Spindle epithelial tumour with thymus-like differentiation: report of two cases

Spindle epithelial tumour with thymus-like differentiation (SETTLE) is a very rare neck malignancy arising from thymic tissue or branchial pouch, mostly seen in the early decades of life. SETTLE is thought to be a low-grade neoplasm but distant metastases have been reported. Fewer than 50 cases have...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2020-02, Vol.102 (2), p.e33-e35
Main Authors: Karaisli, S, Haciyanli, M, Gücek Haciyanli, S, Tavusbay, C, Gur, E O, Kamer, E, Arikan Etit, D
Format: Article
Language:English
Subjects:
Adolescent
Biomarkers, Tumor - blood
Biopsy
Biopsy, Fine-Needle
Calcitonin - blood
Carcinoma, Neuroendocrine - diagnosis
Cell Differentiation
Diagnosis, Differential
Dissection
Female
Follow-Up Studies
Frozen Sections
Humans
Lymphatic system
Male
Metastasis
Middle Aged
Neoplasms, Germ Cell and Embryonal - diagnosis
Neoplasms, Germ Cell and Embryonal - pathology
Neoplasms, Germ Cell and Embryonal - surgery
Online Case Report
Pathology
Patients
Smooth muscle
Surgery
Thyroid cancer
Thyroid Neoplasms - diagnosis
Thyroid Neoplasms - pathology
Thyroid Neoplasms - surgery
Thyroidectomy - methods
Tumors
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Description
Summary:Spindle epithelial tumour with thymus-like differentiation (SETTLE) is a very rare neck malignancy arising from thymic tissue or branchial pouch, mostly seen in the early decades of life. SETTLE is thought to be a low-grade neoplasm but distant metastases have been reported. Fewer than 50 cases have been reported in the PubMed database. We report on the four-year follow-up for a 13-year-old boy, with no signs of recurrence or distant metastasis. In addition, a 45-year-old woman was admitted to hospital with neck mass. Fine-needle aspiration biopsy was compatible with medullary thyroid carcinoma but serum levels of calcitonin were normal. Total thyroidectomy and central compartment lymph node dissection was planned with an initial diagnosis of medullary thyroid carcinoma. At surgery, frozen section analysis converted our diagnosis to SETTLE and the intraoperative strategy was changed. SETTLE should be considered in a patient with normal serum calcitonin levels in the presence of suspicious medullary thyroid carcinoma at fine-needle aspiration biopsy. Frozen section analysis may help to manage the intraoperative strategy. This report describes the first case of SETTLE successfully diagnosed by frozen section analysis.
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2019.0116