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Pham HT, Nguyen HP, Van Nguyen C, Van Dao T, Nguyen AV, Le UT. Intra thyroid thymic carcinoma: A case report and literature review. Int J Surg Case Rep 2024; 119:109762. [PMID: 38762961 PMCID: PMC11126938 DOI: 10.1016/j.ijscr.2024.109762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intrathyroid thymic carcinoma (ITC) is a malignant epithelial tumor with thymic differentiation within the thyroid gland. Its frequency is up to 0.15 % of all malignant thyroid tumors. It is frequently a low-grade tumor. The clinical status is often misleading to other more advanced tumors like cervical lymph node metastasis of nonkeratinizing squamous cell carcinoma, undifferentiated variant, dedifferentiated carcinoma, and medullary carcinoma of the thyroid. CASE PREPARATION The patient came to us with the diagnosis of cervical lymph node metastasis of undifferentiated carcinoma. This patient was first diagnosed with cervical lymph node metastasis in the previous hospital. After having an ITC diagnosis, the patient was operated on the rennet of thyroid glands and had a low dose of radio-chemotherapy for recurrent prevention purposes. It is the first case of such a disease diagnosed at our hospital and also the first case reported in Vietnam. CLINICAL DISCUSSION ITC is rare and appears similar to all thymic carcinoma variants. The most popular type is squamous carcinoma. Immunohistochemical stains are typical for thymic origin tumors with CD5, CD117 positive. ITC is often negative for monoclonal PAX8 but positive in this case (MRQ-50 clone, Sigma-Aldrich). This finding is an exciting one that should considered. CONCLUSION Reporting the case increases the awareness of the disease, especially among Vietnam Doctors and patients.
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Affiliation(s)
- Han Thi Pham
- Quansu pathology and cytology department, Vietnam National Cancer Hospital, Campus 1, 43 Quansu Str., Hoankiem Dist., Hanoi, Viet Nam.
| | - Hoa Phuong Nguyen
- Quansu pathology and cytology department, Vietnam National Cancer Hospital, Campus 1, 43 Quansu Str., Hoankiem Dist., Hanoi, Viet Nam
| | - Chu Van Nguyen
- Quansu pathology and cytology department, Vietnam National Cancer Hospital, Campus 1, 43 Quansu Str., Hoankiem Dist., Hanoi, Viet Nam
| | - Tu Van Dao
- High-Quality Treatment Department, Vietnam National Cancer Hospital, Campus 1, 43 Quan Su, Hoan Kiem, Hanoi
| | - Anh Viet Nguyen
- Head and Neck Radiotherapy Department, Vietnam National Cancer Hospital, Campus 3, 30 Caubuou Str., Thanhtri Dist., Hanoi, Viet Nam
| | - Uyen Thi Le
- Quansu pathology and cytology department, Vietnam National Cancer Hospital, Campus 1, 43 Quansu Str., Hoankiem Dist., Hanoi, Viet Nam
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Gao Y, Pan Y, Luo Y, Cheng R, Zhai Q. Intrathyroid thymic carcinoma: A clinicopathological analysis of 22 cases. Ann Diagn Pathol 2023; 67:152221. [PMID: 37925863 DOI: 10.1016/j.anndiagpath.2023.152221] [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: 09/29/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Intrathyroid thymic carcinoma (ITTC) is a rare malignancy. The current understanding of ITTC is inadequate, and there is no standard treatment for ITTC. In the present study, we aimed to explore the clinicopathological characteristics of ITTC and identify potential therapeutic targets. METHODS The clinicopathological characteristics of 22 ITTC patients at our institution were reviewed. The expression of DNA mismatch repair (MMR) proteins and PD-L1 in ITTC were assessed by immunohistochemistry (IHC). RESULTS All patients underwent surgery. There were nine females and 13 males, with a slight male predominance. Their ages ranged from 42 to 79 years (average, 54. 1 years). The diameters of the neck masses ranged from 10 to 100 mm (average, 39 mm). Ipsilateral lymph node (LN) dissection was performed in 18 patients: 12 demonstrated LN metastasis, six showed no LN metastasis, and no lymph nodes were dissected in four. One patient had liver metastasis. CK5/6, P63, CD5, and CD117 were expressed in all cases. All cases were negative for TTF1, PAX8, thyroglobulin, and BRAF V600E. DNA MMR protein expression was retained in all tested tumors, and EBV-encoded small RNA (EBER) in situ hybridization was consistently negative. The Ki67 proliferation index ranged from 10 to 70 %. All patients were followed-up for 14-134 months, four died, six were lost to follow-up, and the remaining patients survived without disease. The PD-L1 combined positive score ranged from 10 to 80 (average: 40). CONCLUSION Our results confirm that CD5 and CD117 co-expression support a diagnosis of ITTC. All tumors in this cohort were DNA MMR-proficient and were not associated with Epstein-Barr virus (EBV) infection. A high CPS for PD-L1 suggests that immune checkpoint inhibitor therapy may be worthy of further exploration in patients with ITTC.
