoneum and mesentery.2
These tumours occur at all ages. The age of onset
ranges from 1.5 years to 76 years with a median age of 46 years and
the male to female ratio was 13 : 9.2 It is generally regarded as
a high grade sarcoma. Most tumours are circumscribed, none are encapsulated.
Hence recurrence following excisions are common.3 Small tumors, 5
cm or less in diameter, have a much better prognosis than do the larger
tumours.3
Because of the possibility of local recurrence, radical excision without
spillage is of utmost importance.2 Radiotheapy and doxorubicin
containing chemotherapy regimens have been tried with no proven benefit.2
Thus, the possibility of a soft tissue tumour should be kept in mind
while evaluating and treating anterior neck masses.
References
1. Choi JE, Chung HJ, Yoo WJ, et al. Retroperitoneal malignant mesenchymoma
: A case of mesenchymal mixed tumour, leiomyosarcoma, liposarcoma
and fibrosarcoma. Korean J Radiology 2002; 3 (4) : 264-66.
2. Liou Chang - Hsien, Juan Chun - Jung, Wu Ching - Juin, et al. Imaging
results of retroperitoneal malignant mesenchymoma : A case report.
Chirur J Radiology 2000; 25 : 209-13.
3. Nash A, Stout AP. Malignant mesenchymoma in children. Cancer 1961;
14 : 524-33.
WHO
SMOKES IN INDIA?
Consumption of tobacco is more common among poorer people in
India, but there are differences between regions, religions,
and castes. Analysing data on more than 300,000 adults from
the 1998-9 national family health survey, Subramanian and colleagues
found that older men, married people, and poorly educated people
were more likely to consume tobacco by smoking, chewing or both.
Muslims and Hindus were more likely to smoke than Christians,
and a greater proportion of the population in the north east
than in the southern and western states consumed tobacco, independent
of economic status.
Differences in tobacco consumption may increase the imbalance
of adult health in future, conclude the authors.
BMJ, 2004; 328 : 801. |
*Lecturer; **Associate
Professor; ***Senior Resident; ****Professor and Head, Department
of General Surgery, LTMMC and LTMG Hospital, Sion, Mumbai 400 022.
|
