Title: Carcinoma showing thymus-like differentiation (CASTLE) – A Rare Extra-Thyroid Disease
Authors: Dr Lakshmi JS, Dr Pushpaja K Ullattil, Dr Shabin K Sidhique, Mrs Sreedevi E, Mrs Regina LS
DOI: https://dx.doi.org/10.18535/jmscr/v9i7.10
Abstract
Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignant tumor occurs in soft tissues of neck or thyroid gland. It accounts for 0.1% to 0.15% of all thyroid cancers. Immuno-staining with CD5 is a useful marker for differentiating from other malignancy of thyroid.
Case report: A 72-year-old female presented with painless neck swelling which on examination was firm to hard mass at left level III region extending inferiorly up to medial supraclavicular fossa. Imaging showed a solid conglomerate lymph-nodal mass and biopsy reported as poorly differentiated neoplasm. IHC markers confirmed the diagnosis of CASTLE disease. She underwent left modified radical neck dissection along with left hemithyroidectomy and Adjuvant radiation therapy. Now at 8 years of follow-up, no evidence of disease recurrences.
Thus, being a rare entity, early diagnosis and prompt treatment plays an important role in the outcome.
Keywords: Castle disease, thymus like differentiation, thyroid neoplasm, long-term follow-up, extra-thyroidal disease.
References
- Youens KE, Bean SM, Dodd LG, Jones CK: Thyroid carcinoma showing thymus-like differentiation (CASTLE): case report with cytomorphology and review of the literature. Diagn Cytopathol 2011, 39:204–20
- Chan JK, Rosai J: Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept. Hum Pathol 1991, 4:349–367
- Luo CM, Hsueh C, Chen TM: Extrathyroid carcinoma showing thymus-like differentiation (CASTLE) tumor – a new case report and review of literature. Head Neck 2005, 27:927–933.
- Ahuja AT, Chan ESY, Allen PW, Lau KY, King W, Metreweli C: Carcinoma showing thymic-like differentiation (CASTLE tumor). Am J Neuroradiol 1998, 19:1225–1228.
- Choi et al. Extrathyroid carcinoma showing thymus-like differentiation (CASTLE): a new case report and review of the therapeutic role of neck dissection and radiotherapy World Journal of Surgical Oncology 2014, 12:247
- Tsutsui H, Hoshi M, Kubota M, Suzuki A, Nakamura N, Usuda J, Shibuya H, Miyajima K, Ohira T, Ito K, Ikeda N. Management of thyroid carcinoma showing thymus-like differentiation (CASTLE) invading the trachea. Surgery today. 2013 Nov;43(11):1261-8.
- Reimann JD, Dorfman DM, Nose V: Carcinoma showing thymus like differentiation of the thyroid (CASTLE): a comparative study: evidence of thymic differentiation and solid cell nest origin. Am J SurgPathol 2006, 8:994–1001
- Miyauchi A, Kuma K, Matsuzuka F, Matsubayashi S, Kobayashi A, Tamai H, Katayama S: Intrathyroidal epithelial thymoma: an entity distinct from squamous cell carcinoma of the thyroid. World J Surg 1985, 1:128–135.
- Mizukami Y, Kurumaya H, Yamada T, Minato H, Nonomura A, Noguchi M, Matsubara F: Thymic carcinoma involving the thyroid gland: report of two cases. Hum Pathol 1995, 26:576–579.