Carcinoma Showing Thymus-like Differentiation (CASTLE) with Non-Recurrent Laryngeal Nerve: A Case Report

Hyo Geun Choi; Chul Sik Kim; Soo Kee Min; Bumjung Park

doi:10.11106/jkta.2014.7.1.88

Journal List > J Korean Thyroid Assoc > v.7(1) > 1056574

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Kim, Min, and Park: Carcinoma Showing Thymus-like Differentiation (CASTLE) with Non-Recurrent Laryngeal Nerve: A Case Report

Case Report

J Korean Thyroid Assoc 2014;7(1):88-91.

Published online: 29 May 2014

DOI: https://doi.org/10.11106/jkta.2014.7.1.88

Carcinoma Showing Thymus-like Differentiation (CASTLE) with Non-Recurrent Laryngeal Nerve: A Case Report

Hyo Geun Choi¹, Chul Sik Kim², Soo Kee Min³, Bumjung Park¹

¹Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea

²Department of Endocrinology, Hallym University Sacred Heart Hospital, Anyang, Korea

³Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Korea

Correspondence: Bumjung Park, MD, Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 431-796, Korea Tel: 82-31-380-3849, Fax: 82-31-386-3860, E-mail: pbj426@hallym.ac.kr

Received 8 July 2013 Accepted 29 November 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Carcinoma showing thymus-like element (CASTLE) is a very rare malignant neoplasm in the lower portion of the thyroid gland or soft tissue of the neck. Recurrent laryngeal nerve (RLN) is the most frequent site of CASTLE. Non-RLN is also a rare anomaly. Both CASTLE and non-RLN are risk factors for vocal cord paralysis. In this report, the authors describe a 73-year-old patients diagnosed with CASTLE and non-RLN. During total thyroidectomy, one RLN was sacrificed inevitably because of tumor invasion, while the other non-RLN was successfully saved, which was expected based on preoperative computed tomography (CT). If the diagnosis is uncertain, CT should be checked to prevent unexpected risks.

Keywords: Carcinoma, Carcinoma showing thymus-like element (CASTLE), Thyroid, Thymus, Laryngeal nerve

References

1. Miyauchi A, Kuma K, Matsuzuka F, Matsubayashi S, Kobayashi A, Tamai H. et al. Intrathyroidal epithelial thymoma: an entity distinct from squamous cell carcinoma of the thyroid. World J Surg. 1985; 9(1):128–35.

2. Chan JK, Rosai J. Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept. Hum Pathol. 1991; 22(4):349–67.

3. Cheuk W, Chan JKC, Dorfman DM, Giordano T. Carcinoma showing thymus-like differentiation. In : DeLellis RA, Lloyd RV, Heitz PU, Eng C, editors. World Health Organization Classification of Tumours. Pathology and genetics of tumours of endocrine organs. Lyon, France: IARC Press;2004; p.96–7.

4. Henry JF, Audiffret J, Denizot A, Plan M. The nonrecurrent inferior laryngeal nerve: review of 33 cases, including two on the left side. Surgery. 1988; 104(6):977–84.

5. Ito Y, Miyauchi A, Nakamura Y, Miya A, Kobayashi K, Kakudo K. 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. 2007; 127(2):230–6.

6. Toniato A, Mazzarotto R, Piotto A, Bernante P, Pagetta C, Pelizzo MR. Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg. 2004; 28(7):659–61.

7. 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 Surg Pathol. 2006; 30(8):994–1001.

8. Roka S, Kornek G, Schuller J, Ortmann E, Feichtinger J, Armbruster C. Carcinoma showing thymic-like elements–a rare malignancy of the thyroid gland. Br J Surg. 2004; 91(2):142–5.

9. Sun T, Wang Z, Wang J, Wu Y, Li D, Ying H. Outcome of radical resection and postoperative radiotherapy for thyroid carcinoma showing thymus-like differentiation. World J Surg. 2011; 35(8):1840–6.

10. Cappelli C, Tironi A, Marchetti GP, Pirola I, De Martino E, Delbarba A. et al. Aggressive thyroid carcinoma showing thymic-like differentiation (CASTLE): case report and review of the literature. Endocr J. 2008; 55(4):685–90.

11. Pusztaszeri M. Fine needle aspiration biopsy of three cases of squamous cell carcinoma presenting as a thyroid mass: cytological findings and differential diagnosis. The differential diagnosis includes CASTLE. Cytopathology. 2012; 23(1):67–8. author reply 8-9.

Fig. 1.

Preoperative sonography shows 2.2 cm sized hyperechoic mass.

Fig. 2.

Preoperative axial view of neck CT shows a 2.2 cm low-density mass in lower portion of left thyroid gland. (A) The white arrow indicates the tumor. Preoperative coronal view of neck CT shows a 2.2 cm sized low-density mass in lower portion of left thyroid gland around the trachea-esophageal grove. (B) The white arrow indicates the tumor. The aberrant right subclavian artery runs against the vertebral column behind the esophagus. (C) The white arrow indicates the aberrant right subclavian artery.

Fig. 3.

The tumor is divided into variably-sized and irregularly-shaped lobules or bands by fibrous septa. (A) The septa are infiltrated by lymphocytes and plasma cells (H&E stain, ×40). (B) The tumor cells have large vesicular nuclei and prominent nucleoli (H&E stain, ×400). (C) Immunohistochemistry of tumor cells are positive for CD5 (×200). (D) Immunohistochemistry of tumor cells are positive for CD117 (×200). (E) Immunohistochemistry of tumor cells are negative for TTF-1 (×200).

TOOLS

Similar articles