Diagnostic Controversies in Vascular Proliferations of the Thyroid Gland |
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Authors: | Mauro Papotti Marisa Arrondini Veronica Tavaglione Andrea Veltri Marco Volante |
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Institution: | (1) Department of Pathology, University of Turin at San Luigi Hospital, Orbassano, Turin, Italy;(2) Department of Radiology, University of Turin at San Luigi Hospital, Orbassano, Turin, Italy;(3) Department of Clinical and Biological Sciences at San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy |
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Abstract: | Vascular lesions are one of the most controversial issues in thyroid pathology. The differential diagnosis includes benign
lesions on one side, i.e., endothelial reactive hyperplasia (Masson’s “hemangioma”) in goiter and hemangioma, and malignant
tumors on the other, i.e., angiosarcomas and undifferentiated (angio)sarcomatoid carcinomas. Benign reactive endothelial hyperplasia
with atypias mimicking malignant tumors may occur in long-standing nodular goiter, as a result of spontaneous hemorrhage followed
by granulation tissue and fibrous organization. Alternatively, it may follow a fine-needle aspiration biopsy (FNAB) procedure.
Angiosarcoma is a rare primary malignant thyroid tumor, mainly observed in endemic goiter areas displaying morphologic and
phenotypical similar to those typical of angiosarcomas in other locations (including focal cytokeratin expression). The distinction
between angiosarcoma and (angio)sarcomatoid anaplastic carcinoma is difficult and the true existence of angiosarcoma has been
challenged. Other extremely rare vascular lesions or mimics in the thyroid include benign hemangioma and pseudo-angiosarcomatous
variant of medullary carcinoma. The differential diagnosis between benign and malignant vascular conditions in FNAB material
is extremely challenging, and the cytopathology report should be remarkably cautious, especially in poorly cellular and highly
hemorrhagic cases: atypias in endothelial cells are not per se indicative of malignancy, being a common feature of reactive
endothelial hyperplasia in infracted goiter nodules as well. |
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Keywords: | thyroid angiosarcoma reactive endothelial hyperplasia ultrasonography anaplastic carcinoma |
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