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Affiliation(s)
- Yanan Gao
- Department of Pathology, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Hexi District, Tianjin 300060, China.
| | - Yi Pan
- Department of Pathology, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Hexi District, Tianjin 300060, China
| | - Ye Luo
- Department of Pathology, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Hexi District, Tianjin 300060, China
| | - Runfen Cheng
- Department of Pathology, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Hexi District, Tianjin 300060, China
| | - Qiongli Zhai
- Department of Pathology, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Hexi District, Tianjin 300060, China
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Jin X, Huang Z, Guo P, Yuan R. TOETVA: a single surgeon's learning curve and a case report of CASTLE thyroid tumor. Langenbecks Arch Surg 2023; 408:398. [PMID: 37831199 DOI: 10.1007/s00423-023-03140-8] [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: 07/06/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Owing to the lack of visible scars, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers superior aesthetic outcomes compared to conventional thyroidectomy. Carcinoma showing thymus-like differentiation (CASTLE) represents a rare thyroid gland neoplasm. This study aimed to explore the TOETVA learning curve and present a case report of CASTLE. METHODS A study with precise 1:1 matching was conducted to assess the procedure safety and cancer control outcomes of TOETVA in comparison to conventional surgery between May 2020 and May 2023. Cumulative sum analysis was employed to optimally fit the learning curve. Subsequently, a case report of CASTLE treated with TOETVA surgery was presented. RESULTS The mean operative time was longer in the TOETVA group than in the open group. The TOETVA group had a higher incidence of skin numbness and excellent cosmetic outcomes compared to the open group. The learning curves for work area preparation, unilateral thyroid lobectomy, and the entire surgical process were 59, 28, and 50 cases, respectively. There were no differences between the learning and proficient groups, except for operative time, intraoperative blood loss, and drainage volume on the first postoperative day. CONCLUSIONS A comprehensive analysis of the TOETVA learning curve utilizing cumulative and analytical methods demonstrated the feasibility of TOETVA with regards to surgical integrity, safety, and oncological safety. This study's findings suggest that a surgeon's cumulative number of TOETVA cases exceeding 50 can reach the mastery stage. Moreover, diagnosing CASTLE is challenging and necessitates immunohistochemical detection of relatively specific markers associated with thymic epithelial tumors.
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Affiliation(s)
- Xiaohu Jin
- Department of Thyroid and Breast Surgery, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Chongchuan District, No. 6, North Child Lane, Nantong, Jiangsu, China
| | - Zhiqi Huang
- Department of Thyroid and Breast Surgery, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Chongchuan District, No. 6, North Child Lane, Nantong, Jiangsu, China
| | - Peng Guo
- Department of Gastrointestinal Surgery, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Nantong, China
| | - Ronghua Yuan
- Department of Thyroid and Breast Surgery, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Chongchuan District, No. 6, North Child Lane, Nantong, Jiangsu, China.
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Cui A, Du Y, Hou C, Zhang L, Sun L, He H. Case Reports: A role of postoperative radiation therapy in completely resected early stage intrathyroid thymic carcinoma: a case report and literature review of the diagnosis and treatment. Front Oncol 2023; 13:1234961. [PMID: 37849817 PMCID: PMC10577444 DOI: 10.3389/fonc.2023.1234961] [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: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 10/19/2023] Open
Abstract
Background Intrathyroid thymic carcinoma (ITTC) is a rare malignant tumor of the thyroid, probably arising from ectopic thymus or branchial pouch remnants. Most of the literature recommended radical resection as the fundamental treatment for ITTC, and postoperative radiation appears to be able to reduce the recurrence rate in patients with advanced ITTC. However, the issue of adjuvant radiotherapy in completely resected early-stage ITTC has been controversial. Case presentation Here, we reported a new case of early-stage ITTC that treated with total thyroidectomy and the right central neck dissection. Postoperative external beam radiation therapy (50.0 Gy/25 fractions) was given to the thyroid bed and bilateral cervical lymph node area since the tumor involved part of the sternal thyroid muscle. At 4-year follow-up after completion of radiotherapy, she is without evidence of locally recurrent or distant disease. Conclusion Since there are no current guidelines for early-stage ITTC, in combination with this case and previous literature, we may suggest routine adjuvant radiotherapy should be considered in patients with incompletely resected tumors and extraparenchymal extension of ITTC. Moreover, we summarized comprehensive and advanced diagnosis, treatment, prognosis of ITTC and comparison between ITTC, primary squamous cell carcinoma of thyroid gland, differentiated thyroid cancer, and anaplastic thyroid cancer.
