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Chadha P, Kamboj M, Pasricha S, Arora V, Yadav V, Gupta M, Mehta A. Spindle epithelial tumor with thymus-like elements (SETTLE): a diagnostic challenge with distinct therapeutic implication; case report. Diagn Pathol 2024; 19:108. [PMID: 39138528 PMCID: PMC11321057 DOI: 10.1186/s13000-024-01527-9] [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: 04/03/2024] [Accepted: 07/13/2024] [Indexed: 08/15/2024] Open
Abstract
Spindle epithelial tumor with thymus-like elements (SETTLE) is a rare malignant neoplasm of the thyroid gland which is believed to arise from intrathyroidal thymic tissue. It predominantly affects young adults and children presenting with a thyroid mass of variable duration and rarely occurs in adults. It has a high overall survival with a tendency for delayed metastasis. SETTLE is a biphasic lobulated tumor composed of spindle shaped cells along with glandular formations seen on histopathological examination. Despite its typical morphology it is commonly misdiagnosed on histopathology due to its rarity and overlapping morphology with other close mimics such as a carcinoma, synovial sarcoma and thymoma. Herein we report such a case occurring in a middle aged female presenting with a neck mass. She had an initial diagnosis of metastatic poorly differentiated squamous cell carcinoma possibly with an orophayngeal primary in view of co expression of CK, p40 and p16 on immunohistochemistry. The patient underwent surgical resection with modified neck dissection. On review at our hospital it was diagnosed as SETTLE and she remains disease free after a follow-up period of 1 year. Diligent histopathological examination espoused with a judicious panel of IHC markers in conjunction with clinicoradiological findings forms the mainstay of diagnosis. Diffuse and strong p16 immunoexpression has not been documented or evaluated in literature so far, and needs to be explored for its diagnostic utility in this rare entity.
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Affiliation(s)
- Prerna Chadha
- Histopathology and Cytopathology, Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, 110085, India
| | - Meenakshi Kamboj
- Histopathology and Cytopathology, Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, 110085, India
| | - Sunil Pasricha
- Histopathology and Cytopathology, Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, 110085, India.
| | - Vikas Arora
- Head and Neck Oncosurgery, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, 110085, India
| | - Vishal Yadav
- Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, 110085, India
| | - Manoj Gupta
- Nuclear Medicine Department, Rajiv Gandhi Cancer Institute And Research Centre, Delhi, 110085, India
| | - Anurag Mehta
- Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, 110085, India
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2
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Bernardo P, Messias H, Nogueira R, Lopes B, Gomes P. Spindle epithelial tumor with thymus-like element (SETTLE)-Report of a rare thyroid carcinoma. Clin Case Rep 2024; 12:e9300. [PMID: 39130807 PMCID: PMC11316011 DOI: 10.1002/ccr3.9300] [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: 05/30/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/13/2024] Open
Abstract
Spindle epithelial tumor with thymus-like element should be included in the differential diagnosis of thyroid gland cancers, particularly in medullary carcinoma, younger patients and indolent clinical presentation, because it may influence treatment and prognosis.
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Affiliation(s)
| | - Henrique Messias
- Head and Neck Surgery DepartmentInstituto Português de Oncologia de Lisboa Francisco GentilLisbonPortugal
- Division of Clinical and Surgical SciencesUniversity of EdinburghEdinburghUK
| | - Ricardo Nogueira
- Head and Neck Surgery DepartmentInstituto Português de Oncologia de Lisboa Francisco GentilLisbonPortugal
| | - Brazão Lopes
- Pathological Anatomy DepartmentInstituto Português de Oncologia de Lisboa Francisco GentilLisbonPortugal
| | - Pedro Gomes
- Head and Neck Surgery DepartmentInstituto Português de Oncologia de Lisboa Francisco GentilLisbonPortugal
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3
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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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Nagarjun BR, Mehta S, Gandhi J, Trivedi P, Rathod P. When to settle for SETTLE! A lesson learned from our cases. Thyroid Res 2024; 17:6. [PMID: 38438897 PMCID: PMC10913219 DOI: 10.1186/s13044-023-00189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/27/2023] [Indexed: 03/06/2024] Open
Abstract
Spindle epithelial tumor with thymic like elements (SETTLE) is a biphasic tumor composed of epithelial and spindle cell components. It is an uncommon indolent tumor arising in the thyroid gland and most commonly affects the children and young adults. This entity is mostly overlooked because of its rarity and diagnostic difficulty on morphology. We discuss two cases of SETTLE with varied presentation, diagnostic challenges and lessons learnt from them.SETTLE should be considered as a differential especially when dealing with a thyroid lesion in young and adolescent. The article discusses the histologic details and common mimickers to be borne in mind aiding in arrival at the final diagnosis on biopsy specimens.
