Spindle epithelial tumor with thymus‐like differentiation (SETTLE) of the thyroid

Iwasa, Kazunori; Imai, Miwa; Noguchi, Masakuni; Tanaka, Shigehiro; Sasaki, Tadashi; Katsuda, Shogo; Kawahara, Ei; Mizukami, Yuji

doi:10.1002/hed.10111

Cited by 31 publications

(24 citation statements)

References 22 publications

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“…Only two cases have been reported in living children (15,16), and both were identified only after surgical excision. Malignant intrathyroidal thymic tissue, although rare, is more frequent than its benign counterpart (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), and it is known as intrathyroidal epithelial thymoma (ITET)=carcinoma showing thymus-like differentiation (CASTLE). A variant is spindle epithelial tumor with thymus-like differentiation (SETTLE).…”

Section: Discussionmentioning

confidence: 99%

A Six-Year-Old Boy with a Suspicious Thyroid Nodule: Intrathyroidal Thymic Tissue

Hernández-Cassis

Poniecka

Vogel

et al. 2008

Thyroid

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Section: Discussionmentioning

confidence: 99%

A Six-Year-Old Boy with a Suspicious Thyroid Nodule: Intrathyroidal Thymic Tissue

Hernández-Cassis

Poniecka

Vogel

et al. 2008

Thyroid

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“…While most diagnoses are made at the stage when the tumor is still localized, about 20% of patients develop metastases. Metastatic relapse has been observed even many years after first diagnosis, with a mean time to relapse of 11 years [7][8][9][10]. Until now no standard treatment for metastatic SETTLE has been established due to its rarity.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Metastatic Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE) - Long-Term Disease Control by Multimodal Therapy

Quidde

Alsdorf²,

Amsberg³

et al. 2018

Oncol Res Treat

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Background: Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare tumor that occurs mainly in pediatric patients and young adults. Only few of these patients develops metastatic disease; therefore, clinical data regarding treatment and outcome of metastatic SETTLE are extremely limited. Several chemotherapy agents have been used in SETTLE but due to the limited number of patients no evidence-based therapy exists. Case Report: We present a case of metastatic SETTLE presenting with high tumor burden and paraneoplastic hypercalcemia. Prolonged disease control with several lines of platinum-based chemotherapy, anti-epidermal growth factor receptor therapy and additional radiotherapy was achieved. Conclusion: Multi-agent chemotherapy is an active treatment in metastatic SETTLE and can induce sustained tumor control.

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“…Diffuse immunoreactivity of spindle cells for epithelial markers and tonofilaments and rare well-developed desmosomes present in the spindle cells, identified by ultrastructural studies, are evidence of an epithelial nature [1,12,27,28]. In addition, Su et al [12] reported one case of SETTLE that demonstrated a myoepithelial phenotype including immunoreactivity for smooth-muscle actin and ultrastructural evidence of cytoplasmic filaments with dense bodies.…”

Section: Discussionmentioning

confidence: 99%

Spindle Epithelial Tumor with Thymus-Like Differentiation: A Case Report and Review of Literature

Misra¹,

Mitra²,

Yadav³

et al. 2013

Acta Cytologica

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Spindle epithelial tumor with thymus-like differentiation (SETTLE) is an extremely rare type of thyroid tumor with fewer than 35 reported cases available in the literature so far, most of them having been diagnosed histologically after resection. The tumor is believed to be derived from branchial-pouch or thymic remnants, occurring in young adults, predominantly in males, with a male:female ratio 1.8:1. Case: A 14-year-old girl presented with a nodular mass in her right thyroid that had been present for 1 year. Ultrasonological study revealed a heterogeneous solid mass (2.5 × 1.5 × 1.5 cm) in the right lobe of the thyroid. Fine-needle aspiration (FNA) smears were highly cellular and comprised of predominantly dissociated uniform spindle cells with naked oval nuclei along with some aggregates and groups. Occasional islands of epithelial cells were also present. Cytologically, the spindle cells had bland nuclear chromatin, with very scanty mitotic figures. Upon examination of the FNA smears, a provisional diagnosis of SETTLE was suggested along with a request for an incisional biopsy to rule out another differential diagnosis of medullary carcinoma thyroid. On the resected tissue specimen, diagnosis was histologically confirmed to be SETTLE. Immunohistochemical study revealed a strong and diffuse positivity for high-molecular-weight keratin and vimentin, and negativity for thyroglobulin, calcitonin, S-100 protein, desmin, chromogranin and synaptophysin. Conclusion: Cytologically, SETTLE can safely be considered, especially if spindle elements are observed along with the occasional group of epithelial cells in FNA smears from the thyroid of young adults. It can help in the preoperative recognition of lesions based on distinctive cytomorphological features and immunohistochemical characteristics, allowing a more sound therapeutic approach because these patients can present with delayed metastasis.

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Spindle epithelial tumor with thymus‐like differentiation (SETTLE) of the thyroid

Abstract: SETTLE of thyroid gland is an extremely rare entity. A review of the literature reveals that SETTLE has distinctive morphologic features and an immunohistochemical profile.

Cited by 31 publications

References 22 publications

A Six-Year-Old Boy with a Suspicious Thyroid Nodule: Intrathyroidal Thymic Tissue

A Six-Year-Old Boy with a Suspicious Thyroid Nodule: Intrathyroidal Thymic Tissue

Treatment of Metastatic Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE) - Long-Term Disease Control by Multimodal Therapy

Spindle Epithelial Tumor with Thymus-Like Differentiation: A Case Report and Review of Literature

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