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Arshia A, Balikani L, Booth CN. Cytomorphology of monomorphic spindle epithelial tumor with thymus-like elements: A case with local recurrence after subtotal resection. Diagn Cytopathol 2024; 52:E134-E144. [PMID: 38520309 DOI: 10.1002/dc.25301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
Spindle epithelial tumor with thymus-like elements (SETTLE) is a rare biphasic thyroid tumor with low malignant potential that has a distinct morphology. Despite fine needle aspiration (FNA) being a common method for evaluating thyroid nodules and lymph nodes, there are limited cytologic descriptions of SETTLE in the literature due to its rarity. As a result, SETTLE is frequently underdiagnosed or misdiagnosed as medullary carcinoma, thymoma, teratoma, synovial sarcoma, or solitary fibrous tumor, among others. We present a case of a 28-year-old man with a history of a hemithyroidectomy diagnosed as SETTLE found to have a neck nodule along the strap muscle suspicious for recurrence 5 years post-surgery. The ultrasound-guided FNA cytology specimen of the neck nodule showed loosely cohesive, monomorphous ovoid to spindled cells with scant cytoplasm and nuclei with fine to granular chromatin. In addition, there were occasional clusters of cells with a papillary configuration. The tumor cells were associated with magenta, amorphous extracellular material. Immunocytochemical staining of the cell block material revealed that tumor cells were positive for p63, cytokeratin AE1/3, and CK8/18 and negative for TTF-1 and thyroglobulin. Overall, the morphological and immunocytochemical findings were consistent with a local recurrence of SETTLE. The subsequent left anterior strap mass excision revealed a 4 cm encapsulated tumor consistent with SETTLE. Because ofits rarity and low level of awareness, SETTLE poses a diagnostic and therapeutic challenge. We herein present the cytologic findings of monomorphic SETTLE and highlight the potential cytomorphologic and immunophenotypic pitfalls. We also highlight how tumors with high-risk features can be a therapeutic challenge.
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Affiliation(s)
- Asma Arshia
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Lame Balikani
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Christine N Booth
- Department of Pathology, RJT-Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Ren C, Li Y, Huang J, Liu S, Cao Z, Jiang Q, Lin X, Ye F, Gong Y. Primary synovial sarcoma of the thyroid gland: a CARE compliant case report and literature review. Front Med (Lausanne) 2023; 10:1158334. [PMID: 37234243 PMCID: PMC10206046 DOI: 10.3389/fmed.2023.1158334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/29/2023] [Indexed: 05/27/2023] Open
Abstract
Rationale Synovial sarcoma is a subtype of soft tissue sarcoma. Synovial sarcoma in the head and neck region is relatively unusual. Primary synovial sarcoma of the thyroid gland (PSST) is first reported in 2003 by Inako Kikuchi. PSST is extremely rare with only 15 cases documented globally. PSST shows rapid disease progression and a relatively poor prognosis. However, diagnosis and therapy are challenging for clinical surgeons. In this article, we reported the 16th PSST case and reviewed the PSST cases globally for further clinical application. Patient concerns The patient was referred to us because of gradually worsened dyspnea and dysphagia for 20 days. Physical examination showed a 5 × 4 cm mass with a clear boundary and good mobility. Contrast-enhanced ultrasonography (CEUS) and computed tomography (CT) showed a mass in the isthmus of the thyroid gland. The imageology diagnosis tends to be a benign thyroid nodule. Diagnosis After surgery, histopathology, immunohistochemistry, and fluorescence, in situ hybridization indicated the mass to be primary synovial sarcoma of the thyroid gland with no local and distant metastasis. Interventions The patient underwent total thyroidectomy and dissected the lymph nodes in the central compartment. This patient received postoperative chemotherapy (a combination of ifosfamide and epirubicin for five cycles). Patients tolerated chemotherapy well. No recurrence was found during the 9-month follow-up. Lessons Although PSST is an extremely rare disease, we should raise our awareness when we encounter a rapidly growing, cystic-solid mixed thyroid mass with neck compression symptoms to avoid misdiagnosis. Intraoperatively, surgeons should refine surgical procedures to avoid capsular rupture and tumor local implantation metastasis. Intraoperative frozen section pathology is necessary sometimes, especially when the diagnosis could not be established before surgery.
