Extramedullary leukemia, also known as myeloid sarcoma, is a rare form of acute myeloid leukemia and often accompanies bone marrow involvement. Myeloid infiltration of the thyroid gland is extremely rare. Here, a unique case in which thyroid cancer tissue was infiltrated with myeloid cells is presented. We present a case of thyroid papillary cancer infiltrated by blastic cells and bilateral breast and axillary myeloid sarcoma in a 30-year-old Caucasian female patient with a history of osteosarcoma and MDS-RAEB2. The patient firstly received 6 cycles of chemotherapy for osteosarcoma, and allogeneic hematopoietic stem cell transplantation was performed after anthracycline-based chemotherapy due to MDS-RAEB2. The patient remained in remission on follow-up in terms of both osteosarcoma and MDS-RAEB2. Malignant features (Bethesda VI) were observed in the fine needle aspiration biopsy performed from a newly developed firm, fixed thyroid nodule approximately 4–5 cm in length in the left thyroid lobe. Because of the Bethesda VI thyroid nodule, the patient underwent total thyroidectomy. In the pathological evaluation, CD34-, CD117-, MPO-, and HLA-DR-positive blastic cells which infiltrated into follicular variant papillary thyroid carcinoma were detected. In the evaluation performed due to blastic cell infiltration, multiple lesions showing increased 18-fluorodeoxyglucose activity in bilateral breast and axillae were detected. Myeloid sarcoma was found as a result of tru-cut biopsy from these lesions. A fungal cystic lesion was detected in the frontal region of the patient who developed altered consciousness after the second cycle of treatment of myeloid sarcoma. During her follow-up in the intensive care unit, she died of cranial septic embolism and acute infarction. Here, we present a very interesting case that is the first. A staged approach to diagnosis with methods including immunohistochemical staining, radiological imaging methods, and cytogenetic and molecular analyses can help make the definitive diagnosis.

中文翻译：

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髓性白血病细胞甲状腺乳头状癌组织浸润一例报告


髓外白血病，也称为髓系肉瘤，是一种罕见的急性髓系白血病，通常伴有骨髓受累。甲状腺髓样浸润极为罕见。这里介绍了一个独特的病例，其中甲状腺癌组织被骨髓细胞浸润。我们介绍了一名 30 岁白人女性患者，患有母细胞浸润的甲状腺乳头状癌和双侧乳房和腋窝髓样肉瘤，有骨肉瘤和 MDS-RAEB2 病史。患者先因骨肉瘤接受6个周期化疗，因MDS-RAEB2以蒽环类化疗后行异基因造血干细胞移植。在随访中，该患者的骨肉瘤和 MDS-RAEB2 仍处于缓解状态。在对左甲状腺叶中一个新形成的、大约 4-5 厘米长的坚固、固定的甲状腺结节进行细针抽吸活检时，观察到恶性特征 (Bethesda VI)。由于贝塞斯达六号甲状腺结节，患者接受了甲状腺全切除术。病理学评估中，检测到滤泡变异型甲状腺乳头状癌浸润的CD34、CD117、MPO和HLA-DR阳性母细胞。在由于母细胞浸润而进行的评估中，检测到双侧乳房和腋窝中显示 18-氟脱氧葡萄糖活性增加的多个病变。对这些病变进行真切活检后发现骨髓肉瘤。在患者的额叶区域检测到真菌囊性病变，该患者在第二个髓系肉瘤治疗周期后出现意识改变。在重症监护室随访期间，她死于颅内脓毒症栓塞和急性梗塞。 在这里，我们提出一个非常有趣的案例，这是第一个案例。采用免疫组织化学染色、放射成像方法以及细胞遗传学和分子分析等方法进行分阶段诊断可以帮助做出明确的诊断。