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Affiliation(s)
- Ailin Cui
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yaoqiang Du
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chunjie Hou
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lin Zhang
- Department of Ultrasound, Hangzhou Children’s Hospital, Hangzhou Children’s Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Litao Sun
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hongfeng He
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Zhao Y, Liu J. Case report: Thymoid differentiated carcinoma of thyroid: Two cases. Front Surg 2023; 10:1112315. [PMID: 37181600 PMCID: PMC10174443 DOI: 10.3389/fsurg.2023.1112315] [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: 12/02/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Objective Thymoid carcinoma of the thyroid gland is a rare thyroid tumor, which is often presented in case reports. Methods The clinical data of two patients with thymic carcinoma of the thyroid gland were retrospectively reviewed. Results Case 1: a middle-aged woman who was admitted to the hospital because of "progressive enlargement of the anterior cervical mass for 8 months." Color Doppler ultrasound and CT showed malignant tumor with high possibility of bilateral cervical lymph node metastasis. Total thyroidectomy and bilateral central cervical lymph node dissection were performed. Lymph node biopsy showed the metastasis of small cell undifferentiated thyroid carcinoma. Because the biopsy pathological result was not consistent with the pathology of the primary lesion, immunohistochemistry was performed again, and the final diagnosis was thymic carcinoma in the thyroid gland. Case 2: the patient was an elderly man who was admitted to the hospital due to hoarseness for half a month. During the operation, the tumor invaded the trachea, esophagus, internal jugular vein, common carotid artery, and surrounding tissues. Palliative resection of the tumor was performed. The tumor postoperative pathology suggested thymoid carcinoma of the thyroid gland. It recurred and compressed the trachea 4 months after the operation, resulting in dyspnea of the patient, and finally tracheotomy was performed to alleviate the symptoms. Conclusion Case 1 showed multiple differences in pathological diagnosis, suggesting that the lack of specific imaging and clinical manifestations of thymoid-differentiated thyroid carcinoma made the diagnosis so difficult. Case 2 progressed rapidly, suggesting that thymoid-differentiated thyroid carcinoma was not always inert, and the treatment and follow-up should follow the principle of individualization.
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Kuroki M, Shibata H, Iinuma R, Okuda H, Ohashi T, Ogawa T, Horikawa Y. A Case of Thyroid Carcinoma Showing Thymus-Like Differentiation With Breast Cancer Susceptibility Gene 2 Mutation: A Case Report and Literature Review. Cureus 2022; 14:e30655. [DOI: 10.7759/cureus.30655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
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Stanciu M, Ristea RP, Popescu M, Vasile CM, Popa FL. Thyroid Carcinoma Showing Thymus-like Differentiation (CASTLE): A Case Report. Life (Basel) 2022; 12:life12091314. [PMID: 36143350 PMCID: PMC9503371 DOI: 10.3390/life12091314] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Carcinoma showing thymus-like differentiation (CASTLE) is a low-grade thyroid carcinoma, with an indolent clinical course and usually a favorable prognosis. The clinical and imagistic features are not specific for CASTLE but similar to other malignant lesions of the thyroid. Definite diagnosis is based on an immunohistochemical examination, as this carcinoma shows positive CD5 immunoreactivity when compared to other aggressive thyroid carcinomas. Case presentation: The main focus of this study is to outline a rare case of CASTLE compressing the trachea in a 50-year-old female patient who was initially diagnosed with undifferentiated thyroid carcinoma, for which she underwent unsuccessful surgery, as well as postoperative radiotherapy and chemotherapy. After receiving a second medical opinion, the patient underwent a challenging radical resection consisting in total thyroidectomy and central neck dissection, with no local recurrence after 6 months and 2 years of follow-up and negative metastatic follow-up. The correct diagnosis has been established based on pathological and immunohistochemical examinations. Conclusions: In summary, the diagnosis of CASTLE is difficult and requires an experienced histological analysis and CD5 immunoreactivity. Lack of metastasis, complete removal of the tumor, and a low degree of tumor infiltration into nearby structures are all associated with better long-term survival.
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Affiliation(s)
- Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Ruxandra Paula Ristea
- Department of Endocrinology, County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Mihaela Popescu
- Department of Endocrinology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (M.P.); (C.M.V.)
| | - Corina Maria Vasile
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
- Correspondence: (M.P.); (C.M.V.)
