Key result
Cervical vein mass extending to the RA treated as thrombus proves to be thyroid leiomyosarcoma.
Why the study?
Primary thyroid leiomyosarcoma is a very rare tumour with fewer than 40 cases reported, and extension to the right atrium has not been previously documented.
Case Report (n=1)
Primary thyroid leiomyosarcoma can present with transvenous extension to the right atrium, mimicking an extensive venous thrombus.
Apparent venous thrombi extending to the right atrium may represent rare malignancies; this case extends the differential for intracardiac masses.
Background: Primary thyroid leiomyosarcoma (LMS) is a very rare tumour with less than 40 published cases yet. Direct metastatic extension into the great cervical veins and caval veins is extremely uncommon. Extension to the right heart has not yet been reported. Case summary: A 62-year-old man was admitted for sudden onset of left neck pain and dyspnoea. Computed tomography and ultrasonography found an extensive mass of the left great cervical veins, superior vena cava, and a nodule in the left thyroid lobe. Transesophageal echocardiography visualized large protrusion of this mass into the right atrium. Cytology of a thyroid nodule diagnosed a benign hyperplastic nodule. The mass was considered to be likely an extensive thrombus. The patient was started on anticoagulant therapy. The next course was complicated by pulmonary embolism and later by enterorrhagia. Despite clinical stabilization, the patient died suddenly. Autopsy finding differed from the clinical conclusion. Microscopic investigation revealed that the mass seen in the cervical veins down to the right atrium was a spindle cell tumour with a primary site in the left thyroid lobe. Immunohistochemistry was consistent with the final diagnosis of primary thyroid LMS. Discussion: Differential diagnosis of the masses of great cervical veins and right atrium can be challenging. Pure venous thrombus and tumour thrombus must be distinguished. Thyroid LMS should also be considered in patients with masses in the right atrium and thyroid nodules.
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Dúbrava et al. (2022) conducted a case report in Primary thyroid leiomyosarcoma with transvenous extension to the right atrium (n=1). Anticoagulant therapy was evaluated on Clinical course and final diagnosis. A 62-year-old man with a mass in the cervical veins extending to the right atrium, initially treated as a thrombus, was diagnosed post-mortem with primary thyroid leiomyosarcoma.
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