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

Nambirajan, Aruna; Singh, Varsha; Irugu, David Victor Kumar; Agarwal, Shipra; Jain, Deepali

doi:10.1111/cyt.12742

Cited by 5 publications

(6 citation statements)

References 17 publications

(52 reference statements)

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“…Another striking feature observed in our case on IHC was the positivity for HMWCK exhibited by the tumor cells (Figures 3b, 3c) as it may be evidence to suggest an origin from the remnants of the ultimobranchial body. There are a few studies wherein these clinical, histopathological, and immunohistochemical characteristics have been recorded, and the findings from our report are consistent with existing literature [3][4][5][6][7]9].…”

Section: Discussionsupporting

confidence: 91%

“…Fine needle aspiration (FNAC) biopsy for SETTLE shows variable cytological features and the lack of specificity for diagnosing a case of SETTLE [ 4 ]. Moreover, the lack of specific molecular markers for SETTLE makes this ancillary mode of testing unreliable [ 5 ]. It is mainly immunohistochemistry (IHC; positivity for cytokeratin (CK) and vimentin and negativity for thyroid markers such as thyroglobulin and TTF1) that provides sufficient evidence to establish a diagnosis of SETTLE [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Spindle Epithelial Tumor With Thymus-Like Differentiation (SETTLE) Misdiagnosed as Papillary Thyroid Carcinoma: A Case Report

Kathamuthu¹,

Janardan²,

Ramkumar³

et al. 2022

Cureus

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Spindle epithelial tumor with thymus-like differentiation (SETTLE), a rare tumor of the thyroid gland, is difficult to diagnose irrespective of its unique morphology. It is usually misdiagnosed as synovial sarcoma, thymoma, teratoma, or other thyroid carcinomas. In the current case report, we detail a case of a 36-yearold male patient who presented with thyroid swelling that was initially misdiagnosed as papillary thyroid carcinoma instead of SETTLE. Based on fine needle aspiration, the tumor showed a variable pattern with features suggestive of follicular neoplasm in the right lobe and atypia of undetermined significance in the left lobe. Pathological examination showed multiple nodules on both the right and left lobes, with the largest nodule measuring 4.8 x 4.5 x 3 cm. On microscopic examination, a predominant papillary pattern was observed along with spindle cell areas. Immunohistochemistry revealed positive staining for thyroglobulin, CK, HMWCK, CD99, and BCL-2, which led to the diagnosis of SETTLE. The rare nature of the condition and the reduced awareness about it make this tumor a diagnostic challenge. This case report concludes that in case of any biphasic tumor with epithelial and spindle cells in the thyroid gland, it is important to consider the differential diagnosis of SETTLE. Immunohistochemistry is more useful for diagnosing SETTLE, and thus pathologists are encouraged to judiciously advise the patients for immunohistochemistry to establish accurate and efficient diagnosis.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Spindle Epithelial Tumor With Thymus-Like Differentiation (SETTLE) Misdiagnosed as Papillary Thyroid Carcinoma: A Case Report

Kathamuthu¹,

Janardan²,

Ramkumar³

et al. 2022

Cureus

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“…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%

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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“…When encountering spindled tumor cells on FNAC of the thyroid, cytomorphological differential diagnoses include benign and malignant lesions. These are MTC, fibromatosis, solitary fibrous tumor, spindle epithelial tumor with thymus‐like differentiation (SETTLE), schwannoma, synovial sarcoma, spindle cell variants of papillary thyroid carcinoma (PTC) and anaplastic thyroid carcinoma (ATC), Reidel thyroiditis, etc 3–8 . We present cytological findings of the usual type of MTC, showing extensive spindling on cytology smears which was a diagnostic dilemma.…”

Section: Introductionmentioning

confidence: 96%

“…These are MTC, fibromatosis, solitary fibrous tumor, spindle epithelial tumor with thymus-like differentiation (SETTLE), schwannoma, synovial sarcoma, spindle cell variants of papillary thyroid carcinoma (PTC) and anaplastic thyroid carcinoma (ATC), Reidel thyroiditis, etc. [3][4][5][6][7][8] We present cytological findings of the usual type of MTC, showing extensive spindling on cytology smears which was a diagnostic dilemma. An accurate diagnosis was reached with the help of immunocytochemistry (ICC) on the cell block (CB).…”

Section: Introductionmentioning

confidence: 99%

Extensive spindling in medullary thyroid carcinoma posing a diagnostic challenge: A case report

Saini

Kundu

Bhujade

2022

Diagnostic Cytopathology

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Medullary thyroid carcinoma is a neuroendocrine tumor derived from parafollicular or ‘C’ cells with sporadic and familial forms. Fine needle aspiration cytology is a quick way to establish the diagnosis. Sometimes a usual tumor may show prominent spindling on cytomorphology due to sampling issues, which poses a diagnostic challenge. When encountering spindled tumor cells on cytology smears from the thyroid, differential diagnoses encompass many benign and malignant lesions. We present cytological findings of the usual type of medullary thyroid carcinoma showing extensive spindling on cytology smears, which was a diagnostic dilemma. An accurate diagnosis was reached with the judicious use of immunocytochemistry on the cell block. We also discuss the available literature, differential diagnoses, and how to troubleshoot.

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

Cited by 5 publications

References 17 publications

Spindle Epithelial Tumor With Thymus-Like Differentiation (SETTLE) Misdiagnosed as Papillary Thyroid Carcinoma: A Case Report

Spindle Epithelial Tumor With Thymus-Like Differentiation (SETTLE) Misdiagnosed as Papillary Thyroid Carcinoma: A Case Report

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

Extensive spindling in medullary thyroid carcinoma posing a diagnostic challenge: A case report

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