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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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2
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Kairanna N, Vasudevan G, Karanth V, Sharan K. Ectopic Cervical Thymoma: An Uncommon Entity. Indian J Otolaryngol Head Neck Surg 2022; 74:5884-5887. [PMID: 36742565 PMCID: PMC9895253 DOI: 10.1007/s12070-021-02481-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
Thymomas originates from the epithelial cells of thymic tissue. These tumors commonly occur in the anterior mediastinum. However, thymomas can arise anywhere from the aberrant or remnant thymus in the neck or mediastinum. Ectopic cervical thymoma is a rare disease. It is important to be aware that cervical masses can also be thymomas rather than thyroid or parathyroid masses. Here, we present a case of a 62-year-old female who presented with swelling in the neck and was diagnosed with cervical thymoma type AB.
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Affiliation(s)
- Nikitha Kairanna
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Geetha Vasudevan
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Veena Karanth
- Department of Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Krishna Sharan
- Department of Radiotherapy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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3
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Guilmette J, Dias-Santagata D, Lennerz J, Selig M, Sadow PM, Hill DA, Nosé V. Primary Thyroid Neoplasm with Fetal Morphology Associated with DICER1 Mutations: Expanding the Diagnostic Profile of Thyroblastoma. Thyroid 2022; 32:1423-1428. [PMID: 36178347 PMCID: PMC9918346 DOI: 10.1089/thy.2022.0060] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: Thyroblastoma, a primary thyroid neoplasm with histological features of primitive thyroid tissue has recently been described and is included as a distinct entity in the most recent edition of the World Health Organization (WHO) Classification of Tumors (5th edition). In this study, we expand the clinical, morphological, and molecular profile of this aggressive neoplasm. Patient Findings: The patients are females, 19 and 45 years of age, referred for large thyroid nodules. Tumor morphology is biphasic, composed of nests and follicles of epithelial cells, some with colloid-like secretions reminiscent of fetal thyroid follicles intertwined with a primitive stromal spindle cell component. By immunohistochemistry, the epithelial component is diffusely positive for PAX8 and TTF1 markers. Molecular studies showed DICER1 aberrations. Conclusion: A primary primitive thyroid malignancy reminiscent of early fetal embryology with no teratoid element, recently reported as thyroblastoma represents a unique entity, novel in its description, and is likely underdiagnosed.
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Affiliation(s)
- Julie Guilmette
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dora Dias-Santagata
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jochen Lennerz
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Martin Selig
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter M. Sadow
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dana Ashley Hill
- Division of Pathology, Center for Genetic Medicine Research, Children's National Health System, Washington, District of Columbia, USA
- Department of Integrative Systems Biology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - Vania Nosé
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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4
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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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5
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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: 334] [Impact Index Per Article: 167.0] [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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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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7
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Zhang T, He L, Wang Z, Dong W, Sun W, Zhang P, Zhang H. Follicular dendritic cell sarcoma presenting as a thyroid mass: an unusual case report and literature review. J Int Med Res 2020; 48:300060520920433. [PMID: 32589853 PMCID: PMC7436806 DOI: 10.1177/0300060520920433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Thyroid follicular dendritic cell sarcoma (FDCS) is an extremely rare malignancy that originates from follicular dendritic cells of the germinal centers and is characterized by the neoplastic proliferation of spindled to ovoid cells. As there have been only five cases reported in the literature until now, the diagnostic and therapeutic information available to clinicians regarding thyroid FDCS is fairly limited. To our knowledge, this is the first case report of thyroid FDCS without a history of Hashimoto’s thyroiditis. A 48-year-old woman was found to have a slow-growing mass in the left thyroid. After total thyroidectomy and left modified radical neck dissection, the specimen demonstrated morphologic and immunohistochemical features of FDCS. The patient had a favorable prognosis with no evidence of disease 11 months after tumor excision.
