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Chen J, Zhou M, Hu J, Xu F. A case of intrathyroid thymic carcinoma. Asian J Surg 2024; 47:634-635. [PMID: 37805320 DOI: 10.1016/j.asjsur.2023.09.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Jia Chen
- Shaoxing People's Hospital, Shaoxing, 312000, China; School of Medicine, ShaoXing University, Shaoxing, 312000, China
| | - Minghui Zhou
- School of Medicine, ShaoXing University, Shaoxing, 312000, China; Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Jingjing Hu
- School of Medicine, ShaoXing University, Shaoxing, 312000, China; Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Feng Xu
- Shaoxing People's Hospital, Shaoxing, 312000, China.
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Liang J, Huang M, Huang H, Li L, Luo H, Mao W, Gao S, Xu H. Intrathyroidal Thymic Carcinoma: A Retrospective Case Series Study. EAR, NOSE & THROAT JOURNAL 2023; 102:584-589. [PMID: 36408572 DOI: 10.1177/01455613221141225] [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] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Intrathyroidal thymic carcinoma (ITC) is a rare low-grade malignant thyroid tumor. There is neither sufficient understanding of this tumor nor its clinical treatment. This study is to explore the clinicopathological features, treatment, and prognosis of ITC and thereby provide a reference for the diagnosis and treatment of the disease. METHODS The clinical, pathological, therapeutic, and prognostic data of 13 patients with ITC were retrospectively analyzed. RESULTS The case series comprised 7 males and 6 females, with an average age of 51.9 ± 10.1 years. After surgical resection, all patients received post-operative neck radiotherapy at dosages of 60-66 Gy. Five patients with level VI lymph node metastasis additionally received 6 courses of cisplatin chemotherapy. All patients were followed-up for 21-132 months (median = 66 months), and all of them survived without recurrence or metastasis. CONCLUSIONS The diagnosis of ITC depends mainly on pathological and immunohistochemical results, particularly CD5 positive staining. Surgical resection is the preferred primary treatment modality which can be supplemented with radiotherapy and chemotherapy to reduce the risk of recurrence and metastasis.
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Affiliation(s)
- Jinhui Liang
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Mei Huang
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Helang Huang
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Li Li
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Hailin Luo
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Weidong Mao
- Department of Pathology, Hanzhong Central Hospital, Hanzhong, China
| | - Shan Gao
- Department of Radiotherapy, Hanzhong Central Hospital, Hanzhong, China
| | - Haoxiang Xu
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
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Lu D, Zhang Y, Zhao R, Zhou E, Xue X, Li C, Huang S, Chen X. Spindle Epithelial Tumor With Thymus-Like Differentiation of Thyroid (SETTLE): A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2023:1455613231171826. [PMID: 37247430 DOI: 10.1177/01455613231171826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Spindle epithelial tumor with thymus-like differentiation of thyroid (SETTLE) is very rare neoplasm with 2 cellular forms, epithelial cell and spindle cell, and most reported cases have been in young people. An 11-year-old boy presented with painless swelling of the right neck lasting for more than 2 months. A tumor size measuring approximately 3 × 3 cm was resected, and intraoperative frozen pathology suggested a spindle cell tumor, which was confirmed as SETTLE by immunohistochemical staining and external hospital consultation. The immunohistochemical staining profile of the resected tumor tissue was as follows: cytokeratin (CK) (+), smooth muscle actin (weak+), vimentin (+), CK7 (focal+), B-cell lymphoma 2 (partial+), CD99 (-), calcitonin (+), galectin-3 (+), CK19 (+), and Ki-67 (10%+). Ultrasound at 1-year postoperative follow-up revealed no local recurrence of the lesion or lymph node metastasis in the thyroid gland. We summarized the disease characteristics of SETTLE among 6 cases reported to date and found that SETTLE is associated with a good prognosis and low postoperative recurrence rate. Thus, for this type of malignant thyroid tumor, diagnosis depends mainly on postoperative pathology and immunohistochemical staining and simple surgical resection is recommended.
