Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE): A Case Report

Matheson, Cyrus; Blair, Geoffrey K.; Bush, Jonathan W.

doi:10.1080/15513815.2019.1600625

Cited by 6 publications

(13 citation statements)

References 16 publications

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“…1,8 Accurate diagnosis of SETTLE can be challenging due to its rarity and resemblance to other spindle cell predominant tumors. 5 Histologically, SETTLE is a cellular tumor, with fibrous septae separating the tumor into lobules/nodules with variable architectural appearances. The architecture may show a mixture of reticulated, microcystic, and/or hyalinized fascicles of spindle cells merging with areas showing an epithelial appearance, including glomeruloid, tubulo-papillary, glandular, and cystic.…”

Section: Case Reportmentioning

confidence: 99%

“…First, SETTLE is rare and fine-needle aspirate cytology alone lacks sensitivity for a definitive diagnosis due to its similarity with other thyroid and non-thyroid neoplasms. 5 In a 28-year-old man with a history of a hemithyroidectomy and a mass consistent with SETTLE, a neck nodule 5 years postsurgery would most likely represent a recurrence. However, other neck lesions would need to be excluded.…”

Section: Case Reportmentioning

confidence: 99%

“…For a detailed overview, please refer to Table 1. 5,7,9,[11][12][13][14][15][16][17][18] Lastly, in the report of the prior resection (hemithyroidectomy), the tumor involved the surgical margins and had focal areas that were suspicious for lymphatic invasion. No lymph nodes were identified and post-operative imaging showed no evidence of metastatic disease and normal thyroid function tests.…”

Section: Case Reportmentioning

confidence: 99%

“…growing, but rapid growth has been documented in one case. 1,3,5 The tumor is thought to arise from ectopic thymus, thymopharyngeal duct, or branchial pouch. 2,3 Thyroid function tests and serum calcitonin are usually normal, reflecting that the tumor is not of follicular or C-cell origin.…”

mentioning

confidence: 99%

“…2,3 Thyroid function tests and serum calcitonin are usually normal, reflecting that the tumor is not of follicular or C-cell origin. 5 As a result of the rarity of this malignancy and an undefined clinical course, there are no standardized treatment recommendations for these tumors. Some reported treatment modalities include surgical resection (hemithyroidectomy or total thyroidectomy); sometimes with adjuvant chemo or radiation therapy.…”

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confidence: 99%

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Cytomorphology of monomorphic spindle epithelial tumor with thymus‐like elements: A case with local recurrence after subtotal resection

Arshia,

Balikani,

Booth

2024

Diagnostic Cytopathology

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Spindle epithelial tumor with thymus‐like elements (SETTLE) is a rare biphasic thyroid tumor with low malignant potential that has a distinct morphology. Despite fine needle aspiration (FNA) being a common method for evaluating thyroid nodules and lymph nodes, there are limited cytologic descriptions of SETTLE in the literature due to its rarity. As a result, SETTLE is frequently underdiagnosed or misdiagnosed as medullary carcinoma, thymoma, teratoma, synovial sarcoma, or solitary fibrous tumor, among others. We present a case of a 28‐year‐old man with a history of a hemithyroidectomy diagnosed as SETTLE found to have a neck nodule along the strap muscle suspicious for recurrence 5 years post‐surgery. The ultrasound‐guided FNA cytology specimen of the neck nodule showed loosely cohesive, monomorphous ovoid to spindled cells with scant cytoplasm and nuclei with fine to granular chromatin. In addition, there were occasional clusters of cells with a papillary configuration. The tumor cells were associated with magenta, amorphous extracellular material. Immunocytochemical staining of the cell block material revealed that tumor cells were positive for p63, cytokeratin AE1/3, and CK8/18 and negative for TTF‐1 and thyroglobulin. Overall, the morphological and immunocytochemical findings were consistent with a local recurrence of SETTLE. The subsequent left anterior strap mass excision revealed a 4 cm encapsulated tumor consistent with SETTLE. Because ofits rarity and low level of awareness, SETTLE poses a diagnostic and therapeutic challenge. We herein present the cytologic findings of monomorphic SETTLE and highlight the potential cytomorphologic and immunophenotypic pitfalls. We also highlight how tumors with high‐risk features can be a therapeutic challenge.

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Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Cytomorphology of monomorphic spindle epithelial tumor with thymus‐like elements: A case with local recurrence after subtotal resection

Arshia,

Balikani,

Booth

2024

Diagnostic Cytopathology

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Spindle cell tumour with thymus‐like differentiation (SETTLE) on fine needle aspiration cytology: A case report highlighting diagnostic pitfalls

Adegun

Proctor

Falzon

et al. 2021

Diagnostic Cytopathology

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A 7‐year‐old girl presented with a painless neck swelling localised near the left lobe of the thyroid gland, which was initially investigated by fine needle aspiration cytology. This raised a differential diagnosis of medullary thyroid carcinoma and small round blue cell tumour. Only after several additional clinical investigations and a total thyroidectomy was a definitive diagnosis of spindle cell tumour with thymus‐like differentiation (SETTLE) reached. This case report highlights how contemporaneous clinical and investigation findings made arriving at a definitive diagnosis challenging, contributed to diagnostic delay, and ultimately influenced choice of treatment.

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Intrathyroid Thymic Carcinoma

Jain,

Bychkov,

Hirokawa

2023

Thyroid FNA Cytology

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Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE): A Case Report

Cited by 6 publications

References 16 publications

Cytomorphology of monomorphic spindle epithelial tumor with thymus‐like elements: A case with local recurrence after subtotal resection

Cytomorphology of monomorphic spindle epithelial tumor with thymus‐like elements: A case with local recurrence after subtotal resection

Spindle cell tumour with thymus‐like differentiation (SETTLE) on fine needle aspiration cytology: A case report highlighting diagnostic pitfalls

Intrathyroid Thymic Carcinoma

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