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Spindle epithelial tumor with thymus-like elements (SETTLE): a diagnostic challenge with distinct therapeutic
Prerna Chadha1, Meenakshi Kamboj1, Sunil Pasricha2
1Histopathology and Cytopathology, Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, 110085, India.
Diagnostic Pathology
|August 13, 2024
Summary
Spindle epithelial tumor with thymus-like elements (SETTLE) is a rare thyroid cancer. This case highlights diagnostic challenges and the importance of immunohistochemistry for accurate SETTLE diagnosis.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Spindle epithelial tumor with thymus-like elements (SETTLE) is a rare malignant thyroid neoplasm, often misdiagnosed due to overlapping morphology with other cancers.
- SETTLE predominantly affects young individuals but can occur in adults, presenting as a thyroid mass with a tendency for delayed metastasis.
Observation:
- A middle-aged female presented with a neck mass initially diagnosed as metastatic poorly differentiated squamous cell carcinoma based on CK, p40, and p16 co-expression.
- Histopathological review at our institution reclassified the tumor as SETTLE, a biphasic tumor of spindle cells and glandular formations.
Findings:
- Accurate diagnosis of SETTLE requires diligent histopathological examination, a judicious panel of immunohistochemistry (IHC) markers, and clinicoradiological correlation.
- The patient underwent surgical resection and neck dissection, remaining disease-free after 1 year of follow-up.
Implications:
- This case underscores the diagnostic difficulties in rare thyroid tumors like SETTLE and the critical role of IHC in differentiating it from mimics.
- Further research into the diagnostic utility of diffuse and strong p16 immunoexpression in SETTLE is warranted.
