Abstract
The authors report a case of a thyroid hematoma containing an exuberant endothelial cell proliferation. No underlying vascular neoplasm was apparent and the hematoma occurred in a substernal goiter from a 90-yr-old male. Review of the literature revealed four similar previously reported cases of endothelial cell proliferation found in thyroid hematomas for a total of five cases. A fine needle aspiration or biopsy procedure antedated the definitive surgery in four patients and may be responsible for the formation of the hematoma in these cases. Areas of the endothelial proliferation resembled papillary endothelial hyperplasia (Masson’s hemangioma) in four cases and cavernous hemangioma in three. However, these lesions occurred outside of vascular lumina and instead were intimately associated with fibrinous material of the hematoma. In addition, two cases contained foci of endothelial cells with nuclear atypia or intracytoplasmic lumens requiring distinction from angiosarcoma. These vigorous endothelial proliferations most likely represent alterations in the organization of a thyroid hematoma, a process similar to papillary endothelial hyperplasia, which is usually intravascular. Primary vascular neoplasms of the thyroid are exceedingly rare. Nevertheless, awareness of exuberant endothelial cell proliferation as a potential, albeit rare, manifestation of a thyroid hematoma should prompt careful attention to distinguish this reactive process from vascular neoplasms such as hemangioma or angiosarcoma.
Similar content being viewed by others
References
Armstrong WB, Funk GF, Rice DH. Acute airway compromise secondary to traumatic thyroid hemorrhage. Arch Otolaryngol Head Neck Surg 120:427–430, 1994.
Axiotis CA, Merino MJ, Ain K, Norton JA. Papillary endothelial hyperplasia in the thyroid following fine-needle aspiration. Arch Pathol Lab Med 115:240–242, 1991.
Chen K. Extravascular papillary endothelial hyperplasia. J Surg Oncol 36:52–54, 1987.
Tsang K, Duggan MA. Vascular proliferation of the thyroid. A complication of fine needle aspiration. Arch Pathol Lab Med 116:1040–1042, 1992.
LiVolsi VA, Merino MJ. Worrisome histologic alterations following fine-needle aspiration of thyroid. Lab Invest 62:59A, 1990.
Masson P. Hémangioendotheliome végetant intra-vasculaire. Bull Soc Anat (Paris) 93:517–523, 1923.
Henschen F. L’endovasculite proliférante thrombopoiétique dans la lésion vasculaire locale. Ann Anat Pathol 9:113–121, 1932.
Enzinger FM, Weiss S. Reactive vascular proliferations mimicking angiosarcoma. In: Enzinger FM, Weiss S, eds. Soft tissue tumors. 2nd ed. St. Louis, MO: Mosby, 1988; 522–532.
Hashimoto H, Daimaru Y, Enjoji M. Intravascular papillary endothelial hyperplasia. A clinicopathologic study of 91 cases. Am J Dermatopathol 5(6):539–545, 1983.
Egloff B. The hemangioendothelioma of the thyroid. Virchows Arch A Pathol Anat 400:119–142, 1983.
Eusebi V, Carcangui ML, Dina R, Rosai J. Keratin-positive epithelioid angiosarcoma of the thyroid. A report of four cases. Am J Surg Pathol 14:737–747, 1990.
Rosai J, Carcangui ML, DeLellis RA. Sarcomas. In: Rosai J, Carcangui ML, DeLellis RA, eds. Atlas of tumor pathology. Tumors of the thyroid gland. 3rd series. Washington, DC: Armed Forces Institute of Pathology, 1992; 259–265.
Pickleman JR, Lee JF, Strauss HF, Paloyan E. Thyroid hemangioma. Am J Surg 129:331–333, 1975.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Aulicino, M.R., Kaneko, M. & Unger, P.D. Excessive endothelial cell proliferation occurring in an organizing thyroid hematoma: Report of a case and review of the literature. Endocr Pathol 6, 153–158 (1995). https://doi.org/10.1007/BF02739878
Issue Date:
DOI: https://doi.org/10.1007/BF02739878