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Submitted: 05 July 2018 Modified: 06 July 2018
HERDIN Record #: R07-VSMMC-18070510275392

A rare case of recurrent fibrosarcoma of the thyroid gland in a 63-year old female patient.

Jose Roberto  Q. Orlanda

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Fibrosarcoma is a rare malignant tumor of mesenchymal cell originaccounting for 1% to 3% of all human sarcomas. It is derived from fibrous connective tissue, composed of malignant fibroblasts in a collagen background. The natural course of the disease is highly unpredictable with some authors reporting slow-growing tumors, while others develop a rapid course.

In this case, a 63-year old female patient presented with an anterior neck mass for 30 years for which patient underwent right lobectomy with isthmusectomy. Biopsy of the right thyroid lobe revealed an Adult Thyroid Teratoma. A recurrent right anterior neck mass 11 months post-operatively was noted. Imaging studies were non-specific. CT scan revealed a lobulated mass at the right thyroid bed with no tracheal or vascular involvement. Modified Radical Neck Dissection Type II, Excision of Recurrent Anterior Neck Mass and Completion Thyroidectomy was successfully performed. Histopathological examination revealed Recurrent Fibrosarcoma, Grade 1 with a  Nodular Colloid Goiter on the left thyroid gland. Post-operative course was unremarkable and patient was discharged improved on the 4th hospital day. Patient was offered adjuvant radiotherapy but did not initially comply. On the 5th month post-op, a recurrence was noted on the right supraclavicular area. It was until then that the patient  underwent radiotherapy.

Cytologic findings sometimes reveal inconclusive results and can fail to provide the correct diagnosis. Thus, histopathologic diagnosis from a tumor tissue sample is necessary. Surgical operation with adequate margins remains the mainstay of treatment and post-operative radiotherapy is applied with inadequate surgical resection. More vigilance is necessary in the diagnosis of anterior neck masses since cases like this can only be definitively identified histologically.

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