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Affiliation(s)
- Ting Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Liang He
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhihong Wang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wenwu Dong
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ping Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
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8
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Demirel D, Erkul E, Erkılıç S, Narlı Issın G, Ramzy I. Primary Synovial Sarcoma of the Thyroid: Challenges in Cytologic Diagnosis and Review of the Literature. Acta Cytol 2020; 64:498-506. [PMID: 32454502 DOI: 10.1159/000507312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/17/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary synovial sarcoma (SS) of the thyroid (PSST) is extremely rare. Its differential diagnosis from other neoplasms is essential since it has different management protocols and prognosis. CASE A 26-year-old man with a 4.5-cm solid lobulated mass was seen at an outside hospital. Fine needle aspiration (FNA) was interpreted as a papillary carcinoma, and a total thyroidectomy was performed. The final histologic diagnosis was spindle epithelial tumor with thymus-like differentiation (SETTLE). No metastases were detected at that time, and the patient received radioactive iodine treatment. Two years post-surgery, he was seen at our hospital with a local recurrence, and FNA was considered as consistent with SETTLE. The mass was resected, and a left modified radical neck dissection was performed. The tumor revealed necrosis and a high mitotic index. Following histologic, immunohistochemical, and molecular studies, the tumor was classified as a PSST. The patient received chemotherapy and targeted immunotherapy, but he died 41 months after the initial presentation. CONCLUSION The main diagnostic pitfall of PSST is SETTLE. The presence of mitotic figures and basal lamina material, negative staining for smooth muscle actin, and positive staining for transducer-like enhancer of split 1 antibody favor SS over SETTLE. SYT gene rearrangement is essential to establish the definitive diagnosis of PSST.
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Affiliation(s)
- Dilaver Demirel
- Department of Pathology, University of Health Sciences, Medical School, Gaziosmanpasa Health Application and Research Center, Istanbul, Turkey,
| | - Evren Erkul
- Department of Otorhinolaryngology, University of Health Sciences, Gulhane Medical School, Sultan Abdulhamid Han Health Application and Research Center, Istanbul, Turkey
| | - Suna Erkılıç
- Department of Pathology, Gaziantep University, Medical School, Gaziantep, Turkey
| | - Gizem Narlı Issın
- Department of Pathology, Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Ibrahim Ramzy
- Department of Pathology and Laboratory Medicine, University of California, Irvine, California, USA
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9
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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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10
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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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11
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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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12
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Waters D, Obeidin F, Alexiev BA, Rao MS, Peabody TD, Agulnik M, Yeldandi A. Ectopic hamartomatous thymoma in an immunocompromised male. Pathol Res Pract 2019; 215:152497. [PMID: 31257088 DOI: 10.1016/j.prp.2019.152497] [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] [Received: 03/21/2019] [Revised: 05/27/2019] [Accepted: 06/08/2019] [Indexed: 11/16/2022]
Abstract
Ectopic hamartomatous thymoma (EHT) is a rare benign neoplasm classically occurring in the lower neck of adult males. Here we present a case of EHT occurring in a 43-year-old immunocompromised male and a brief review of existing literature. The patient presented with a palpable mass overlying the left clavicle which, on imaging, showed a solitary nodule possibly eroding the cortical bone. A biopsy predominantly showed spindle cells that were immunopositive for keratin AE1/AE3 as well as weakly positive for CD99, SMA, and CD34. A diagnosis of synovial sarcoma was favored; at which point surgical resection was performed. The resected mass was well-demarcated with a tan-yellow cut surface. Microscopically, the lesion was composed of a mixture of spindle cells, glands, and mature adipose tissue. The spindle cells were plump with bland nuclei, and the epithelial component showed morphology similar to glands of salivary or breast tissue with a bilayered appearance (luminal and basal). No pleomorphism, mitotic figures, or necrosis was present. Immunohistochemical stains were performed and showed the spindle cells to express a myoepithelial phenotype (cytokeratin AE1/AE3, p63, calponin positive). The glands showed SMA and p63 positivity in the basal cells (similar to salivary gland and breast). Overall, given the clinical context, histomorphologic, and immunohistochemical profile, a diagnosis of EHT was made. At 12 months of follow-up there was no evidence of recurrence.
