Thyroid Angiosarcoma Complicated by Neck Hematoma

Abstract Background: Primary angiosarcoma of the thyroid is a rare, aggressive malignancy most typically found in Alpine regions Europe. We present case non-Alpine complicated by recurrent surgical bed hematoma. Case: An 81-year-old Albanian man presented with two months dyspnea and hemoptysis was to have large mass, multiple subcentimeter pulmonary nodules, left pleural effusion seen on CTA chest. He had suppressed TSH < 0.008 uIU/mL (n 0.400-4.200 uIU/mL) presentation normal free T4 (1.36 ng/dL; n 0.80-1.50 ng/dL) total T3 (107 87-178 ng/dL). Labs from 3 years prior were consistent subclinical hyperthyroidism: 0.28 uIU/mL, 1.35 ng/dL, 3.98 pg/mL 2-4.4 pg/mL). A ultrasound performed showed bilateral largest which 6.0 x 7.8 5.4 cm right lower pole. no compressive symptoms clinically euthyroid. FNA nodule non-diagnostic cytology fluid negative for malignancy. underwent bronchoscopy blood clots without endobronchial lesions, VATS biopsy, hemithyroidectomy. Pathology high grade epithelioid arranged solid, variably discohesive nests sheets, associated vague vasoformative features hemorrhage. Immunostains diffusely strongly positive ERG as well CD31 AE1/3, but PAX-8, TTF-1, thyroglobulin, supporting diagnosis angiosarcoma. The remainder tissue non-neoplastic multinodular hyperplasia. After initial discharge, he re-presented post-op day 10 bleeding site. CT neck extensive hematoma (10.3 5.0 8.7 cm) taken back OR evacuation. Residual tumor along R carotid artery determined be culprit. Over next month patient remained admitted supportive transfusions, palliative radiation nodules residual initiated. His hospitalization proximal extremity DVT, treated an IVC filter. Repeat chest imaging at six weeks new progressive nodules. Upon completion RT discharged debilitated, fatigued, using supplemental oxygen. family elected pursue hospice care. Conclusion: This represents extrathyroidal extension resulting severe morbidity precluding further systemic interventions. These highly vascular tumors likely elevated risk postoperative clinicians should recognize.