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Affiliation(s)
- Chutong Ren
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yashan Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiangsheng Huang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sushun Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhexu Cao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Jiang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Lin
- Department of General Surgery, Huaihua Second People's Hospital, Huaihua, Hunan, China
| | - Fei Ye
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Gong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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3
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Saini T, Kundu R, Bhujade H. Extensive spindling in medullary thyroid carcinoma posing a diagnostic challenge: A case report. Diagn Cytopathol 2022; 50:E339-E343. [PMID: 35880247 DOI: 10.1002/dc.25020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/07/2022]
Abstract
Medullary thyroid carcinoma is a neuroendocrine tumor derived from parafollicular or 'C' cells with sporadic and familial forms. Fine needle aspiration cytology is a quick way to establish the diagnosis. Sometimes a usual tumor may show prominent spindling on cytomorphology due to sampling issues, which poses a diagnostic challenge. When encountering spindled tumor cells on cytology smears from the thyroid, differential diagnoses encompass many benign and malignant lesions. We present cytological findings of the usual type of medullary thyroid carcinoma showing extensive spindling on cytology smears, which was a diagnostic dilemma. An accurate diagnosis was reached with the judicious use of immunocytochemistry on the cell block. We also discuss the available literature, differential diagnoses, and how to troubleshoot.
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Affiliation(s)
- Tarunpreet Saini
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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4
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Pusztaszeri MP, Florianova L, Payne R, Baloch ZW. Spindle cell variant of follicular thyroid carcinoma: an extremely unusual case and review of the literature. Diagn Cytopathol 2022; 50:E333-E338. [PMID: 35866458 DOI: 10.1002/dc.25018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022]
Abstract
Spindle cell proliferations originating in follicular derived thyroid neoplasms are rare and known to cause diagnostic conundrums. We describe a unique case of a spindle cell variant of follicular thyroid carcinoma (FTC) in a 48-year-old female without relevant past medical history, who was being followed for a 1.4 cm left thyroid nodule for the past 15 months. A fine needle aspiration (FNA) of the nodule was interpreted as benign (Bethesda II). On follow-up ultrasound the nodule demonstrated a slight increase in size (to 1.5 cm) and the appearance of coarse calcifications A repeat FNA was performed 12 months later and interpreted as malignant neoplasm (Bethesda VI), containing a population of spindle and epithelioid cells that could not be further classified. A left subtotal thyroidectomy showed an encapsulated tumor mainly composed of fibroblast-like spindle cells, extensive foci of calcifications and focal ossification, with minimal tumor capsule invasion without vascular invasion. Tumor cells expressed vimentin, ERG and SMA (focal), while being negative for pancytokeratin, thyroglobulin, TTF-1, Pax-8, calcitonin, CEA and other lineage-specific mesenchymal, neuroendocrine and melanocytic markers. Importantly, a few residual thyroid follicles were identified within the nodule, and a diagnosis of minimally invasive FTC with extensive spindle cell changes, calcification and osseous metaplasia was rendered. This is only the second cytologic report of a pure spindle cell FTC. The rarity of this neoplasm and its potential broad differential diagnosis create diagnostic difficulties both on cytology and histology.
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Affiliation(s)
| | | | - Richard Payne
- Department of Head and Neck Surgery, McGill University, Montreal, Canada
| | - Zubair W Baloch
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
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5
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Manukyan I, DeBrito P, Rossi CT, Russo PA, Sidawy M. Spindle epithelial tumor with thymus-like differentiation in fine needle aspiration of thyroid gland: Report of two cases. Diagn Cytopathol 2021; 50:E54-E58. [PMID: 34636490 DOI: 10.1002/dc.24886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 11/05/2022]
Abstract
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare, malignant tumor of the thyroid gland that typically affects young males and has a propensity for late metastasis. With fine needle aspiration (FNA) being a primary tool for diagnosis of thyroid lesions, there are rare reports of cytological features of SETTLE on FNA since its initial characterization 30 years ago . Here we report two cases of SETTLE, involving 9-year-old and 15-year-old male patients. Both patients underwent US-guided FNA with a subsequent resection confirming the diagnosis of SETTLE. In the first patient the thymic origin of the tumor was suspected on FNA, but the diagnosis of SETTLE was established only after resection. Five years later, this patient presented with an enlarged ipsilateral cervical lymph node. Needle biopsy confirmed it to be a metastatic tumor compatible with SETTLE. In the second patient the diagnosis of SETTLE was suggested on FNA. Cytology of the thyroid gland nodule on FNA from both patients showed loosely cohesive and single spindle-shaped epithelial cells associated with metachromatic stroma. The differential diagnosis of spindle cell lesions of the thyroid should include SETTLE based on characteristic morphological features, after more common entities of thyroid gland such as medullary carcinoma are excluded.