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
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Jiang L, Zheng W, Chen C. Genomic variation associated with carcinoma showing thymus‐like elements (
CASTLE
) in thyroid gland. Laryngoscope Investig Otolaryngol 2022; 7:894-900. [PMID: 35734076 PMCID: PMC9194970 DOI: 10.1002/lio2.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/26/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Lin Jiang
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences Hangzhou China
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province Hangzhou China
| | - Wei‐Hui Zheng
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences Hangzhou China
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province Hangzhou China
| | - Chao Chen
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences Hangzhou China
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province Hangzhou China
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Ibrahiem AT, Fawzy MS, Abdulhakim JA, Toraih EA. GLUT1 and ASCT2 Protein Expression in Papillary Thyroid Carcinoma Patients and Relation to Hepatitis C Virus: A Propensity-Score Matched Analysis. Int J Gen Med 2022; 15:2929-2944. [PMID: 35308569 PMCID: PMC8932928 DOI: 10.2147/ijgm.s354108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/07/2022] [Indexed: 12/11/2022] Open
Abstract
Purpose Recently, glucose and amino acid transporters have gradually become a hot topic in thyroid gland biology and cancer research. We aimed to investigate the expressions of glucose transporter 1 (GLUT1) and glutamine transporter 2 (ASCT2) in papillary thyroid carcinoma (PTC) and their clinical significance and relation to HCV-related hepatitis. Patients and Methods Screening 202 TC tissue samples against the selection criteria using a propensity-score matched analysis to adjust for age, sex, side of tumor, histopathological variants, TNM staging system, and the positivity for HCV yielded 51 matched (17 HCV positive and 34 HCV negative) PTC samples. The expressions of GLUT1 and ASCT2 expressions were detected by immunohistochemical staining. Kaplan–Meier survival curves were generated for disease-free and overall survival, and multivariate Cox regression analysis was applied to identify predictors for mortality. Results Of 51 thyroid cancer tissues, 85% showed positive GLUT1 cytoplasmic staining, and 26% had a high expression score. All thyroid cancer specimens demonstrated ASCT2 cytoplasmic staining with membranous accentuation. Of these, 78% showed a high expression score, and 22% showed weak staining. On stratifying the study cohort based on the HCV status, HCV negative cohort showed a significantly higher immunoreactivity score for GLUT1 (p = 0.004) but not ASCT2 (p = 0.94) than HCV positive group. The expressions of the studied transporters showed no significant associations with the prognostic features of PTC nor the disease-free/overall survival. Conclusion GLUT1 and ASCT2 immunohistochemical staining showed positive expression with variable intensity in nearly 85% and 100% of PTC tissue samples compared to normal ones, respectively. Furthermore, GLUT1 protein expression, not ASCT2, showed a higher immunoreactivity score in PTC patients who are negative for HCV than cancer patients with positive HCV. Meanwhile, the expression of both protein markers was not associated with the clinicopathological characteristics of the studied PTC patients. Further large-scale multicenter studies are recommended to validate the present findings.
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Affiliation(s)
- Afaf T Ibrahiem
- Department of Pathology, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Manal S Fawzy
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Correspondence: Manal S Fawzy, Tel +966 583241944, Fax +966 146640705, Email
| | - Jawaher A Abdulhakim
- Medical Laboratory Department, College of Applied Medical Sciences, Taibah University, Yanbu, Saudi Arabia
| | - Eman A Toraih
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
- Genetics Unit, Histology and Cell Biology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Walker E, Karthik S, Chengot P, Vaidyanathan S. It's not all about the thyroid! Extrinsic and unusual pathology affecting the thyroid gland: A pictorial review. Clin Imaging 2022; 85:29-42. [DOI: 10.1016/j.clinimag.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/11/2022]
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Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M. Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. Endocr Pathol 2020; 31:197-217. [PMID: 32632840 PMCID: PMC7395918 DOI: 10.1007/s12022-020-09638-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
Thyroid pathology encompasses a heterogenous group of clinicopathological entities including rare and diagnostically challenging neoplasms. The review is focused on morphological, immunohistochemical, and molecular features of rare thyroid neoplasms that can pose diagnostic problems. The tumors are organized based on growth patterns including thyroid neoplasms with predominantly papillary, follicular, solid, and spindle cell growth pattern, as well as neoplasms with distinct cytological characteristics. A special section is also dedicated to rare thyroid tumors with peculiar patterns including thyroid carcinoma with Ewing family tumor elements and intrathyroidal thymic-related neoplasms.
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Affiliation(s)
- José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), Santiago de Compostela, Spain.
- Medical Faculty, University of Santiago de Compostela, Santiago de Compostela, Spain.
- Department of Anatomic Pathology, Clinical University Hospital, Travesía Choupana s/n, 15706, Santiago de Compostela, Spain.
| | - Catarina Eloy
- i3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- Medical Faculty, University of Porto, Porto, Portugal
| | - Manuel Sobrinho-Simões
- i3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- Medical Faculty, University of Porto, Porto, Portugal
- Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
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Tahara I, Oishi N, Mochizuki K, Oyama T, Miyata K, Miyauchi A, Hirokawa M, Katoh R, Kondo T. Identification of Recurrent TERT Promoter Mutations in Intrathyroid Thymic Carcinomas. Endocr Pathol 2020; 31:274-282. [PMID: 32594366 DOI: 10.1007/s12022-020-09635-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intrathyroid thymic carcinoma (ITTC) is a rare malignant neoplasm considered to be a eutopic thymic carcinoma (TC) arising ectopically in the thyroid. Histopathologically, ITTC resembles squamous cell carcinoma of the thymus with positive TC markers such as CD5 and c-KIT. Despite these similar histological findings, ITTC is clinically less aggressive than TC. In this study, we compared clinical, histological, and genetic characteristics of ITTCs and TCs. We collected 9 ITTCs and 8 TCs with their clinicopathological profiles. Immunohistochemistry for CD5, p63, CD117/c-KIT, Ki-67, p53, TTF-1, thyroglobulin, PAX8, EGFR, and PD-L1/CD274 plus in situ hybridization for EBER was performed. We further investigated mutation status of KIT, EGFR, BRAF, and TERT promoter using Sanger sequencing. In our study, ITTCs affected significantly younger patients than TCs. After a mean follow-up of 86 months, all patients with ITTC were alive, while two patients with TC had died. Immunohistochemistry showed ITTCs and TCs had a similar immunophenotype except for EGFR and p53. Genetic analysis did not identify KIT or BRAF mutations in any ITTCs or TCs. EGFR mutations were positive in 11% (1/9) of ITTCs and 25% (2/8) of TCs. Notably, TERT promoter C228T mutation was identified in 22% (2/9) of ITTCs but none of the TCs. There were no significant differences in age, tumor size, or sex between TERT-mutated and TERT-wild-type ITTCs. Collectively, ITTC and TC have similar histopathologic and immunophenotypic features but different clinical outcomes. Recurrent TERT promoter mutation may be a key event related to cancer progression in ITTCs and warrants further investigation.
