Carcinoma showing thymus-like differentiation (CASTLE) with neuroendocrine differentiation.
ABSTRACT Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignant neoplasm that histologically resembles thymic carcinoma and arises in the thyroid gland or adjacent soft tissue of the neck. Herein is reported the case of a 62-year-old male patient with CASTLE exhibiting neuroendocrine differentiation, who was treated with total pharyngolaryngo-esophagectomy and total thyroidectomy. Gross examination of the surgical specimen showed a grayish-white, solid, lobulated tumor, mainly located between the trachea and esophagus, and involving the lower part of the left thyroid lobe. Histologically, the tumor consisted of epithelial cell nests separated by thick fibrous septa. The tumor cells were polygonal in shape, and contained pale cytoplasm and a vesicular nucleus with prominent nucleoli. There were few mitotic figures. Rosette-like arrangements that suggested neuroendocrine differentiation were observed in part of the tumor. The tumor cells were positive for CD5 and neuroendocrine markers including synaptophysin and chromogranin A.
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ABSTRACT: We present here a case of extrathyroid CASTLE (the third case reported in the English literature) treated with excision and neck dissection without radiotherapy. Also, we reviewed the literature and analyzed the therapeutic results of each treatment modality for CASTLE. A 27-year-old male had initially presented with a painless, right neck mass for 2 months. Computed tomography of the neck showed a 3.8 x 3.2 x 3.8 cm heterogeneously enhancing mass at right level IIa, and no definite thyroid lesion was found. An excisional biopsy was done and the pathologic diagnosis was CASTLE. Then we performed a right modified radical neck dissection and right thyroid lobectomy. After three years, no evidence of tumor recurrence was noted. Total excision followed by neck dissection could be a sufficient surgical treatment option for CASTLE. Postoperative radiotherapy might be an alternative treatment option for neck dissection in patients with positive nodal status.World Journal of Surgical Oncology 08/2014; 12(1):247. · 1.20 Impact Factor
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ABSTRACT: The small cell group of thyroid tumors that includes lymphoma, poorly differentiated carcinoma, medullary carcinoma, secondary neoplasms, as well as tumors with uncertain histogenesis, remains as a valid diagnostic cul-de-sac due to its heterogeneous constitution. The existence of small cell thyroid tumors with EWSR1-FLI1 rearrangement together with neuroendocrine and/or carcinomatous differentiation raises not only differential diagnostic problems but also a very interesting therapeutic dilemma. This review explores the classification of small cell tumors of the thyroid taking into account the immunophenotype and molecular profile of such tumors.International Journal of Surgical Pathology 11/2013; · 0.96 Impact Factor
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ABSTRACT: Ectopic thymic tissue can be present in the thyroid gland and a carcinoma showing thymus-like differentiation (CASTLE) may arise from such tissue. We are reported the case of a 26-year-old man with CASTLE, with cervical subcutaneous nodules relapse, who showed a good response to treatment with surgery, chemotherapy and radiotherapy. The problematic aspect of this case was the diagnosis; only on review were we able to make a final diagnosis. CASTLE is a very rare neoplasm. It is important to differentiate this cancer from others tumors such as primary or metastatic squamous cell carcinoma of the head and neck or squamous cell thyroid carcinoma, because the therapy and prognosis are different. Diagnosis is complicated and requires careful histological analysis (CD5- and P63-positive with presence of Hassall's corpuscles); unfortunately there is no gold standard treatment so, in this case, we administered a sandwich of chemotherapy and radiotherapy.World journal of clinical oncology. 12/2014; 5(5):1117-1120.