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Affiliation(s)
- Irena Manukyan
- Department of Pathology, MedStar Georgetown University Hospital, Washington, D.C., USA.,Department of Personalized Genomic Medicine, Columbia University Medical Center, New York, New York, USA
| | - Pedro DeBrito
- Department of Pathology, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Christopher T Rossi
- Department of Pathology, Children's National Medical Center, Washington, D.C., USA
| | - Pierre A Russo
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Sidawy
- Department of Pathology, MedStar Georgetown University Hospital, Washington, D.C., USA
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6
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Lee J, Cho Y, Choi KH, Hwang I, Oh YL. Metastatic leiomyosarcoma of the thyroid gland: cytologic findings and differential diagnosis. J Pathol Transl Med 2021; 55:360-365. [PMID: 34384147 PMCID: PMC8476313 DOI: 10.4132/jptm.2021.06.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/22/2021] [Indexed: 12/03/2022] Open
Abstract
Metastatic leiomyosarcoma to the thyroid is an extremely rare occurrence, and only 18 cases have been reported. Here, we report a case of a 37-year-old woman who presented with multiple masses on the scalp. Excisional biopsy was done and the mass revealed fascicles of smooth muscle fibers which showed positive staining for smooth muscle actin, thus confirming the diagnosis of leiomyosarcoma. The patient was also found to have a 0.9 cm mass within the left thyroid. Fine-needle aspiration was done and the cytological smear showed hypercellular spindle cell clusters with hyperchromatic and large nuclei. Normal thyroid follicular cells were found within or around tumor cells. In this report, we present the cytologic findings of metastatic leiomyosarcoma to the thyroid and offer differential diagnoses of the aspirated spindle cells.
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Affiliation(s)
- Jiyeon Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yunjoo Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyue Hee Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Inwoo Hwang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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7
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Adegun OK, Proctor I, Falzon M, Pomplun S. Spindle cell tumour with thymus-like differentiation (SETTLE) on fine needle aspiration cytology: A case report highlighting diagnostic pitfalls. Diagn Cytopathol 2021; 49:E325-E328. [PMID: 33794064 DOI: 10.1002/dc.24744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/11/2022]
Abstract
A 7-year-old girl presented with a painless neck swelling localised near the left lobe of the thyroid gland, which was initially investigated by fine needle aspiration cytology. This raised a differential diagnosis of medullary thyroid carcinoma and small round blue cell tumour. Only after several additional clinical investigations and a total thyroidectomy was a definitive diagnosis of spindle cell tumour with thymus-like differentiation (SETTLE) reached. This case report highlights how contemporaneous clinical and investigation findings made arriving at a definitive diagnosis challenging, contributed to diagnostic delay, and ultimately influenced choice of treatment.
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Affiliation(s)
- Oluyori K Adegun
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian Proctor
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary Falzon
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sabine Pomplun
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
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8
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Mohammadnia Avval M, Kumar PV, Dehghani F. Multiple Auer Rods in Fine-Needle Aspiration Smears of Medullary Thyroid Carcinoma: An Unusual Finding. Int Med Case Rep J 2020; 13:85-88. [PMID: 32210641 PMCID: PMC7071880 DOI: 10.2147/imcrj.s244905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Medullary thyroid carcinoma (MTC) is a rare tumor. Fine-needle aspiration (FNA) cytology is a popular method for the preoperative diagnosis of MTC. Case Report A 45-year-old man was referred to our center for a palpable thyroid nodule. Ultrasound-guided FNA was carried out for the patient. Cytology slides showed many isolated and small clusters of round to oval cells, some with a moderate amount of cytoplasm and red cytoplasmic granules. Rare cells showed multiple red Auer rods. Histology confirmed the diagnosis of MTC. Conclusion Cytologic findings of MTC in FNA are variable, and several rare cytologic findings have been reported. Cytoplasmic red granules are one of the usual findings, whereas detection of cells containing multiple Auer rods is an unusual finding, which has not been reported so far.