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Affiliation(s)
| | - Shailee Mehta
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - Jahnavi Gandhi
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Priyank Rathod
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
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Lincango Naranjo EP, Cordero-Garate J, Rojas T, Dominguez CM, Solis-Pazmino P, Godoy R, Salazar-Vega J, Dy B, Garcia C. Spindle Epithelial Tumor with Thymus-Like Differentiation: The First Case Report from Ecuador. VideoEndocrinology 2022. [DOI: 10.1089/ve.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eddy P. Lincango Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Department of Teaching and Research, Hospital Vozandes Quito, Quito, Ecuador
| | | | - Tatiana Rojas
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Medical School, Universidad San Francisco de Quito, Quito, Ecuador
| | | | - Paola Solis-Pazmino
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Department Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Richard Godoy
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Head and Neck Department, ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello), Quito, Ecuador
| | - Jorge Salazar-Vega
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Endocrinology Department, Hospital Eugenio Espejo, Quito Ecuador
| | - Benzon Dy
- Division of Endocrine Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cristhian Garcia
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Head and Neck Department, ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello), Quito, Ecuador
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Baloch ZW, Asa SL, Barletta JA, Ghossein RA, Juhlin CC, Jung CK, LiVolsi VA, Papotti MG, Sobrinho-Simões M, Tallini G, Mete O. Overview of the 2022 WHO Classification of Thyroid Neoplasms. Endocr Pathol 2022; 33:27-63. [PMID: 35288841 DOI: 10.1007/s12022-022-09707-3] [Citation(s) in RCA: 380] [Impact Index Per Article: 190.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
This review summarizes the changes in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors that relate to the thyroid gland. The new classification has divided thyroid tumors into several new categories that allow for a clearer understanding of the cell of origin, pathologic features (cytopathology and histopathology), molecular classification, and biological behavior. Follicular cell-derived tumors constitute the majority of thyroid neoplasms. In this new classification, they are divided into benign, low-risk, and malignant neoplasms. Benign tumors include not only follicular adenoma but also variants of adenoma that are of diagnostic and clinical significance, including the ones with papillary architecture, which are often hyperfunctional and oncocytic adenomas. For the first time, there is a detailed account of the multifocal hyperplastic/neoplastic lesions that commonly occur in the clinical setting of multinodular goiter; the term thyroid follicular nodular disease (FND) achieved consensus as the best to describe this enigmatic entity. Low-risk follicular cell-derived neoplasms include non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), thyroid tumors of uncertain malignant potential, and hyalinizing trabecular tumor. Malignant follicular cell-derived neoplasms are stratified based on molecular profiles and aggressiveness. Papillary thyroid carcinomas (PTCs), with many morphological subtypes, represent the BRAF-like malignancies, whereas invasive encapsulated follicular variant PTC and follicular thyroid carcinoma represent the RAS-like malignancies. This new classification requires detailed subtyping of papillary microcarcinomas similar to their counterparts that exceed 1.0 cm and recommends not designating them as a subtype of PTC. The criteria of the tall cell subtype of PTC have been revisited. Cribriform-morular thyroid carcinoma is no longer classified as a subtype of PTC. The term "Hürthle cell" is discouraged, since it is a misnomer. Oncocytic carcinoma is discussed as a distinct entity with the clear recognition that it refers to oncocytic follicular cell-derived neoplasms (composed of > 75% oncocytic cells) that lack characteristic nuclear features of PTC (those would be oncocytic PTCs) and high-grade features (necrosis and ≥ 5 mitoses per 2 mm2). High-grade follicular cell-derived malignancies now include both the traditional poorly differentiated carcinoma as well as high-grade differentiated thyroid carcinomas, since both are characterized by increased mitotic activity and tumor necrosis without anaplastic histology and clinically behave in a similar manner. Anaplastic thyroid carcinoma remains the most undifferentiated form; squamous cell carcinoma of the thyroid is now considered as a subtype of anaplastic carcinoma. Medullary thyroid carcinomas derived from thyroid C