Carcinoma showing thymic-like elements—a rare malignancy of the thyroid gland

Roka, R.; Kornek, Gabriela; Schüller, J.; Ortmann, Elisabeth; Feichtinger, J.; Armbruster, Christine

doi:10.1002/bjs.4510

Cited by 79 publications

(67 citation statements)

References 8 publications

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“…Besides thyroid, CASTLE also occurs in the left parapharyngeal space, 5 carotid and posterior space, 7 and subcutaneous tissue of head and neck. 8 This tumor occurs in middle-aged individuals with a mean age of 50 years and has a slight female predominance (female to male ratio, 1.3:1), 6,9 In our study, the mean age at initial diagnosis was 51 years, and the female to male ratio was 1:1.7. Because the number of cases was small, there seems to be no significant sexual predominance in our study.…”

Section: Discussionmentioning

confidence: 44%

“…6,20 Some of the literature has reported that postoperative radiation could prevent locoregional recurrence. 1,5,9,21 In our study, 7 of 8 patients accepted postoperative radiation, and no locoregional recurrence occurred in 8 cases. For locoregional recurrence, Sun et al reported that recurrences may be controlled by salvage surgery with subsequent operation and/or radiotherapy.…”

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confidence: 47%

“…When the tumor extensively invades the larynx, trachea, esophagus, or even the innominate vein, surgical procedures are challenging because reconstruction of the upper aerodigestive tract is needed. 9,18,19 Central compartment dissection is necessary for all thyroid CASTLE. And, suspected or proven lateral compartment cancer should receive selective neck dissection or modified neck dissection.…”

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confidence: 99%

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Clinical Analysis of Thyroid Carcinoma Showing Thymus-Like Differentiation: Report of 8 Cases

Liu

Teng

Sun

et al. 2013

International Surgery

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Thyroid carcinoma showing thymus-like differentiation (CASTLE) is a kind of rare neoplasm of the thyroid gland. Because thyroid CASTLE is rare and difficult to diagnose, its clinicopathologic features have not been well defined, and no universally accepted treatment recommendation is available. We analyzed retrospectively the clinicopathologic data of 8 patients with thyroid CASTLE who underwent surgery and radiotherapy at the Shengjing Hospital of China Medical University between December 2008 and June 2012. All patients accepted radical surgery. All patients accepted postoperative radiotherapy, except one 79-year-old patient. There was no evidence of recurrence or metastasis during the follow-up period. The pattern of immunohistochemical staining was similar to that of thymic carcinoma. Six of 8 CASTLE cases expressed CD5. All 8 CASTLE patients were negatively expressed in thyroglobulin, thyroid transcription factor 1, and calcitonin. Patients with thyroid CASTLE have good outcomes after radical resection and postoperative radiotherapy. Positive CD5 immunoreactivity can contribute to diagnosis of this disease.

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Section: Discussionmentioning

confidence: 44%

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confidence: 47%

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confidence: 99%

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Clinical Analysis of Thyroid Carcinoma Showing Thymus-Like Differentiation: Report of 8 Cases

Liu

Teng

Sun

et al. 2013

International Surgery

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“…Chan and Rosai defined four clinic-pathologic entities: ectopic hamartomatous thymoma, ectopic cervical thymoma, spindle epithelial tumour with thymus-like differentiation (SETTLE), and Carcinoma showing thymic-like differentiation (CASTLE) [2]. This tumour is postulated to arise from either ectopic thymic tissue or remnants of branchial pouches, which retain the potential to differentiate along the thymic line [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…In 2004, this disease has been designated as an independent clinicopathologic entity of thyroid tumors in the WHO classification [3]. A systematic review of English literature evidences less than thirty cases; from them, it clearly appears that CASTLE is considered an indolent slowgrowing neoplasia even when lymph nodes metastasis are present [4,5]. This data is confirmed in a recent study by the Japanese Society of Thyroid Surgery [5].…”

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confidence: 93%

Aggressive Thyroid Carcinoma Showing Thymic-Like Differentiation (Castle): Case Report and Review of the Literature

et al. 2008

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Abstract. Carcinoma showing thymic-like differentiation (CASTLE) is a rare tumour of the thyroid, which arises from ectopic thymic tissue or remnants of branchial pouches. A systematic review of English literature evidences less than thirty cases; from them, it clearly appears that CASTLE is considered an indolent slow-growing neoplasia even when lymph nodes metastasis are present. We describe a case of very aggressive CASTLE, which showed seeding along fine needle aspiration tract.

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Nontender Mass on the Right Side of the Neck

Hsu

Lin

Yeh

et al. 2014

JAMA Otolaryngol Head Neck Surg

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A woman in her 50s was admitted to our hospital with a 5-week history of a nontender mass on the right side of the neck. No husky voice, dysphagia, or odynophagia were reported. A physical examination revealed a 2 × 2-cm tumor over the right side of her neck at level III. Bilateral vocal fold movements were normal. The free thyroxine level was 0.94 ng/dL, and the thyroid-stimulating hormone level was 1.33 mIU/mL. (To convert thyroxine to picomoles per liter, multiply by 12.871.) Fine-needle aspiration (FNA) was performed, and cellular changes suspected to be malignant neoplasm were reported. Computed tomographic images of the neck showed enlargement of the right side of the thyroid gland with retrosternal extension, and total thyroidectomy was arranged (Figure, A, arrowhead). During the operation, the tumor was found to extend to the thoracic cavity and to be attached tightly to the right carotid artery. The surgical specimen showed a 6.5 × 6.0 × 2.8-cm dark brown and elastic mass replacing most of the right side of the thyroid. The tumor possessed a rough surface, and focal hemorrhages were also noted. The thyroid tumor appeared to be composed of broad anastomosing islands of tumor cells separated by desmoplastic stroma (Figure, B). No lymphovascular invasion or extrathyroidal extensions were identified. The tumor cell nests were well demarcated, with smooth borders in some areas, and a syncytial pattern could also be observed with irregular borders in other areas. Microscopically, the tumor was composed of confluent nests and lobules of epithelioid and spindle-shaped cells surrounded by fibrous septa. The tumor cells had vesicular nuclei and eosinophiliccytoplasm.Markedanisonucleosiswithirregularnuclearcontours were also noted. The nuclear-cytoplasmic ratios were very high, and the pleomorphic tumor cell nuclei along with a small nucleoli were evident. Increased lymphocyte and plasma cell infiltration around and within the tumor cell nests was seen. Immunohistochemical studies revealed that the tumor cells were positive for cytokeratin (Figure, C), CD5 ( Figure, D), and p63 but were negative for thyroid transcription factor-1.

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Carcinoma showing thymic-like elements—a rare malignancy of the thyroid gland

Cited by 79 publications

References 8 publications

Clinical Analysis of Thyroid Carcinoma Showing Thymus-Like Differentiation: Report of 8 Cases

Clinical Analysis of Thyroid Carcinoma Showing Thymus-Like Differentiation: Report of 8 Cases

Aggressive Thyroid Carcinoma Showing Thymic-Like Differentiation (Castle): Case Report and Review of the Literature

Nontender Mass on the Right Side of the Neck

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