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Affiliation(s)
- Ippei Tahara
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kunio Mochizuki
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Toshio Oyama
- Department of Pathology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Kazuyuki Miyata
- Department of Pathology, Kofu Municipal Hospital, Kofu, Yamanashi, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan
| | | | - Ryohei Katoh
- Department of Pathology, Ito hospital, Tokyo, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan.
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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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14
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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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15
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Fung ACH, Tsang JS, Lang BHH. Thyroid Carcinoma Showing Thymus-Like Differentiation (CASTLE) with Tracheal Invasion: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1845-1851. [PMID: 31819030 PMCID: PMC6913266 DOI: 10.12659/ajcr.919208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 49-year-old Final Diagnosis: Thyroid carcinoma showing thymus-like differentiation (CASTLE) Symptoms: Hoarseness Medication: — Clinical Procedure: Thyroidectomy Specialty: Surgery
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Affiliation(s)
- Adrian Chi Heng Fung
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong S.A.R., China (mainland)
| | - Julian Shun Tsang
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong S.A.R., China (mainland)
| | - Brian Hung Hin Lang
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong S.A.R., China (mainland)
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16
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Lorenz L, von Rappard J, Arnold W, Mutter N, Schirp U, Scherr A, Jehle AW. Pembrolizumab in a Patient With a Metastatic CASTLE Tumor of the Parotid. Front Oncol 2019; 9:734. [PMID: 31475102 PMCID: PMC6702522 DOI: 10.3389/fonc.2019.00734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/22/2019] [Indexed: 11/25/2022] Open
Abstract
Carcinoma showing thymus-like elements (CASTLE) is a rare tumor, most commonly found in the thyroid gland. Here we report a case of CASTLE tumor localized to the parotid gland, recognized in retrospect after a late manifestation of symptomatic pleural carcinomatosis. The original tumor in the parotid gland was treated by surgery followed by radiotherapy. Ten years later, a metastatic disease with recurrent pleural effusions occurred. Pleural carcinomatosis was strongly positive for CD5, CD117, and p63 as was the original tumor of the parotid, which allowed the diagnosis of a CASTLE tumor. Additionally, the pleural tumor expressed high levels of programmed death ligand 1 (PD-L1), and the patient underwent treatment with the monoclonal PD-L1 inhibitor pembrolizumab achieving a partial remission. To the best of our knowledge, this is the first patient with a metastatic CASTLE tumor treated with a PD-L1 inhibitor.
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Affiliation(s)
- Lisa Lorenz
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Joscha von Rappard
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Walter Arnold
- Department of Pathology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Nicole Mutter
- Department of Oncology, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Udo Schirp
- Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Andreas Scherr
- Department of Pneumology, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Andreas Werner Jehle
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland.,Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
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17
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Ren WH, Dong K, Huang XZ, Zhu YL. Intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation: Case report with cytomorphology, immunocytochemistry, and review of the literature focusing on cytology. Diagn Cytopathol 2019; 47:1197-1202. [PMID: 31318494 DOI: 10.1002/dc.24281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/17/2019] [Accepted: 07/08/2019] [Indexed: 01/12/2023]
Abstract
Intrathyroidal thymic carcinoma is a malignant epithelial tumor of the thyroid gland with thymic epithelial differentiation; it is the malignant counterpart of ectopic thymoma of the thyroid gland and histologically resembles thymic carcinoma. Given its favorable prognostic course, preoperative cytological diagnosis is important to distinguish this neoplasm from other more aggressive thyroid neoplasms that can have similar or overlapping cytomorphological features. However, there is little information about the cytology of this disease available in the literature, even in the latest fourth edition of World Health Organization classification of tumors of endocrine organs. Here, we report a case of intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation in a 33-year-old woman and present a review of the literature.
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Affiliation(s)
- Wen-Hao Ren
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Dong
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiao-Zheng Huang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan-Li Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
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18
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Yang H, Zhong JT, Zhou SH, Han HM. Roles of GLUT-1 and HK-II expression in the biological behavior of head and neck cancer. Oncotarget 2019; 10:3066-3083. [PMID: 31105886 PMCID: PMC6508962 DOI: 10.18632/oncotarget.24684] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 02/28/2019] [Indexed: 12/29/2022] Open
Abstract
The Warburg effect plays an important role in the proliferation and invasion of malignant tumors. Glucose transporter 1 and hexokinase II are two key energy transporters involved in mediating the Warburg effect. This review will analyze the mechanisms of these two markers in their effects on the biological behavior of head and neck cancer.