cells retain their distinct section, and there is a separate section for mixed tumors composed of both C cells and any follicular cell-derived malignancy. A grading system for medullary thyroid carcinomas is also introduced based on mitotic count, tumor necrosis, and Ki67 labeling index. A number of unusual neoplasms that occur in the thyroid have been placed into new sections based on their cytogenesis. Mucoepidermoid carcinoma and secretory carcinoma of the salivary gland type are now included in one section classified as "salivary gland-type carcinomas of the thyroid." Thymomas, thymic carcinomas and spindle epithelial tumor with thymus-like elements are classified as "thymic tumors within the thyroid." There remain several tumors whose cell lineage is unclear, and they are listed as such; these include sclerosing mucoepidermoid carcinoma with eosinophilia and cribriform-morular thyroid carcinoma. Another important addition is thyroblastoma, an unusual embryonal tumor associated with DICER1 mutations. As in all the WHO books in the 5th edition, mesenchymal and stromal tumors, hematolymphoid neoplasms, germ cell tumors, and metastatic malignancies are discussed separately. The current classification also emphasizes the value of biomarkers that may aid diagnosis and provide prognostic information.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Virginia A LiVolsi
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Manuel Sobrinho-Simões
- Department of Pathology, Institute of Molecular Pathology and Immunology, IPATIMUP, University of Porto, Porto, Portugal
| | - Giovanni Tallini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Ozgur Mete
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
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Matheson CL, Blair GK, Bush J. Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE): A Case Report. Fetal Pediatr Pathol 2019; 38:399-405. [PMID: 30998418 DOI: 10.1080/15513815.2019.1600625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a tumor with an indolent disease course and late metastatic potential. It occurs primarily in children and adolescents, although it can present later in life. It was first described by Chan and Rosai [Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept. Hum Pathol. 1991;22(4):349-67. doi:10.1016/0046-8177(91)90083-2], and there have been approximately 46 cases published in the English literature. Case report: We present an 8-year-old female with a SETTLE, undergoing an initial fine-needle aspiration and later a diagnostic biopsy. There is no evidence of disease recurrence at 3.5 years of follow-up. Conclusion: Though fine-needle aspirate biopsy is useful in directing the diagnostic workup of SETTLE by indicating concerning pathology, the broad differential diagnosis associated with it requires histology in conjunction with a limited immunohistochemical panel and unremarkable cytogenetics workup. Surgical resection is the main stay of treatment, and long-term follow-up is important in these patients.
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Affiliation(s)
| | - Geoffrey K Blair
- Division of Pediatric Surgery, University of British Columbia , Vancouver , BC , Canada
| | - Jonathan Bush
- Division of Anatomical Pathology, University of British Columbia , Vancouver , BC , Canada
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Karaisli S, Haciyanli M, Gücek Haciyanli S, Tavusbay C, Gur EO, Kamer E, Arikan Etit D. Spindle epithelial tumour with thymus-like differentiation: report of two cases. Ann R Coll Surg Engl 2019; 102:e33-e35. [PMID: 31530165 DOI: 10.1308/rcsann.2019.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Spindle epithelial tumour with thymus-like differentiation (SETTLE) is a very rare neck malignancy arising from thymic tissue or branchial pouch, mostly seen in the early decades of life. SETTLE is thought to be a low-grade neoplasm but distant metastases have been reported. Fewer than 50 cases have been reported in the PubMed database. We report on the four-year follow-up for a 13-year-old boy, with no signs of recurrence or distant metastasis. In addition, a 45-year-old woman was admitted to hospital with neck mass. Fine-needle aspiration biopsy was compatible with medullary thyroid carcinoma but serum levels of calcitonin were normal. Total thyroidectomy and central compartment lymph node dissection was planned with an initial diagnosis of medullary thyroid carcinoma. At surgery, frozen section analysis converted our diagnosis to SETTLE and the intraoperative strategy was changed. SETTLE should be considered in a patient with normal serum calcitonin levels in the presence of suspicious medullary thyroid carcinoma at fine-needle aspiration biopsy. Frozen section analysis may help to manage the intraoperative strategy. This report describes the first case of SETTLE successfully diagnosed by frozen section analysis.