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Affiliation(s)
- Dan Lu
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Yi Zhang
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Runyu Zhao
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Enhui Zhou
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Xiaocheng Xue
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Can Li
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Shuixian Huang
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Xiaoping Chen
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
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Yanhai WMD, Hua YMD, Hanqing LMD, Xiaoli LMD, Luying LBS, Pingting ZBS. Ultrasonographic Features of Intrathyroidal Thymic Carcinoma: Review and Analysis of 10 Cases. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yamamoto H, Kusafuka K, Nozaki Y, Iwasaki T, Nogami M, Hongo T, Yasumatsu R, Oda Y. Carcinoma showing thymus-like differentiation (CASTLE) of the salivary gland: Report of 2 cases of a hitherto under-recognized extrathyroid counterpart. Pathol Res Pract 2021; 227:153646. [PMID: 34649052 DOI: 10.1016/j.prp.2021.153646] [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: 05/04/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
Carcinoma showing thymus-like differentiation (CASTLE) outside the thyroid gland is extremely rare. Here we report two cases of CASTLE of the major salivary gland. The tumors occurred in the parotid gland of a 31-year-old female (Case 1) and in the submandibular gland of a 40-year-old female (Case 2). Both tumors showed a lobulated growth pattern, and were histologically composed of a nested or sheet-like proliferation of carcinoma cells with round- to oval-shaped nuclei, distinct nucleoli and pale eosinophilic cytoplasm, accompanied by various degrees of lymphocytic infiltration. Immunohistochemical staining revealed that the tumors were positive for pan-cytokeratin, p40, CD5, CD117 and bcl-2. In addition, PD-L1 expression was seen in 10-90% of tumor cells. After the initial surgery, Case 1 remained tumor-free for 20 months, while Case 2 suffered lymph node recurrence at 4 months, followed by lung metastasis, which was treated with chemoradiotherapy and anti-PD-1 immune checkpoint inhibitor, resulting in a partial response. The present findings indicate that an extrathyroid counterpart of CASTLE can occur as a primary salivary gland neoplasm. Salivary CASTLEs seem to show a wide range of biological behavior, and long-term follow-up may be needed. Immune checkpoint inhibitor targeting PD-1 might become a promising treatment option in patients with CASTLE; however, further study with a larger number of cases is necessary to establish the optimal therapeutic strategy and prognostic factors for this rare cancer.
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Affiliation(s)
- Hidetaka Yamamoto
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan; Division of Pathology, Kyushu University Hospital, Fukuoka, Japan.
| | | | - Yui Nozaki
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan; Division of Pathology, Kyushu University Hospital, Fukuoka, Japan
| | - Tomohiro Iwasaki
- Department of Pathology, Shizuoka General Hospital, Shizuoka, Japan
| | - Miwako Nogami
- Division of Pathology, Kyushu University Hospital, Fukuoka, Japan
| | - Takahiro Hongo
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Ryuji Yasumatsu
- Department of Otorhinolaryngology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
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Ardighieri L, Tomasoni M, Battocchio S, Facchetti F, Maroldi R, Nicolai P, Lombardi D. Carcinoma Showing Thymus-Like Differentiation (CASTLE) Arising in the Sublingual Gland. Int J Surg Pathol 2020; 29:301-307. [PMID: 32672084 DOI: 10.1177/1066896920941604] [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] [Indexed: 01/12/2023]
Abstract
Carcinoma showing thymic-like differentiation (CASTLE) is a rare tumor most commonly occurring in the thyroid and soft tissues of the neck. We report the first case of CASTLE occurring in the sublingual gland. The patient, a 35-year-old healthy man, presented with a submucosal lesion located in the anterior right floor of the oral cavity and an ipsilateral neck mass. The lesion had been previously investigated by neck computed tomography and ultrasound-guided fine needle aspiration cytology and diagnosed as metastatic squamous cell carcinoma. After oral cavity magnetic resonance imaging, positron emission tomography, and a non-diriment, fine needle aspiration cytology of the sublingual mass, the patient was treated as affected by a sublingual gland malignancy with removal of primary tumor and neck dissection. Morphological and immunohistochemical findings were diagnostic for primary sublingual gland CASTLE. The patient received adjuvant radiotherapy and is free of disease 2 years after treatment. We describe the pathological features of the lesion and discuss the possible differential diagnoses.
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Jiang L, Zheng WH, Xi Y, Chen C. An extrathyroid CASTLE tumor in the left neck. Oral Oncol 2020; 109:104656. [PMID: 32245700 DOI: 10.1016/j.oraloncology.2020.104656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Lin Jiang
- Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Hangzhou, PR China; Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, PR China; Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Wei-Hui Zheng
- Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Hangzhou, PR China; Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, PR China; Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Yun Xi
- Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Hangzhou, PR China; Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, PR China; Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Chao Chen
- Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Hangzhou, PR China; Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, PR China; Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, PR China.