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Affiliation(s)
| | | | - Fereydoon Dehghani
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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9
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Chen YH, Perrino CM, Cheng L, Wu HH. Fine-needle aspiration cytology of metastatic spindle cell follicular thyroid carcinoma: A case report. Diagn Cytopathol 2019; 47:608-611. [PMID: 30794342 DOI: 10.1002/dc.24159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/08/2019] [Indexed: 11/07/2022]
Abstract
Follicular thyroid carcinoma, spindle cell variant is extremely rare. The tumor is predominantly composed of spindle cells with a fusiform appearance that are arranged in intersecting fascicles. Fine-needle aspiration biopsy of this entity has not been previously described. We report a case of a 58-year-old woman who presented with metastasis to a left neck lymph node 15 years after the original diagnosis. Fine-needle aspiration cytology showed numerous bland, spindled to epithelioid cells with thin, elongated, and plump nuclei with finely granular chromatin and inconspicuous nucleoli. The tumor cells had a moderate amount of cytoplasm with occasional elongated cytoplasmic tails. The cells were arranged in irregular aggregates with a fascicular pattern or singly dispersed. The tumor cells demonstrated positive staining for pan-keratin, PAX8, thyroid transcription factor-1, and thyroglobulin, which confirmed thyroid primary origin.
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Affiliation(s)
- Yu-Hsin Chen
- Department of Endocrinology and Metabolism, Cathay General Hospital, Taipei, Taiwan
| | - Carmen M Perrino
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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10
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Goh GH, Petersson F. Plexiform Fibrohistiocytic Tumor Presenting as a Central Neck Mass Clinically Mimicking a Thyroglossal Duct Cyst: An Unusual Case Reported with Histo-cytopathologic Correlation and a Review of the Cytopathology Literature. Head Neck Pathol 2019; 14:262-267. [PMID: 30758757 PMCID: PMC7021857 DOI: 10.1007/s12105-019-01022-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/04/2019] [Indexed: 12/21/2022]
Abstract
We present the case of an uncommon example of a plexiform fibrohistiocytic tumor (PFHT) occurring in the anterior central neck region of a 40 year-old female with previous subtotal thyroidectomy. The tumor clinically mimics a complicated thyroglossal duct cyst. On fine needle aspiration cytology, the tumor was composed of sheets of bland spindle cells and nests of plump histiocytoid cells in vaguely whorled arrangements. Occasional multinucleated giant cells were also identified. The excised specimen showed an irregular, highly infiltrative subcutaneous tumor arranged in a nodular/plexiform pattern concentrated to the center of the tumor mass. In addition, the tumor contained numerous tongue-like extensions composed of variably cellular, fibroblastic/fibromatosis-like areas. These fibroblastic/fibromatosis-like extensions reached far from the epicenter of the tumor and were associated with scattered small plexiform nodules of histiocytic cells. These tongue-like extensions multifocally involved the surgical margins. The fibroblastic and histiocytoid cells showed diffuse smooth muscle actin (SMA) expression. The multinucleated giant cells and also the histiocytoid proliferation were positive for CD68. This case illustrates an uncommon both anatomical and demographic manifestation of PFHT and also characterize the fine needle aspiration cytologic features in this tumor, which previously have been reported in a few cases.
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Affiliation(s)
- Giap Hean Goh
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Fredrik Petersson
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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11
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Abdulrahman AA, Al-Loh Ashi S, Jain M, Hou JS. Spindle epithelial tumor with thymus-like differentiation (SETTLE): Case report with longest follow up & latency to metastasis. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Baste Subia MN, Digoy P, Hum M, Yu Z, Conrad R. Cytologic findings of spindle epithelial tumor with thymus-like elements. Laryngoscope 2017; 128:E78-E82. [DOI: 10.1002/lary.27020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Maria N. Baste Subia
- Department of Pathology and Laboratory Medicine; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
| | - Paul Digoy
- Department of Surgery; Oklahoma State University Center for Health Sciences; Oklahoma City Oklahoma U.S.A
| | - Martina Hum
- Department of Pediatric Oncology; St. Francis Hospital; Tulsa Oklahoma U.S.A
| | - Zhongxin Yu
- Department of Pathology and Laboratory Medicine; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
| | - Rachel Conrad
- Department of Pathology and Laboratory Medicine; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
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13
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Yi K, Rehman A, Jang SM, Paik SS. Review of the touch preparation cytology of spindle epithelial tumor with thymus-like differentiation. J Cytol 2016; 33:27-9. [PMID: 27011438 PMCID: PMC4782399 DOI: 10.4103/0970-9371.175495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We experienced a case of spindle epithelial tumor with thymus-like differentiation (SETTLE) with touch preparation cytology performed during the intraoperative frozen section diagnosis in a 22-year-old woman. The tumor was partially encapsulated by fibrous capsule. It was a highly cellular biphasic tumor characterized by fasciculated spindle cells with streaming pattern and tubulopapillary epithelial component. The tumor cells were positive for cytokeratin, vimentin, c-kit, epithelial membrane antigen (EMA), and thyroid transcription factor-1 (TTF-1). However, the tumor cells were negative for thyroglobulin, calcitonin, CD99, S-100 protein, CD34, smooth muscle actin, HBME-1, and galectin-3. The reviewed touch smears showed tight clusters with high cellularity. Most cellular clusters showed papillary configuration. However, some clusters showed spindle cells with streaming pattern. The spindle tumor cells showed elongated and cigar-shaped nuclei. Although the incidence is very rare, SETLLE should be included in the differential diagnosis when a spindle cell neoplasm is encountered in touch preparation cytology in young patients with a thyroid mass.