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Affiliation(s)
- S Karaisli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - M Haciyanli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - S Gücek Haciyanli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - C Tavusbay
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - E O Gur
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - E Kamer
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - D Arikan Etit
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Nambirajan A, Singh V, Irugu DVK, Agarwal S, Jain D. Spindle epithelial tumour with thymus-like elements presenting with lymph node metastasis: An illustrative case report with review of literature. Cytopathology 2019; 30:657-661. [PMID: 31209931 DOI: 10.1111/cyt.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Varsha Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Ogundoyin OO, Ogun G, Oluwasola A, Junaid TA. Spindle Epithelial Tumor of Thymus-like Differentiation (SETTLE) in a 3-year-old African girl. Clin Case Rep 2019; 7:1119-1122. [PMID: 31183079 PMCID: PMC6553348 DOI: 10.1002/ccr3.2163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/01/2019] [Accepted: 03/30/2019] [Indexed: 11/15/2022] Open
Abstract
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare tumor of the thyroid gland occurring in children and young adults. This report presents SETTLE as a tumor that can also affect young children (under fives). Although majority of the reports were in Caucasians, the tumor can affect all races.
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Affiliation(s)
| | - Gabriel Ogun
- Department of Pathology, College of MedicineUniversity of IbadanIbadanNigeria
| | - Abideen Oluwasola
- Department of Pathology, College of MedicineUniversity of IbadanIbadanNigeria
| | - Tamaldeen A. Junaid
- Department of Pathology, Faculty of MedicineKuwait UniversityKuwait CityKuwait
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Stevens TM, Morlote D, Swensen J, Ellis M, Harada S, Spencer S, Prieto-Granada CN, Folpe AL, Gatalica Z. Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE): A Next-Generation Sequencing Study. Head Neck Pathol 2018; 13:162-168. [PMID: 29736783 PMCID: PMC6514029 DOI: 10.1007/s12105-018-0927-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/02/2018] [Indexed: 12/27/2022]
Abstract
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a malignant biphasic neoplasm of the thyroid or neck with propensity for late metastasis. Unlike synovial sarcoma, its main morphologic mimic, SETTLE lacks synovial sarcoma-associated translocations. A single case of SETTLE has shown a KRAS mutation but to date no comprehensive next generation sequencing studies of this rare neoplasm have been undertaken. Herein, we subjected 5 well defined cases of SETTLE to direct sequence analysis of 592 genes and fusion gene analysis of 52 genes frequently rearranged in human cancers. We identified one case with two pathogenic variants in the KMT2D gene, one being in an intron splice site (c.674-1A>G) and the other being a frameshift variant (p.M2829fs). This same case also had a pathogenic nonsense variant in the KMT2C gene (p.R1237*). A second case of SETTLE carried a pathogenic NRAS missense variant, Q61R. No other molecular alterations, microsatellite instability, gene fusions or amplifications were identified.
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Affiliation(s)
- Todd M. Stevens
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave South, Birmingham, AL 35249 USA
| | - Diana Morlote
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave South, Birmingham, AL 35249 USA
| | | | | | - Shuko Harada
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave South, Birmingham, AL 35249 USA
| | - Sharon Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Carlos N. Prieto-Granada
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave South, Birmingham, AL 35249 USA
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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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13
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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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14
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Spindle Epithelial Tumor with Thymus-like Element (Settle): a Case Report. Indian J Surg Oncol 2016; 8:231-233. [PMID: 28546728 DOI: 10.1007/s13193-016-0607-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/11/2016] [Indexed: 10/20/2022] Open
Abstract
Spindle epithelial tumor with thymus-like element (SETTLE) is a very rare malignant neoplasm of the thyroid. It is generally encountered in children, adolescents, and young adults Objective: We aimed to present a patient with SETTLE and to review the clinical and pathologic features of this rare tumor. A 13-year-old male patient presented to our clinic with complaints of a rapidly growing lump on his neck. There was no evidence of distant metastases at time of presentation. A total thyroidectomy was performed. Lymph node dissection was not performed. On the first postoperative day, the patient was discharged uneventfully. Histopathological and immunohistochemical analysis revealed a SETTLE in our case. During 1 year of follow-up, the patient had no complaints or symptoms, without tumor recurrence on imaging studies. Although SETTLE is a very rare entity, it should be considered when diagnosing rapidly growing masses in the thyroid, especially in younger patients.
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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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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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