Spindle epithelial tumor with thymus-like differentiation: A case report and comprehensive review of the literature and treatment options

Abstract

Although SETTLE is initially indolent, it has the capacity to metastasize late in its course. The malignant potential of this tumor might be underestimated because of the lack of long-term follow-up. In cases in which complete surgical resection is not possible, radiotherapy or combination chemotherapy is effective.

Cytologic findings of spindle epithelial tumor with thymus‐like elements

“…Only 43 other cases have been reported in the literature to our knowledge. SETTLE predominately affects children and young adults, with an average age of 19 years (range, 2–59 years) and a 1.4:1 male to female ratio . Most patients present with painless thyroid enlargement for several years prior to diagnosis.…”

“…We also reviewed literature to see which morphologic component (epithelial or spindled) was more common in metastatic lesions of SETTLE. Twelve cases with metastatic disease or lymph node involvement were identified in a recent review . The cited articles were reviewed, showing limited pathologic descriptions of metastatic disease, with most case reports focusing on the main tumor and merely stating that the metastatic disease was morphologically similar to the primary tumor.…”

Spindle epithelial tumour with thymus‐like elements presenting with lymph node metastasis: An illustrative case report with review of literature

“…Formally recognised as a distinct tumour entity in 1991, ~50 cases of spindle epithelial tumour with thymus‐like elements (SETTLE) have been reported since . Hypothesised to arise from remnants of the fourth and fifth branchial pouches with differentiation along the thymic line, SETTLE usually presents as a solitary, non‐functional, intrathyroidal mass in children and young adults . Conservative surgical resection is the treatment of choice, and the 5‐year overall survival rate is good (~75%) .…”

Treatment of Metastatic Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE) - Long-Term Disease Control by Multimodal Therapy

“…In addition, the extensive osteolytic bone metastases might have further contributed to the profound hypercalcemia of our patient; 1 other patient with SETTLE also had paraneoplastic hypercalcemia due to excessive PTHrP production [18].…”

“…Recently another case of metastatic SETTLE treated with chemotherapy has been reported [18]. In this instance the patient was treated with a regimen of carboplatin, ifosfamide and paclitaxel.…”