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Affiliation(s)
- Kijong Yi
- Department of Pathology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Abdul Rehman
- Department of Pathology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Se Min Jang
- Department of Pathology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Seung Sam Paik
- Department of Pathology, College of Medicine, Hanyang University, Seoul, South Korea
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14
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Ippolito S, Bellevicine C, Arpaia D, Peirce C, Ciancia G, Vigliar E, Troncone G, Biondi B. Spindle epithelial tumor with thymus-like differentiation (SETTLE): clinical-pathological features, differential pathological diagnosis and therapy. Endocrine 2016; 51:402-12. [PMID: 26289127 DOI: 10.1007/s12020-015-0716-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/07/2015] [Indexed: 11/29/2022]
Abstract
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare tumor of the thyroid gland. An algorithm for the diagnosis and treatment of SETTLE has yet to be established. The aim of this study was to identify all case reports of SETTLE and to compare the clinical-pathological features and therapy of the cases identified. We performed a PubMed search for case reports of SETTLE in English published up to November 2014 in which "SETTLE" and "Spindle epithelial tumor with thymus-like differentiation" were keywords. We identified 35 articles for a total of 42 cases. We found that SETTLE usually occurs in children and adolescents as an asymptomatic neck mass. Thyroid function tests and tumor markers are invariably within normal range in all patients, and fine needle aspiration biopsy is rarely diagnostic for SETTLE. All 42 patients had undergone thyroidectomy. After surgical resection, chemotherapy (adjuvant or first/second-line treatment) and/or radiotherapy were administered to control tumor growth in cases with metastatic involvement. Although SETTLE presents a low-grade malignancy, it can metastasize to lymph nodes, the mediastinum, lung, vertebrae, and kidney even many years after the initial diagnosis. SETTLE may have a good prognosis if appropriately treated at initial presentation and if patients undergo long-term monitoring with regular clinical and morphological evaluations.
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Affiliation(s)
- Serena Ippolito
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudio Bellevicine
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Debora Arpaia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carmela Peirce
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Ciancia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
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15
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Murro D, Slade JM, Syed S, Gattuso P. Fine needle aspiration of secondary synovial sarcoma of the thyroid gland. Diagn Cytopathol 2015; 43:928-32. [DOI: 10.1002/dc.23327] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/24/2015] [Accepted: 08/05/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Diana Murro
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | | | - Sahr Syed
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Paolo Gattuso
- Department of Pathology; Rush University Medical Center; Chicago Illinois
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16
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Hang JF, Hsu CY, Lai CR. Fine-needle aspiration cytology of type A thymoma with adenoid cystic pattern: a case report with emphasis on peculiar hyaline globules in cytologic smear. Diagn Cytopathol 2014; 43:247-50. [PMID: 24962366 DOI: 10.1002/dc.23194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/12/2014] [Accepted: 06/11/2014] [Indexed: 11/10/2022]
Abstract
Here we report a case of type A thymoma with adenoid cystic pattern, which extended to the lower anterior neck and clinically mimicked a nontoxic thyroid goiter. The cytologic smears of fine-needle aspiration showed cohesive fragments of short spindle cells with finely granular chromatin and inconspicuous nucleoli. Scant interspersed lymphocytes were present. On air-dried Liu stained preparation, there were many magenta-colored hyaline globules wrapped by spindle tumor cells. The cytomorphologic findings correlated with the adenoid cystic pattern in histology. The cytologic differential diagnosis and the prognostic aspects of type A thymoma were briefly discussed.