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Kong F, Ying H, Zhai R, Du C, Huang S, Zhou J, He X, Hu C, Wang Z, Sun T, Ji Q. Clinical outcome of intensity modulated radiotherapy for carcinoma showing thymus-like differentiation. Oncotarget 2018; 7:81899-81905. [PMID: 27626313 PMCID: PMC5348440 DOI: 10.18632/oncotarget.11914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/02/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the efficacy and toxicity of adjuvant intensity-modulated radiotherapy (IMRT) after surgery for carcinoma showing thymus-like differentiation (CASTLE). METHODS Between September 2008 and June 2015, 14 CASTLE patients were retrospectively enrolled. The clinical features, treatment procedure and clinical outcomes were reviewed. All patients received postoperative IMRT. The radiation doses ranged from 56Gy/28 fractions to 66Gy/33 fractions. Treatment-related toxicities were graded by National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 3.0. RESULTS After a median follow-up period of 42 months, only one patient suffered local recurrence and distant metastasis. The most frequently seen acute toxicities were mucositis and dermatitis (grade 1-2). No grade 3-4 toxicities were observed. CONCLUSIONS Although based upon a small series of consecutively treated patients, our study showed that adjuvant IMRT provides satisfactory local-regional control for CASTLE, with acceptable toxicities. Further studies are still warranted to clarify our findings.
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Affiliation(s)
- Fangfang Kong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Ruiping Zhai
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Chengrun Du
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Shuang Huang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, P. R. China
| | - Junjun Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Zhuoying Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Tuanqi Sun
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Qinghai Ji
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
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Wu B, Sun T, Gu Y, Peng W, Wang Z, Bi R, Ji Q. CT and MR imaging of thyroid carcinoma showing thymus-like differentiation (CASTLE): a report of ten cases. Br J Radiol 2016; 89:20150726. [PMID: 26954328 DOI: 10.1259/bjr.20150726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To study the CT and MR imaging features of carcinoma showing thymus-like differentiation (CASTLE) and to raise awareness of this rare thyroid tumour. METHODS The imaging appearances of 10 CASTLE tumours confirmed by surgical pathology were retrospectively reviewed and correlated with clinical and histological findings. RESULTS Seven patients with newly diagnosed and three patients with recurrent tumours were identified (six males and four females). CASTLE tumours were commonly located in the lower neck between the inferior pole of the thyroid and the upper mediastinum. The average tumour size was 4.2 cm (range: 2.5-6 cm). On plain CT scans, most tumours were ill-defined nodular masses of uniform density. After enhancement, most cases showed mild enhancement, while heterogeneous enhancement could be seen in more than half the cases. On the MR images, tumours presented with homogeneous isointensity on T1 weighted images and they appeared to be slightly hyperintense on T2 weighted images. On post-contrast images, marked enhancement was seen in two patients, and heterogeneous enhancement was seen in three cases. Aggressive local infringements mainly included the ipsilateral strap muscle, tracheoesophageal groove area and tracheal wall. The specimens stained positively for CD5 and CD117, indicating thymic differentiation. CONCLUSION CASTLE has no characteristic imaging features when compared with other thyroid nodules, except for its unique location in the lower neck between the inferior pole of the thyroid and the upper mediastinum. CD5- and CD117-specific immunoreactivity is useful for diagnosis. ADVANCES IN KNOWLEDGE We reported 10 cases of CT and MR images illustrating the features of CASTLE, and we raised the level of awareness of this rare malignant thyroid tumour.
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Affiliation(s)
- Bin Wu
- 1 Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan Univerisity, Shanghai, China
| | - Tuanqi Sun
- 2 Department of Oncology, Shanghai Medical College, Fudan Univerisity, Shanghai, China.,3 Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China
| | - Yajia Gu
- 1 Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan Univerisity, Shanghai, China
| | - Weijun Peng
- 1 Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan Univerisity, Shanghai, China
| | - Zhuoying Wang
- 2 Department of Oncology, Shanghai Medical College, Fudan Univerisity, Shanghai, China.,3 Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China
| | - Rui Bi
- 2 Department of Oncology, Shanghai Medical College, Fudan Univerisity, Shanghai, China.,4 Department of Pathology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China
| | - Qinghai Ji
- 2 Department of Oncology, Shanghai Medical College, Fudan Univerisity, Shanghai, China.,3 Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China
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