A Case of Carcinoma Showing Thymus-Like Differentiation (CASTLE) of the Thyroid

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  • INOUE Yuzuru
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • KOHI Shiro
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • GOBARA Masato
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • JODEN Fumi
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • YABUKI Kei
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • TANOUE Takayuki
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • SATO Nagahiro
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • KATSUKI Takefumi
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • NAGATA Takahisa
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan. Department of Surgery, Aobadai Hospital, Japan
  • SHIBAO Kazunori
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.
  • HISAOKA Masanori
    Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Japan.
  • HIRATA Keiji
    Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan.

Bibliographic Information

Other Title
  • 甲状腺の胸腺様分化を示す癌Carcinoma Showing Thymus-Like Differentiation（CASTLE）of the Thyroidの１例
  • 症例報告 甲状腺の胸腺様分化を示す癌Carcinoma Showing Thymus-Like Differentiation (CASTLE) of the Thyroidの1例
  • ショウレイ ホウコク コウジョウセン ノ キョウセン ヨウ ブンカ オ シメス ガン Carcinoma Showing Thymus-Like Differentiation (CASTLE) of the Thyroid ノ 1レイ

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Abstract

The case presented herein was a 70-year-old woman who had no compliant, but had a mass in the lower part of the right lobe of the thyroid detected by ultrasound (US). The US image of the tumor, measuring 13 mm in diameter, showed a low and heterogeneous internal echo level with calcification and an irregular margin. The tumor appeared to extend to the adjacent sternothyroid muscle, and cervical lymph node swelling was detected in a computer tomography (CT) image, but no metastatic lesion was found by positron emission tomography (PET)-CT. In a fine needle aspiration cytology of the tumor, papillary thyroid carcinoma was suggested because of the atypical epithelial cells having some changes other than intranuclear inclusion bodies. A subtotal thyroidectomy and central neck lymph node dissection were performed. The excised tumor was histologically composed of irregular nests or sheets of atypical squamoid epithelial cells with some ductal structures that leached to the sternothyroid muscle and involved the right lower parathyroid gland. Carcinoma showing thymus-like differentiation (CASTLE) was diagnosed histopathologically and immunohistochemically with the following immunohistochemical results: Cluster of differentiation 5 (CD5) (+), tumor protein p63 (p63) (+), KIT proto-oncogene receptor tyrosine kinase (c-KIT(CD117)) (+), thyroglobulin (−), and thyroid transcription factor-1 (TTF-1) (−). CASTLE is a rare carcinoma of the thyroid that architecturally resembles thymic epithelial tumors. Many CASTLE patients have been misdiagnosed as other carcinomas, such as anaplastic carcinoma, poorly differentiated carcinoma or squamous cell carcinoma of the thyroid. Immunohistochemical examination, including CD5 played an important role in the final diagnosis of CASTLE, although the distinction from diagnosis as squamous cell carcinoma or mucoepidermoid carcinoma in Hematoxylin-Eosin staining was challenging in our case. Nodal metastasis and perithyroidal tumor extension of CASTLE can predict its worse prognosis. Thus, at least careful follow-up studies are mandatory in cases of CASTLE.

Journal

  • Journal of UOEH

    Journal of UOEH 40 (3), 259-266, 2018-09-01

    The University of Occupational and Environmental Health, Japan

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