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Affiliation(s)
- Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, 11217, Taipei, Taiwan, Republic of China
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Recondo G, Busaidy N, Erasmus J, Williams MD, Johnson FM. Spindle epithelial tumor with thymus-like differentiation: A case report and comprehensive review of the literature and treatment options. Head Neck 2014; 37:746-54. [DOI: 10.1002/hed.23634] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/12/2013] [Accepted: 02/17/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Gonzalo Recondo
- Department of Internal Medicine; Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno; Buenos Aires Argentina
| | - Naifa Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jeremy Erasmus
- Department of Radiology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michelle D. Williams
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Faye M. Johnson
- Department of Thoracic/Head and Neck Medical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
- The University of Texas Graduate School of Biomedical Sciences at Houston; Houston Texas
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18
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Abstract
Primary leiomyosarcoma of the thyroid gland is uncommon. To date, 20 cases have been reported in English in the literature. The tumors usually present in elderly patients with female predilection and are associated with poor clinical outcome. Herein, we report an additional case of primary thyroid leiomyosarcoma in a 64-year-old woman. She underwent total thyroidectomy and later was discovered to have multiple lung and liver metastases. The patient died 3 months after surgery. The major differential diagnoses including undifferentiated (anaplastic) carcinoma of the thyroid, spindle cell variant of medullary thyroid carcinoma, spindle cell tumor with thymus-like differentiation, uncommon primary tumor of the thyroid and metastatic tumors with predominant spindle cells are discussed.
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Affiliation(s)
- Jantima Tanboon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, 10700, Thailand.
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19
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Llamas-Gutierrez FJ, Falcon-Escobedo R, De Anda-Gonzalez J, Angeles-Angeles A. Spindle epithelial tumor with thymus-like differentiation of the thyroid (SETTLE):. Ann Diagn Pathol 2013; 17:217-21. [DOI: 10.1016/j.anndiagpath.2011.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/18/2011] [Indexed: 11/30/2022]
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20
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Kaur J, Srinivasan R, Kakkar N. Fine needle aspiration cytology of a spindle epithelial tumour with thymus-like differentiation (SETTLE) occurring in the thyroid. Cytopathology 2011; 23:413-5. [DOI: 10.1111/j.1365-2303.2011.00942.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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Magnata Filho LA, Bordallo MAN, Pessoa CHCN, Corbo R, Bulzico DA, Dias FL, Machado AL, Soares AB, Ferman S. Thyroid spindle epithelial tumor with thymus-like differentiation (SETTLE): case report and review. ACTA ACUST UNITED AC 2010; 54:657-62. [PMID: 21085772 DOI: 10.1590/s0004-27302010000700011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 08/21/2010] [Indexed: 11/22/2022]
Abstract
Spindle epithelial tumor with thymus-like element (SETTLE) is a rare malignant neoplasm of the thyroid, occurring predominantly in children, adolescents, and young adults. SETTLE usually presents itself as a thyroid mass, without metastases at diagnosis. It is believed to derive from branchial pouch or thymic remnant tissue showing primitive thymic differentiation. This article reports the clinical, cytological, histological and immunohistochemical features of a SETTLE in a 3-year-old girl. Microscopic exam revealed a nodular, highly cellular neoplasm displayed in the classic biphasic pattern, with mixture of prominent spindle cell component and a minor glandular component lined by mucinous or respiratory-type epithelium. The immunohistochemical study showed strong and diffuse positivity for pan-CK, vimentin and smooth muscle actin. The present case is the first SETTLE case reported in Brazil. To date, the patient described remains without evidence of recurrence or metastasis 5 years after surgery.