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Affiliation(s)
- David Waters
- Northwestern University, 303 E Chicago Ave Ward 3-140 W127, Chicago, 60611, United States.
| | - Farres Obeidin
- Northwestern University, 303 E Chicago Ave Ward 3-140 W127, Chicago, 60611, United States
| | - Borislav A Alexiev
- Northwestern University, 303 E Chicago Ave Ward 3-140 W127, Chicago, 60611, United States
| | - M Sambasiva Rao
- Northwestern University, 303 E Chicago Ave Ward 3-140 W127, Chicago, 60611, United States
| | - Terrance D Peabody
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, 675 N Saint Clair St, Chicago, IL, 60611, United States
| | - Mark Agulnik
- Department of Internal Medicine - Medical Oncology, Northwestern University Feinberg School of Medicine, 675 N Saint Clair St, Chicago, IL, 60611, United States
| | - Anjana Yeldandi
- Northwestern University, 303 E Chicago Ave Ward 3-140 W127, Chicago, 60611, United States
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13
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Wei J, Yang J, Liang W, Xu C, Wen Y. Clinicopathological features of primary thyroid leiomyosarcoma without Epstein-Barr virus infection: A case report. Oncol Lett 2019; 17:281-287. [PMID: 30655765 PMCID: PMC6313169 DOI: 10.3892/ol.2018.9609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/07/2018] [Indexed: 12/12/2022] Open
Abstract
Primary thyroid leiomyosarcoma (LMS) is a rare tumor type with an unusual location, the diagnosis is based entirely on histological and immunohistochemical evaluations. In the present study, a rare case of a 74-year-old female patient who exhibited a right anterior neck mass for 12 months, which rapidly enlarged for the last 3 months. Ultrasound of the thyroid revealed a 55×42 mm hypoechoic mass with clear margins in the right lobe. Histological examination of the tumor demonstrated malignant spindle cells in interlacing fascicles and whorls. Additionally, nuclear pleomorphism, tumor giant cells, necrosis and abnormal mitotic figures were observed. The immunohistochemistry indicated that the tumor cells were strongly positive for smooth muscle actin, desmin, p53 and vimentin expression, but negative for cytokeratin, epithelial membrane antigen, thyroid transcription factor-1, paired box-8, 34βE12, cytokeratin 5/6, cluster of differentiation (CD)117, myoglobin, S100, p16. The final histopathological diagnosis was primary thyroid LMS.
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Affiliation(s)
- Jianguo Wei
- Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang 312000, P.R. China
| | - Jianfeng Yang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang 312000, P.R. China
| | - Wenqing Liang
- Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang 312000, P.R. China
| | - Chunwei Xu
- Department of Pathology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian 350014, P.R. China
| | - Yuanyuan Wen
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhoushan, Zhejiang 316021, P.R. China
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14
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Lee S, Kim YS, Lee JH, Hwang SH, Oh YH, Ko BK, Ham SY. Spindle epithelial tumor with thymus-like differentiation of the thyroid in a 70-year-old man. Ann Surg Treat Res 2018; 94:337-341. [PMID: 29854712 PMCID: PMC5976575 DOI: 10.4174/astr.2018.94.6.337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/01/2017] [Accepted: 06/27/2017] [Indexed: 12/02/2022] Open
Abstract
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare tumor of the thyroid gland mostly occurring in young patients. The imaging findings of SETTLE tumors are yet to be defined. However, they are usually described as well-defined heterogeneously enhanced masses on CT scan. The current case has the potential growth as compared with a 2009 chest radiography. We took into account the possibility of SETTLE in the case of a bulky mass in patients over 70 years old, particularly in the lower neck. Herein, we report a case of the oldest patient so far. The patient underwent a right lobectomy of the thyroid and mass excision. Follow-up CT scans after 6 months revealed no local recurrence. Surgery is the gold standard treatment for SETTLE. Chemotherapy and radiotherapy could be another possible option for patients with advanced stage SETTLE.
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Affiliation(s)
- Sunhye Lee
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yon Seon Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jeong Hyeon Lee
- Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yu-Hwan Oh
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byung Kyun Ko
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Medical Center, Seoul, Korea
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15
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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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16
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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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