Selected references [613677]
Selected references
1Gao R,JiaX,JiT,Feng J,Yang A,Zhang G.Management andPrognostic Factors forThyroid Carcinoma Showing Thymus -Like Elements (CASTLE) :ACase Series Study .Front Oncol .
2018 ;8:477.Published 2018 Oct26.doi:10.3389 /fonc .2018 .00477
2.Lominska C,Estes CF,Neupane PC,Shnayder Y,TenNapel MJ,O'Neil MF.CASTLE Thyroid Tumor :ACase Report andLiterature Review .Front Oncol .2017 ;7:207.Published 2017 Sep13.
doi:10.3389 /fonc .2017 .00207
3.Yamamoto Y,Yamada K,Motoi Netal(2013 )Sonographic findings inthree cases ofcarcinoma showing thymus -likedifferentiation .JClin Ultrasound 41(9):574–578Emilia Solomon ¹ ², Mirela Grigorovici², Radu Gheorghe Solomon³, Ioan Simon², Cristina Preda¹
¹UMF Gr T Popa, Iasi, Romania ²CF Clinical Hospital, Iasi, Romania ³ISUD, Faculty of Medicine, Lucian Blaga
University, Sibiu, Romania ⁴
Introduction
Carcinoma showing thymus -like differentiation (CASTLE) isarare malignancy, localized inthe
thyroid parenchyma .This tumor arises from theectopic thymus orbranchial pouch remnants .Asfar
asweknow, less than 50 CASTLE cases aredescribed inliterature .The diagnosis isbased on
immunoreactivity, themain characteristic ispositivity toCD5,which reveals athymic differentiation .
Case report
Discussions.
Thediagnosis ofCASTLE isachallenge forthephysician, asthere isagreat resemblance with anaplastic thyroid
carcinoma andsquamous -cellcarcinoma ofthethyroid .Acorrect diagnosis isessential because thetreatment and
prognosis isdifferent .CASTLE isanindolent andslow -growing malignancy, with agreat response tochemo and
radio therapy .Inourcase, extrathyroidal infiltrations andnodal metastasis arerisk factors that areseriously
decreasing thepatient lifeexpectancy .We report thecase ofa63-years -old male, who
presented with a3cmsolid, hypoechoic nodule inthe
lower part oftheleftthyroid lobe, with underlying
structures fixation .The ipsilateral lymph node
involvement was noted .The mass was irregularly
shaped and adherent tothetracheoesophageal area,
with amass effect onthetrachea, inhiscervical
superior mediastinal portion .Vessel displacement was
recorded, asthetumor was incontact with theleft
common carotid artery inposterior, with jugular vein
inposterolateral, and right common carotid artery
inferior .
Hewassurgically treated byasubtotal thyroidectomy
with central neck dissection .
Carcinoma showing thymus -like differentiation
a case report
Histopathological findings -irregular sheets of atypical
epithelial cells showing a squamoid appearance and
lymphocytes rich stroma
The histopathologically and immunohistochemically
exam revealed carcinoma, showing thymus -like
differentiation (CASTLE) with cluster ofdifferentiation
5(CD5)(+), CD 63(+)and CK 5(+).Postsurgical
chemotheraphy was applied (6cycles with carboplatin
andpaclitaxel), afterwards external beam radiation (66
Gy/33fractions/ 50days) .Ultrasonography findings -irregular tumor involving the
lower part of the left thyroid lobe, extending to the
superior mediastinum
2 cervical lymph node -hypoechoic, round in
shape with well -defined borders ; the inferior
one has 6.7 mm, while the superior one is
smaller but has peripheral vascularity
Post-surgery ultrasound remnant mass
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