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22
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Spindle epithelial tumor with thymus-like differentiation: a morphologic, immunohistochemical, and molecular genetic study of 11 cases. Am J Surg Pathol 2009; 33:1179-86. [PMID: 19417583 DOI: 10.1097/pas.0b013e31819e61c8] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is an extremely rare tumor of the thyroid and neck, first described by Chan and Rosai. SETTLE is a low-grade malignancy, with potential for late lung, lymph node, and other visceral metastases. The clinicopathologic features of SETTLE overlap significantly with those of synovial sarcoma. Thirteen cases previously diagnosed as "SETTLE" (11 cases) or "malignant neoplasm-SETTLE versus synovial sarcoma" (2 cases), were retrieved. Immunohistochemistry for low-molecular-weight cytokeratins, high-molecular-weight cytokeratins, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, bcl-2, CD34, CD99, CD117, INI-1, and TLE1 were performed. Reverse transcriptase polymerase chain reaction for the SS18/SSX1 and SS18/SSX2 fusion genes and fluorescent in-situ hybridization for SYT rearrangement was performed. The 11 cases diagnosed, as "SETTLE" were negative for synovial sarcoma-associated fusion genes, whereas the other 2 cases were positive. SETTLE occurred in 7 females and 4 males (7 to 50 y of age, median 13.5 y) and involved the thyroid gland in 10 cases. Clinical follow-up showed 3 patients to be disease-free 7, 10, and 15 years after surgery. One patient had a lymph node metastasis at diagnosis and lung metastases 14 months after diagnosis. SETTLE infiltrated the thyroid, and consisted of a vaguely nodular admixture of fascicular, reticular, hyalinized, and microcystic areas. Spindled zones blended imperceptibly into areas showing epithelial differentiation, in the form of glomeruloid glandular structures, sertoli-like tubules, and small glands, lined by cuboidal to columnar cells. Mitotic activity was very low, necrosis was absent, and pleomorphism was not present. By immunohistochemistry, SETTLE showed extensive expression of high-molecular-weight cytokeratins in 7 of 8 cases (88%). Expression of low-molecular-weight cytokeratins and epithelial membrane antigen was limited, confined to only scattered cells in 7 of 8 (88%), and 4 of 8 (50%) of cases, respectively. Cytokeratin 7 expression was more widespread (7 of 8 cases, 88%). Cytokeratin 20 was negative. Expression of CD99 and bcl-2 was seen in 6 of 8 (75%) and 7 of 8 (88%) cases, respectively. CD117, INI-1, and TLE1 expression was seen in 6 of 8 (75%), 8 of 8 (100%), and 1 of 5 (20%) of cases, respectively. We conclude that traditional morphologic study and a limited panel of ancillary immunostains are sufficient for the distinction of SETTLE from synovial sarcoma in almost all instances. Molecular genetic study may, however, be helpful in selected cases, particularly in limited biopsies.
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23
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Ryska A, Cap J, Vaclavikova E, Dvorakova S, Bendlova B, Hovorkova E, Kohout A. Paraganglioma-like medullary thyroid carcinoma: fine needle aspiration cytology features with histological correlation. Cytopathology 2009; 20:188-94. [DOI: 10.1111/j.1365-2303.2008.00580.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Tong GX, Hamele-Bena D, Liu JC, Horst B, Remotti F. Fine-needle aspiration biopsy of primary osteosarcoma of the thyroid: report of a case and review of the literature. Diagn Cytopathol 2008; 36:589-94. [PMID: 18618703 DOI: 10.1002/dc.20840] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Primary osteosarcoma of the thyroid is an extremely rare tumor, with only 27 well-documented cases reported in the literature, including only one in the cytology literature. We describe here an additional case with fine-needle aspiration biopsy findings. A 60-year-old woman presented with a 1-month history of progressive midline neck swelling. CT and ultrasound demonstrated a large thyroid mass with tracheal compression. Fine-needle aspiration biopsies were performed and showed pleomorphic spindle and epithelioid neoplastic cells, multinucleated giant cells, and scant metachromatic extracellular matrix material. Cell block sections contained minute tissue fragments with neoplastic spindle cells. Immunohistochemical stains showed the tumor cells to be positive for vimentin and negative for cytokeratins, TTF-1, calcitonin, synatophysin, chromogranin, and S-100 protein, suggesting a sarcoma; however, the differential diagnosis also included anaplastic thyroid carcinoma and medullary thyroid carcinoma. Tissue biopsy revealed a high-grade spindle cell neoplasm with osteoid production, consistent with osteosarcoma of the thyroid. The patient developed a large pulmonary embolus and superior vena cava syndrome and no further surgical intervention was performed. She died 5 weeks after the initial diagnosis. Upon retrospective review, the cytologic features resemble osteosarcoma in other areas. Although cytologic features on fine-needle aspiration biopsy may suggest a diagnosis of this rare entity, definitive diagnosis should be deferred to histologic examination.
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Affiliation(s)
- Guo-Xia Tong
- Department of Pathology, Columbia University Medical Center, New York, New York 10032, USA
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