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Affiliation(s)
- Hang Yang
- Department of Otorhinolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.,Present Address: Department of Otorhinolaryngology, The People's Hospital of Jiangshan City, Jiangshan, Zhejiang, 324100, China
| | - Jiang-Tao Zhong
- Department of Otorhinolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Shui-Hong Zhou
- Department of Otorhinolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - He-Ming Han
- Department of Otorhinolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
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19
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Suzuki A, Hirokawa M, Takada N, Higuchi M, Tanaka A, Hayashi T, Kuma S, Miyauchi A. Utility of monoclonal PAX8 antibody for distinguishing intrathyroid thymic carcinoma from follicular cell-derived thyroid carcinoma. Endocr J 2018; 65:1171-1175. [PMID: 30210064 DOI: 10.1507/endocrj.ej18-0282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Follicular cell-derived thyroid carcinomas, including thyroid squamous cell carcinomas (SCCs) and anaplastic carcinomas, are immunoreactive for paired-box gene 8 (PAX8), while non-follicular cell-derived thyroid carcinomas stain negative for the PAX8 antibody. Intrathyroid thymic carcinoma (ITTC) arising from the intrathyroidal ectopic thymus exhibits moderate-to-strong nuclear reactivity for polyclonal PAX8. This is difficult to understand given that PAX8 is not associated with embryonic thymic development. We aimed to determine the diagnostic significance of monoclonal PAX8 antibody in distinguishing ITTCs from follicular cell-derived thyroid carcinomas. Ten ITTCs, 14 poorly differentiated thyroid carcinomas (PDTCs), 14 thyroid SCCs, 7 thymic tissue specimens, 7 thymomas, and 1 thymic carcinoma were analyzed using antibodies against polyclonal and monoclonal PAX8, thyroid transcription factor-1, p63, and CD5. Four ITTCs (40.0%) stained positive for polyclonal PAX8; none stained positive for monoclonal PAX8. All PDTCs and 92.9% of SCCs were immunoreactive for both polyclonal and monoclonal PAX8. All PDTCs, 46.2% of SCCs, and none of the ITTCs were immunoreactive for thyroid transcription factor-1. Eight ITTCs (80.0%), but none of the PDTCs and SCCs, were immunoreactive for CD5. We are the first to show that ITTCs stain negative for monoclonal PAX8. Monoclonal PAX8 is a more reliable marker than polyclonal PAX8 for determining follicular cell origin. We conclude that monoclonal PAX8 is a useful marker for distinguishing ITTCs from PDTCs and SCCs. Monoclonal PAX8 negativity is additional evidence in support of ITTCs not being follicular cell-derived thyroid carcinomas, but having a thymic origin.
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Affiliation(s)
- Ayana Suzuki
- Department of Clinical Laboratory, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Nami Takada
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Miyoko Higuchi
- Department of Clinical Laboratory, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Aki Tanaka
- Department of Clinical Laboratory, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Seiji Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
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20
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Gao R, Jia X, Ji T, Feng J, Yang A, Zhang G. Management and Prognostic Factors for Thyroid Carcinoma Showing Thymus-Like Elements (CASTLE): A Case Series Study. Front Oncol 2018; 8:477. [PMID: 30416983 PMCID: PMC6212596 DOI: 10.3389/fonc.2018.00477] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/08/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction: This study aims to identify the prognostic factors that influence therapeutic modalities for thyroid carcinoma showing thymus-like elements (CASTLE). Materials and Methods: Reported studies with CASTLE patients published between 2004 and 2018 were retrieved from a cross-database literature search. Three patients treated in our institute were also included as one case series. Standardized data collection was performed; data pertaining to clinical stages, treatment regimens, and survival time were collected and statistically analyzed. Results: Up to 26 case series of CASTLE were selected, including 51 males and 38 females with a median age of 48 years. Follow-up time ranged from 2 to 362 months and the median survival time was 158.03 months. Lymph node metastasis and tumor invasion of adjacent tissue both showed a significant negative effect on survival (p = 0.001 and 0.013, respectively). Radiotherapy significantly improved survival (p = 0.034), while neck dissection significantly prolonged survival only in patients with extrathyroidal extension (p = 0.043). Conclusions: Extrathyroidal infiltration and nodal metastasis are important factors in cancer outcomes. Radiation therapy appears to be important for better outcomes in CASTLE patients, and neck dissection is recommended for patients with extrathyroidal extension.
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Affiliation(s)
- Rui Gao
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xi Jia
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ting Ji
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinteng Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Aimin Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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21
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Liu CY, Huang SH. EBV-associated lymphoepithelioma-like thyroid carcinoma with favorable outcome: case report with cytopathologic and histopathologic study. Diagn Pathol 2018; 13:39. [PMID: 29885658 PMCID: PMC5994248 DOI: 10.1186/s13000-018-0713-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/20/2018] [Indexed: 11/26/2022] Open
Abstract
Background Lymphoepithelioma-like carcinoma (LELC) is a rare entity among thyroid tumors. Based on the limited number of case reports that exist, the association of Epstein–Barr virus (EBV) with primary thyroid LELCs seems inconsistent. Case presentation We present a confusing cytological case of lymphoepithelioma-like thyroid carcinoma with expression of EBV. The patient presented with a central neck mass and bilateral lymphadenopathy. Fine-needle aspiration cytology revealed three-dimensional and syncytial fragments of epithelioid cells accompanied by small lymphocytes. The surgical specimen of resected thyroid tumor disclosed typical histopathological features of LELC. Metastatic papillary carcinoma was also discovered in the metastatic lymph nodes. In situ hybridization for EBV-encoded RNA (EBER-ISH) was positive in the tumor cells. Negative immunoreactivity for TTF-1, Pax-8, and CD5 was observed. The patient is currently undergoing regular follow-up and is 1 year and 10 months postresection with no evidence of recurrence. Conclusions Long-term survival is discussed in relation to this variant of thyroid carcinoma, which might differ in behavior from anaplastic carcinoma. Further investigation is required to elucidate the clinical significance of EBV expression and progression of this unique variant of thyroid carcinoma.
