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Intrathyroidal thymic carcinoma: a case report.

Chi-Ming Tai¹, Cher-Wei Liang, Tien-Chun Chang

¹Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan.

Journal of the Formosan Medical Association = Taiwan Yi Zhi

|April 24, 2003

Summary

Carcinoma showing thymus-like differentiation (CASTLE) is a rare neck malignancy. This case highlights the importance of differentiating intrathyroidal thymic carcinoma from anaplastic thyroid carcinoma due to differing prognoses.

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Area of Science:

Oncology
Pathology
Endocrinology

Background:

Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignancy with potential occurrence in the thyroid gland.
Distinguishing intrathyroidal CASTLE from other thyroid tumors presents diagnostic challenges.

Observation:

A 34-year-old male presented with a left lower neck mass, diagnosed via ultrasonography and fine-needle aspiration as poorly differentiated carcinoma.
Surgical resection revealed a 3.7 cm mass in the left thyroid lobe, microscopically showing poorly differentiated squamoid cells, keratin pearls, and adjacent thymus-like tissue with Hassall's corpuscles.

Findings:

Immunohistochemistry confirmed tumor cells positive for cytokeratin and CD5, but negative for thyroglobulin.
The diagnosis was keratinizing squamous cell carcinoma arising from intrathyroidal thymic tissue.

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Adjuvant radiotherapy was administered due to a dubious surgical margin, with no recurrence observed at twenty months post-surgery.

Implications:

Intrathyroidal thymic carcinoma, though rare, requires differentiation from anaplastic thyroid carcinoma for appropriate patient management.
Accurate diagnosis is crucial as these distinct entities possess different prognoses and treatment strategies.