Korean J Endocr Surg.  2011 Dec;11(4):292-296. 10.0000/kjes.2011.11.4.292.

Carcinoma Showing Thymus Like Differentiation (CASTLE): A Case Report

• Kim JH
• Park KM
• Kim SJ
• Cho YU
• Chu YC

• KMID: 2375393
• DOI: http://doi.org/10.0000/kjes.2011.11.4.292

Abstract

Carcinoma showing thymus-like differentiation (CASTLE) is a very rare malignant neoplasm of the thyroid, which resembles lymphoepithelioma or squamous cell carcinoma of the thymus. It originates from ectopic thymic tissue or remnants of the branchial pouches. We recently experienced a case of CASTLE in the thyroid gland of a 65-year-old woman. The patient presented with a non-tender mass in the right thyroid gland and dyspnea and coughing upon bending. The patient was diagnosed with "˜cystic change of adenomatous goiter' of the thyroid by fine needle aspiration cytology. Right thyroidectomy was performed because of nodular hyperplasia on frozen biopsy. Histologic examination of the resected tumor showed that the tumor was lobulated and expansive growth pattern, with fibrous septa dividing the tumor and infiltrated by lymphocytes and plasma cells. Tumor cells possessed oval, large vesicular nuclei and prominent nucleoli, and the immunohistochemical staining was positive for CD5. The patient was diagnosed with thyroid CASTLE. We performed complete thyroidectomy. There has been no local regional recurrence.

Keyword

Thymus; Thyroid gland; Thyroidectomy

MeSH Terms

Aged
Biopsy
Biopsy, Fine-Needle
Carcinoma, Squamous Cell
Cough
Dyspnea
Female
Humans
Hyperplasia
Lymphocytes
Plasma Cells
Recurrence
Thymus Gland*
Thyroid Gland
Thyroidectomy

Figure

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  Fig. 1 We colud find right hypoechogenic nodule (4.5×4 cm) with irregular margin and it had cystic component.

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  Fig. 2 There is a 3.8 cm sized mass-like lesion in the right in-frathyroid area and the mass compresses trchea posteriorly. The border between trachea and mass is blurred, indicating the invasion of mass into the trachea.

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  Fig. 3 The tumor was measured 4.3×4.0×3 cm and was well-defined and firm. The cut surface was creamy yellow and granular with focal necrosis and hemorrhage.

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  Fig. 4 This slide show that the CASTLE has lobulated or expansive growth, fibrous septa (H&E ×40).

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  Fig. 5 There is indistinct cell borders, large vesicular nuclei with prominent nucleoli, a low mitotic count and there may be an associated lymphoplasmocytic infiltrate (H&E ×400).

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  Fig. 6 Immunostainigs for CD5 of the resected tumor showed tumor cells with strong positive staining.

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  Fig. 7 (A) There is abnormal hypermstabolic lension in the infrahyoid anterior neck. (B) There is abnormal hypermetabolic lesion in the left thyroid lobe.

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