Abstract
Background
Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignant tumor of the thyroid. It is difficult to diagnose, and there is no universally recognized therapeutic regimen. This study aims to define the clinicopathological features and discuss the optimal management of CASTLE.
Methods
We retrospectively analyzed six patients with CASTLE who accepted surgery at the First Hospital of China Medical University between January 2010 and December 2015.
Results
The six patients (three women and three men) had median age of 53 years (range 47–61 years). All patients presented with a slow-growing, painless neck mass; three patients also had hoarseness. All tumors were located in middle-lower or lower lobe, and two tumors extended to the substernal region. All patients underwent radical surgery without postoperative radiotherapy or chemotherapy. Five patients had extrathyroidal extension and two had lymph node metastasis. All six tumors were positive for CD5 and negative for thyroglobulin (Tg) and thyroid transcription factor (TTF)-1. Median follow-up was 32 months (range 23–81 months). Lateral cervical lymph node metastasis occurred in one patient at 26 months after initial treatment.
Conclusions
CASTLE is a rare, aggressive malignant tumor of the thyroid. Ultrasound, computed tomography, and fine-needle aspiration biopsy may not be sufficient to establish the diagnosis preoperatively; pathological examination and immunohistochemistry, particularly positive CD5 staining, are necessary to establish the diagnosis. Patients with CASTLE can yield a favorable outcome after radical surgery.
Similar content being viewed by others
References
Miyauchi A, Kuma K, Matsuzuka F et al (1985) Intrathyroidal epithelial thymoma: an entity distinct from squamous cell carcinoma of the thyroid. World J Surg 9(1):128–135. https://doi.org/10.1007/BF01656263
Chan JK, Rosai J (1991) Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept. Hum Pathol 22(4):349–367
Reimann JD, Dorfman DM, Nose V (2006) Carcinoma showing thymus-like differentiation of the thyroid (CASTLE): a comparative study: evidence of thymic differentiation and solid cell nest origin. Am J Surg Pathol 30(8):994–1001
Ge W, Yao YZ, Chen G et al (2016) Clinical analysis of 82 cases of carcinoma showing thymus-like differentiation of the thyroid. Oncol Lett 11(2):1321–1326
Hanamura T, Ito K, Uehara T et al (2015) Chemosensitivity in carcinoma showing thymus-like differentiation: a case Report and review of the literature. Thyroid Off J Am Thyroid Assoc 25(8):969–972
Huang C, Wang L, Wang Y et al (2013) Carcinoma showing thymus-like differentiation of the thyroid (CASTLE). Pathol Res Pract 209(10):662–665
Tsutsui H, Hoshi M, Kubota M et al (2013) Management of thyroid carcinoma showing thymus-like differentiation (CASTLE) invading the trachea. Surg Today 43(11):1261–1268
Yamamoto Y, Yamada K, Motoi N et al (2013) Sonographic findings in three cases of carcinoma showing thymus-like differentiation. J Clin Ultrasound 41(9):574–578
Sun T, Wang Z, Wang J et al (2011) Outcome of radical resection and postoperative radiotherapy for thyroid carcinoma showing thymus-like differentiation. World J Surg 35(8):1840–1846. https://doi.org/10.1007/s00268-011-1151-2
Liu Z, Teng XY, Sun DX et al (2013) Clinical analysis of thyroid carcinoma showing thymus-like differentiation: report of 8 cases. Int Surg 98(2):95–100
Ito Y, Miyauchi A, Nakamura Y et al (2007) Clinicopathologic significance of intrathyroidal epithelial thymoma/carcinoma showing thymus-like differentiation: a collaborative study with Member Institutes of The Japanese Society of Thyroid Surgery. Am J Clin Pathol 127(2):230–236
Wu MH, Wu HY (2016) Thyroid carcinoma showing thymus-like differentiation with tracheal invasion. Asian Cardiovasc Thorac Ann 24(9):878–880
Pusztaszeri M, Yerly S, Lobrinus J et al (2013) Carcinoma showing thymus-like elements of the thyroid (CASTLE) arising in close association with solid cell nests. Evidence for a precursor lesion. Thyroid Off J Am Thyroid Assoc 23:511–516
Chow S, Chan J, Tse L et al (2007) Carcinoma showing thymus-like element (CASTLE) of thyroid: combined modality treatment in 3 patients with locally advanced disease. Eur J Surg Oncol 33(1):83–85
Damiani S, Filotico M, Eusebi V (1991) Carcinoma of the thyroid showing thymoma-like features. Virchows Arch 418(5):463–466
Roka S, Kornek G, Schüller J et al (2004) Carcinoma showing thymic-like elements—a rare malignancy of the thyroid gland. Br J Surg 91(2):142–145
Piacentini MG, Romano F, Fina S et al (2006) Carcinoma of the neck showing thymic-like elements (CASTLE): report of a case and review of the literature. Int J Surg Pathol 14(2):171–175
Kakudo K, Mori I, Tamaoki N et al (1988) Carcinoma of possible thymic origin presenting as a thyroid mass: a new subgroup of squamous cell carcinoma of the thyroid. J Surg Oncol 38(3):187–192
Kusada N, Hara Y, Kobayashi S et al (2005) A case of aggressive carcinoma showing thymus-like differentiation with distant metastases. Thyroid Off J Am Thyroid Assoc 15(12):1383–1388
Cappelli C, Tironi A, Marchetti GP et al (2008) Aggressive thyroid carcinoma showing thymic-like differentiation (CASTLE): case report and review of the literature. Endocr J 55(4):685–690
Abeni C, Ogliosi C, Rota L et al (2014) Thyroid carcinoma showing thymus-like differentiation: case presentation of a young man. World J Clin Oncol 5(5):1117–1120
Acknowledgements
We would like to thank Elixigen Company (Huntington Beach, California, USA) for proofreading and editing the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Dong, W., Zhang, P., Li, J. et al. Outcome of Thyroid Carcinoma Showing Thymus-Like Differentiation in Patients Undergoing Radical Resection. World J Surg 42, 1754–1761 (2018). https://doi.org/10.1007/s00268-017-4339-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-017-4339-2