OP109 – Clinical Analysis of Carcinoma Showing Thymus-like Differentiation of the Thyroid


    Wang, Yunjun1; Sun, Tuanqi1; Xiang, Jun1; Wang, Zhuoying1;  Li, Duanshu1;  Wu, Yi1
    1 Department of Head and Neck Surgery, Fudan University Shanghai Cancer Centre

    Objective: To analyze the clinicopathologic features, diagnosis, treatment and prognosis of ?carcinoma showing thymus-like differentiation of the thyroid? CASTLE?in order to improve the ability of managing it.

    Method:  Patients of surgically resected specimens of CASTLE were collected in Head & Neck Surgery Department, Fudan University Shanghai Cancer Centre from 2007-09-01to 2015-09-01. Characteristics of preoperative imagine examination (e.g. ultrasound and CT scan), cytological examination, treatment, histologic and immunohistochemical results and prognosis were analyzed retrospectively.

    Results: 16 patients were included in this study, and all accepted surgery. Postoperative radiotherapy was practiced in 13 patients. The immunohistochemical results showed that CD5, CD117 were almost positive in all patients while Tg, TTF-1, Calcitonin were negative. 4 patients were lost to follow-up. The rest 12 patients were alive without tumor recurrence and metastasis (median follow-up period 43.3±28.6 months).

    Conclusion: CASTLE is a low malignant tumor with a slow progression and good prognosis. CD5 and CD117 play an important role in differential diagnosis. Radical surgery is the first choice of treating CASTLE while postoperative radiotherapy might reduce local recurrence.


    1. Miyauchi A, Kuma K, Matsuzuka F, et al. Intrathyroidal epithelial thymoma: an entity distinct from squamous cell carcinoma of the thyroid.[J]. World J Surg, 1985,9(1):128.
    2. Chan J K, Rosai J. Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept[J]. Hum Pathol, 1991,22(4):349-367.
    3. DeLellisRA?LloydRV?Heitz PU?et al. WHO classification of tumours. Pathology and genetics of tumours of endocrine organs?M?.3thed?Lyon: IARC Press?2004?96?97
    4. Ge W, Yao Y, Chen G, et al. Clinical analysis of 82 cases of carcinoma showing thymus-like differentiation of the thyroid.[J]. Oncol Lett, 2016,11(2):1321.
    5. Liu Z, Teng X Y, Sun D X, et al. Clinical analysis of thyroid carcinoma showing thymus-like differentiation: report of 8 cases[J]. Int Surg, 2013,98(2):95-100.
    6. Ito Y, Miyauchi A, Nakamura Y, et al. Clinicopathologic significance of intrathyroidal epithelial thymoma/carcinoma showing thymus-like differentiation: a collaborative study with Member Institutes of The Japanese Society of Thyroid Surgery[J]. Am J Clin Pathol, 2007,127(2):230-236.
    7. Roka S, Kornek G, Schüller J, et al. Carcinoma showing thymic-like elements–a rare malignancy of the thyroid gland.[J]. Br J Surg, 2004,91(2):142.
    8. Yamamoto Y, Yamada K, Motoi N, et al. Sonographic findings in three cases of carcinoma showing thymus-like differentiation[J]. J Clin Ultrasound, 2013,41(9):574-578.
    9. Sun T, Wang Z, Wang J, et al. Outcome of radical resection and postoperative radiotherapy for thyroid carcinoma showing thymus-like differentiation[J]. World J Surg, 2011,35(8):1840-1846.
    10. Hirokawa M, Kuma S, Miyauchi A. Cytological findings of intrathyroidal epithelial thymoma/carcinoma showing thymus-like differentiation: a study of eight cases.[J]. Diagn Cytopathol, 2012,40 Suppl 1:E16.
    11. Huang C, Wang L, Wang Y, et al. Carcinoma showing thymus-like differentiation of the thyroid (CASTLE)[J]. Pathol Res Pract, 2013,209(10):662-665.
    12. Wang Y, Liu B, et al. Thyroid neoplasm Carcinoma showing thymus-like differentiation Immunophenotype GLUT-1 Ultrastructure [J]. J Diag Pathol, 2016,23(01):10-1
    13. Liang J, Huang H, et al. The clinical analysis of thyroid carcinoma showing thymus-like differentiation. [J]. J Clin Otorhinolaryngol Head Neck Surg(China), 2015,23(19):1736-1738.
    14. Hirokawa M, Miyauchi A, Minato H, et al. Intrathyroidal epithelial thymoma/carcinoma showing thymus-like differentiation; comparison with thymic lymphoepithelioma-like carcinoma and a possibility of development from a multipotential stem cell. [J]. APMIS, 2013,121(6):523.
    15. Dorfman D M, Shahsafaei A, Miyauchi A. Intrathyroidal epithelial thymoma (ITET)/carcinoma showing thymus-like differentiation (CASTLE) exhibits CD5 immunoreactivity: new evidence for thymic differentiation[J]. Histopathology, 1998,32(2):104-109.
    16. Reimann J D, Dorfman D M, Nose V. Carcinoma showing thymus-like differentiation of the thyroid (CASTLE): a comparative study: evidence of thymic differentiation and solid cell nest origin[J]. Am J Surg Pathol, 2006,30(8):994-1001.
    17. Yamazaki M, Fujii S, Daiko H, et al. Carcinoma showing thymus-like differentiation (CASTLE) with neuroendocrine differentiation[J]. Pathol Int, 2008,58(12):775-779.
    18. Veits L, Schupfner R, Hufnagel P, et al. KRAS, EGFR, PDGFR-alpha, KIT and COX-2 status in carcinoma showing thymus-like elements (CASTLE)[J]. Diagn Pathol, 2014,9:116.
    19. Hanamura T, Ito K, Uehara T, et al. Chemosensitivity in Carcinoma Showing Thymus-Like Differentiation: A Case Report  and Review of the Literature[J]. Thyroid, 2015,25(8):969-972.


Leave a Reply