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Affiliation(s)
- Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, No.2, Lane 59, Jiancheng Road, Sijhih District, New Taipei City, 22174, Taiwan. .,College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| | - Shih-Hung Huang
- Department of Pathology, Cathay General Hospital, Taipei, Taiwan
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22
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Rajeshwari M, Singh V, Nambirajan A, Mridha AR, Jain D. Carcinoma showing thymus like elements: Report of a case with EGFR T790M mutation. Diagn Cytopathol 2017; 46:413-418. [PMID: 29115061 DOI: 10.1002/dc.23859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/05/2022]
Abstract
Carcinoma showing thymus-like differentiation of the thyroid (CASTLE) is a rare tumor involving the thyroid and perithyroidal soft tissues. It shares morphological, immunohistochemical and molecular similarities with thymic carcinomas. Due to its relatively better prognosis, it needs differentiation from other primary and metastatic tumors of this region. A 40-year-old lady presented with a gradually progressive anterior neck swelling for one year. Imaging showed bulky right and left lobes of thyroid along with a solid soft tissue mass in the pretracheal region. Fine needle aspiration smears showed features of poorly differentiated carcinoma. Total thyroidectomy with excision of the mass revealed histopathological features characteristic of CASTLE, with evidence of thyroiditis in adjoining thyroid. Epidermal growth factor receptor (EGFR) assay revealed presence of EGFR T790M somatic mutation in exon 20. The same was not detectable on direct sequencing. We present a rare case of CASTLE, occurring in association with Hashimoto thyroiditis, with emphasis on cytological features and report for the first time the presence of a low level somatic mutation in EGFR (EGFR T790M mutation).
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Affiliation(s)
- Madhu Rajeshwari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Varsha Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
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23
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Haroon Al Rasheed MR, Acosta A, Tarjan G. Encapsulated follicular variant of papillary thyroid carcinoma/noninvasive follicular thyroid neoplasm with papillary-like nuclear features with Spindle Cell Metaplasia: Case report and review of literature. Pathol Res Pract 2017; 213:416-421. [PMID: 28216141 DOI: 10.1016/j.prp.2016.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/30/2016] [Accepted: 12/31/2016] [Indexed: 12/23/2022]
Abstract
Spindle cell lesions of the thyroid are rare overall, and span a wide clinical spectrum that ranges from spindle cell metaplasia (SCM1) to anaplastic carcinoma. Their differentiation is only seldom straightforward, and usually requires the integration of the clinical, histological and immunohistochemical data. Only a handful of publications have described cases of SCM in the thyroid and we add to that literature by reporting a unique case of encapsulated follicular variant of papillary thyroid carcinoma/noninvasive follicular thyroid neoplasm with papillary-like nuclear features with SCM. In addition, we review the literature on the relationship between SCM and different thyroid lesions, summarizing the morphological and immunohistochemical features that aid in its differentiation from more aggressive spindle cell proliferations.
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Affiliation(s)
| | - Andres Acosta
- Department of Pathology, University of Illinois at Chicago, 840 S. Wood Street, Suite 130 CSN, Chicago, IL, 60612, USA.
| | - Gabor Tarjan
- Department of Pathology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
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24
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Collins JA, Ping B, Bishop JA, Ali SZ. Carcinoma Showing Thymus-Like Differentiation (CASTLE): Cytopathological Features and Differential Diagnosis. Acta Cytol 2016; 60:421-428. [PMID: 27643719 DOI: 10.1159/000448836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND CASTLE (carcinoma showing thymus-like differentiation) is a rare tumor (accounting for less than 0.15% of thyroid neoplasms) with most of the reported cases from Asia. Although this tumor is rare, distinguishing it from more aggressive neoplasms is critical because of its improved prognosis. To date, there have been limited studies on its cytomorphological features. Herein, we review the cytomorphological features of 10 fine-needle aspiration (FNA) cases of histologically confirmed CASTLE and discuss the findings in light of the current literature. METHODS We retrospectively (1989-2016) identified 10 cases of CASTLE from 17,415 surgical cases of thyroid carcinoma from The Johns Hopkins Hospital and Fudan University Shanghai Cancer Center. The cases were reviewed for discrete cytomorphological characteristics. RESULTS All of the cases displayed predominantly single (dishesive) epithelial cell populations, high nuclear/cytoplasmic ratios, hyperchromatic to open/vesicular nuclei and macronucleoli. The majority of cases additionally showed hypercellular, three-dimensional fragments in a background of lymphocytes. The fragments displayed syncytial architecture without molding and rarely squamous differentiation. All cases lacked follicular differentiation, intranuclear inclusions, nuclear molding, or neuroendocrine-type chromatin. CONCLUSIONS Cytopathological features alone do not appear to be distinctive or definitive of CASTLE but rather allow for the inclusion of CASTLE within the differential diagnosis. Procurement of cell block material is important and resulted in the single case of CASTLE accurately diagnosed on FNA. Cytopathological features that favored CASTLE included syncytial fragments of malignant cells with pleomorphic large nuclei, vesicular chromatin, and prominent nucleoli in a background of lymphocytes. These cytopathological findings in the appropriate clinicoradiological context warrant its inclusion in the reported differential diagnosis in order to be able to implement appropriate clinical management.
