Ann Surg Treat Res.  2018 Jun;94(6):337-341. 10.4174/astr.2018.94.6.337.

Spindle epithelial tumor with thymus-like differentiation of the thyroid in a 70-year-old man

• Lee S
• Kim YS
• Lee JH
• Hwang SH
• Oh YH
• Ko BK
• Ham SY

• KMID: 2412404
• DOI: http://doi.org/10.4174/astr.2018.94.6.337

Abstract

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare tumor of the thyroid gland mostly occurring in young patients. The imaging findings of SETTLE tumors are yet to be defined. However, they are usually described as well-defined heterogeneously enhanced masses on CT scan. The current case has the potential growth as compared with a 2009 chest radiography. We took into account the possibility of SETTLE in the case of a bulky mass in patients over 70 years old, particularly in the lower neck. Herein, we report a case of the oldest patient so far. The patient underwent a right lobectomy of the thyroid and mass excision. Follow-up CT scans after 6 months revealed no local recurrence. Surgery is the gold standard treatment for SETTLE. Chemotherapy and radiotherapy could be another possible option for patients with advanced stage SETTLE.

Keyword

Thyroid neoplasms; Surgery; X-ray computed tomography

MeSH Terms

Aged*
Drug Therapy
Follow-Up Studies
Humans
Neck
Radiography
Radiotherapy
Recurrence
Thorax
Thyroid Gland*
Thyroid Neoplasms
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Chest radiography showing tracheal deviation to left side with narrowing of midtrachea due to mass in right lower neck and anterior mediastinum.

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  Fig. 2 Axial and coronal view of the mass showing heterogeneous enhancement with displacing trachea to left side and compression to lumen on contrast-enhanced CT (CECT) scan. (A) Axial non CECT revealed bulky mass lesion in the right paratracheal space, displacing the trachea. (B) Coronal reconstructed CECT scan showed a huge mass with heterogenous contrast enhancement and compress the trachea.

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  Fig. 3 On ultrasound, mass showed heterogeneous echogenicity and increased vascularity. (A) Transverse neck ultrasound revealed bulky mass with heterogenous echo pattern. (B) On color Doppler application, increased tumor vascular flow was shown.

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  Fig. 4 Microscopic findings of the tumor of H&E stain. (A) An encapsulated multilobular tumor traversed by fibrous band is seen on low power field (×12.5). (B) On high power field (×400), tumor cells were uniformly plump spindle cells with elongated nuclei and arranged in short fascicular pattern. (C) Spindle cell component merged into epithelial component with tubulocystic configuration in central area. (D) Entrapped normal thyroid follicles (lower center) were observed in peripheral areas of tumor.

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