Primary thyroid rhabdomyosarcoma in an adult: A challenging case with histomolecular diagnosis and literature review

INTRODUCTION AND IMPORTANCE: Primary thyroid sarcomas are very rare tumours, accounting for less than 1 % of all thyroid malignancies. We present the fifth case in the literature of primary thyroid rhabdomyosarcoma and the third in adults with, for the first time, an extensive molecular analysis. CASE PRESENTATION: A 61-year-old woman presented with a rapidly progressive neck mass with extensive local invasion of the tumour. CLINICAL DISCUSSION: Histologically, the neoplasm was composed of sheets of pleomorphic or spindle-shaped cells with eosinophilic cytoplasm and few large and very pleomorphic cells admixed with the spindle cell proliferation, without any thyroid epithelial component. Immunohistochemically, the tumour cells were positive for muscular markers and negative for epithelial and thyroid differentiation markers. Molecular tests revealed the presence of NF1, PTEN and TERT pathogenic mutations. Classifying undifferentiated neoplasm with muscular differentiation into the thyroid is challenging as many more common differential diagnoses could be favoured including anaplastic thyroid carcinoma with rhabdoid phenotype, leiomyosarcoma, and other rare sarcomas. CONCLUSION: Primary thyroid rhabdomyosarcoma is extremely rare and can be diagnostically challenging. We emphasize the histological, immunohistochemical and molecular criteria in order to make an accurate diagnosis.