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Affiliation(s)
- Jennifer A Collins
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md., USA
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25
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Abstract
Over the past three decades, Immunohistochemistry has materially changed the practice of diagnostic surgical pathology. Foundational observations in this field were critical to a reasoned assessment of both the risks and opportunities that immunohistochemistry afforded the surgical pathologist, and our current practice draws heavily on those early assessments. As we collectively look to and acknowledge those who recognized the value of this technique and who helped guide its development as a companion to (not a replacement for) histomorphologic evaluation, we are drawn to those whose mastery of detail and ability to draw common patterns from seemingly unrelated phenomena helped define the diagnostic power of immunohistochemistry. The focus of this review is on one individual, Dr. Juan Rosai, whose contributions transcend the simple linkage of molecular observations to morphology, recognizing novel patterns in both form and color (the latter often the lovely shades of diaminobenzidine), seemingly viewing our diagnostic world at times through an entirely different lens. By looking at Dr. Rosai's early work in this field, reviewing a selection of his seminal observations, particularly in the Immunohistochemistry of thyroid and thymic neoplasia, revisiting how his special insight is often guided by the work of the early masters of morphology, and how his mentorship of others has helped shaped academic surgical pathology practice, perhaps we can get a glimpse through that lens.
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Affiliation(s)
- Paul E Swanson
- Cumming School of Medicine, Calgary Laboratory Services, Calgary, Alberta.
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26
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Gupta A, Jain S, Khurana N, Kakar AK. Expression of p63 and Bcl-2 in Malignant Thyroid Tumors and their Correlation with other Diagnostic Immunocytochemical Markers. J Clin Diagn Res 2016; 10:EC04-8. [PMID: 27630849 DOI: 10.7860/jcdr/2016/13899.8157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/02/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Bcl-2 is a marker recently studied in thyroid tumours and proposed to have prognostic significance. p63 is expressed in a proportion of papillary thyroid carcinoma cases and may have a role in tumour progression. AIM To study expression of Bcl2 and p63 in thyroid tumours and correlation of Bcl-2 with diagnostic markers including Thyroglobulin, Calcitonin and Carcinoembryonic antigen. MATERIALS AND METHODS Cytology smears of 35 cases of thyroid cancer were studied over a period of 18 months. In 20 cases histopathology was available. Immunocytochemistry for Bcl-2 and p63 was done, and diagnostic markers were applied as and when required. RESULTS p63 showed focal nuclear expression in 46.1% of papillary thyroid carcinoma cases, and was negative in all other tumours. Bcl-2 was positive in 88.9% of follicular carcinomas, 100% of papillary carcinomas and 83.3% of medullary carcinoma cases, and showed focal weak expression in 40% of Anaplastic Carcinoma (ATC) cases, thereby signifying down regulation (p-value = 0.001). There was significant down regulation of Thyroglobulin (Tg) in ATC vs well differentiated follicular derived tumours (p-value ≤ 0.016). Positive correlation was noted between expression of Bcl-2 and Calcitonin (0.93) and Bcl-2 and Carcinoembryonic Antigen (CEA) (0.89), and weak positive correlation (0.65) between Tg and Bcl-2. CONCLUSION Bcl-2 is downregulated in anaplastic carcinomas as compared to well differentiated thyroid tumours, and shows correlation with differentiation associated tumour antigens. Thus, loss of Bcl-2 was associated with loss of differentiation in thyroid tumours. Anaplastic carcinoma as such is associated with worse prognosis and loss of Bcl-2 may be partly responsible for the same. p63 is specific but less sensitive marker for PTC. Further studies are required to determine the role of Bcl-2 and p63 in thyroid tumours.
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Affiliation(s)
- Ashumi Gupta
- Assistant Professor, Department of Pathology, Baba Saheb Ambedkar Medical College and Hospital , New Delhi, India
| | - Shyama Jain
- Professor and Head of the Department, Department of Pathology, Maulana Azad Medical College , New Delhi, India
| | - Nita Khurana
- Professor, Department of Pathology, Maulana Azad Medical College , New Delhi, India
| | - Arun Kumar Kakar
- Director Professor, Department of Surgery, Lok Nayak Hospital , New Delhi, India
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