A Carcinoma Showing Thymus-Like Elements of the Thyroid Arising in Close Association with Solid Cell Nests: Evidence for a Precursor Lesion?

Yerly, Stéphane David; Lobrinus, Johannes Alexander; Bongiovanni, Massimo; Becker, Minerva; Zare, Maryam; Granger, Perrine; Pusztaszeri, Marc

doi:10.1089/thy.2011.0415

Cited by 12 publications

(3 citation statements)

References 17 publications

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“…It is also difficult to cytologically make a correct diagnosis of this disease. For all the cases of intrathyroidal thymic carcinoma we could search in PubMed, as shown in Table , the cytological diagnosis rate of this disease was only 5.3% (3/57), and one case was diagnosed based on a history of metastatic CASTLE in the pleura. A total of 77.2% (44/57) of intrathyroidal thymic carcinoma cases were given a correct qualitative diagnosis but without further definite subclassification, including “poorly differentiated carcinoma” (19.3%, 11/57), “carcinoma” (40.4%, 23/57), and “malignant tumor” (17.5%, 10/57); 14.04% (8/57) were given a wrong subclassification, including “undifferentiated carcinoma” (5.3%, 3/57), “papillary thyroid carcinoma” (7.0%, 4/57), and “Hürthle cell neoplasm” (1.8%, 1/57); one case (1.8%) was diagnosed as atypia of undetermined significance (AUS), and one case (1.8%) was diagnosed as an indeterminate nodule in which only necrotic material was aspirated.…”

Section: Discussionmentioning

confidence: 99%

Intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation: Case report with cytomorphology, immunocytochemistry, and review of the literature focusing on cytology

Ren

Dong

Huang

et al. 2019

Diagnostic Cytopathology

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Intrathyroidal thymic carcinoma is a malignant epithelial tumor of the thyroid gland with thymic epithelial differentiation; it is the malignant counterpart of ectopic thymoma of the thyroid gland and histologically resembles thymic carcinoma. Given its favorable prognostic course, preoperative cytological diagnosis is important to distinguish this neoplasm from other more aggressive thyroid neoplasms that can have similar or overlapping cytomorphological features. However, there is little information about the cytology of this disease available in the literature, even in the latest fourth edition of World Health Organization classification of tumors of endocrine organs. Here, we report a case of intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation in a 33-year-old woman and present a review of the literature. K E Y W O R D S cytology, intrathyroidal thymic carcinoma, neuroendocrine differentiation

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Section: Discussionmentioning

confidence: 99%

Intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation: Case report with cytomorphology, immunocytochemistry, and review of the literature focusing on cytology

Ren

Dong

Huang

et al. 2019

Diagnostic Cytopathology

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“…4a) [2,3]. The histological features are correlative with the proposed histogenesis of this neoplasm arising from either an embryologic thymic tissue rest or remnants from the thymopharyngeal duct or branchial pouches, including the ultimobranchial body [2,17,18]. …”

Section: Discussionmentioning

confidence: 97%

Carcinoma Showing Thymus-Like Differentiation (CASTLE): Cytopathological Features and Differential Diagnosis

Collins

Bishop

et al. 2016

Acta Cytologica

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Background: CASTLE (carcinoma showing thymus-like differentiation) is a rare tumor (accounting for less than 0.15% of thyroid neoplasms) with most of the reported cases from Asia. Although this tumor is rare, distinguishing it from more aggressive neoplasms is critical because of its improved prognosis. To date, there have been limited studies on its cytomorphological features. Herein, we review the cytomorphological features of 10 fine-needle aspiration (FNA) cases of histologically confirmed CASTLE and discuss the findings in light of the current literature. Methods: We retrospectively (1989-2016) identified 10 cases of CASTLE from 17,415 surgical cases of thyroid carcinoma from The Johns Hopkins Hospital and Fudan University Shanghai Cancer Center. The cases were reviewed for discrete cytomorphological characteristics. Results: All of the cases displayed predominantly single (dishesive) epithelial cell populations, high nuclear/cytoplasmic ratios, hyperchromatic to open/vesicular nuclei and macronucleoli. The majority of cases additionally showed hypercellular, three-dimensional fragments in a background of lymphocytes. The fragments displayed syncytial architecture without molding and rarely squamous differentiation. All cases lacked follicular differentiation, intranuclear inclusions, nuclear molding, or neuroendocrine-type chromatin. Conclusions: Cytopathological features alone do not appear to be distinctive or definitive of CASTLE but rather allow for the inclusion of CASTLE within the differential diagnosis. Procurement of cell block material is important and resulted in the single case of CASTLE accurately diagnosed on FNA. Cytopathological features that favored CASTLE included syncytial fragments of malignant cells with pleomorphic large nuclei, vesicular chromatin, and prominent nucleoli in a background of lymphocytes. These cytopathological findings in the appropriate clinicoradiological context warrant its inclusion in the reported differential diagnosis in order to be able to implement appropriate clinical management.

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“…By contrast, reports of ectopic thymic carcinoma are very limited in view of its rarity, except for carcinoma showing thymus-like elements of the thyroid, so called CASTLE, whose pathogenesis is suspected to be a remnant of the branchial pouch from which the thyroid gland originates, and is thus not ectopic thymus tissue [2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A Surgical Case of Heterotopic Thymic Carcinoma Coexisting With Hepatocellular Carcinoma

2015

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Although thymomas arising in ectopic regions other than the upper anterior mediastinum are well known, thymic carcinomas in ectopic locations are very rare. On the other hand, the therapeutic strategies for synchronous double primary cancers arising from different organs are still controversial. We have experienced a case of thymic carcinoma in an ectopic location with a coexisting hepatocellular carcinoma (HCC) for which management presented a number of difficulties. A 67-year-old man with HCC presented with a slow-growing nodular shadow in the left lower anterior mediastinum, i.e. the left cardiophrenic angle. During 7 years of intensive treatment for the HCC, the mediastinal nodule, which had been suspected clinically to be a lymph node metastasis from the HCC, grew to 4 cm in diameter. Surgical intervention for the mediastinal nodule was carried out for treatment and definitive diagnosis using a mediastinoscope inserted via a transverse xyphoid incision. Intraoperative pathological diagnosis from frozen sections of the mediastinal nodule revealed thymic carcinoma, and therefore the procedure was converted to thymothymectomy via a median sternotomy. Despite postoperative multimodality treatment, the patient died due to multifocal metastasis and pleuritis carcinomatosa from the thymic carcinoma within 7 months after the thymothymectomy. The unusual location of the thymic carcinoma in this case and the synchronous nature of the coexisting primary HCC resulted in delay of surgical resection for the former. More intensive observation and early intervention in the form of diagnostic or therapeutic resection should be performed for any mediastinal nodule that appears during the course of treatment for HCC.

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A Carcinoma Showing Thymus-Like Elements of the Thyroid Arising in Close Association with Solid Cell Nests: Evidence for a Precursor Lesion?

Cited by 12 publications

References 17 publications

Intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation: Case report with cytomorphology, immunocytochemistry, and review of the literature focusing on cytology

Intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation: Case report with cytomorphology, immunocytochemistry, and review of the literature focusing on cytology

Carcinoma Showing Thymus-Like Differentiation (CASTLE): Cytopathological Features and Differential Diagnosis

A Surgical Case of Heterotopic Thymic Carcinoma Coexisting With Hepatocellular Carcinoma

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