Dualim Diana Mellisa, Loo Guo Hou, Suhaimi Shahrun Niza Abdullah, Md Latar Nani Harlina, Muhammad Rohaizak, Abd Shukor Nordashima
The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia.
Ann Med Surg (Lond). 2019 Jun 30;44:57-61. doi: 10.1016/j.amsu.2019.06.013. eCollection 2019 Aug.
Thyroid carcinoma showing thymic-like differentiation (CASTLE) is a rare malignancy of the thyroid gland, and it accounts for 0.1-0.15% of all thyroid cancers. As the name suggests, it has a histological and immunophenotypic resemblance to thymic carcinoma. Preoperative diagnosis of CASTLE can be difficult as its clinical manifestations, and histological characteristic resembles other aggressive and advanced thyroid carcinomas. It is essential to distinguish CASTLE from other aggressive neoplasms as the former has a more favourable prognosis. Immunohistochemical staining with CD5 can help to differentiate thyroid CASTLE from other aggressive thyroid neoplasms. Due to the rarity of this disease, there is no clear definitive treatment strategy. Surgical resection of CASTLE is usually attempted initially. Nodal involvement and extrathyroidal extension are shown to be the main prognostic factors that influenced the survival of patients. Therefore, complete resection of the tumour is vital to reduce local recurrence rates and to improve the chance of long-term survival. Radiotherapy (RT) for CASTLE is an effective treatment. Curative surgery followed by adjuvant RT should be considered in cases with extrathyroidal extension and nodal metastases. With RT, shrinkage of the tumour and reduction of local recurrence rate is possible. With that in mind, we present a case of CASTLE who presented with airway compression symptoms three years after thyroid surgery. He subsequently underwent tumour debulking surgery and a tracheostomy. The patient refused adjuvant chemoradiotherapy, and during our serial follow-up, he is well and symptom-free.
甲状腺癌伴胸腺样分化（CASTLE）是一种罕见的甲状腺恶性肿瘤，占所有甲状腺癌的0.1 - 0.15%。顾名思义，它在组织学和免疫表型上与胸腺癌相似。CASTLE的术前诊断可能具有挑战性，因为其临床表现和组织学特征与其他侵袭性和晚期甲状腺癌相似。将CASTLE与其他侵袭性肿瘤区分开来至关重要，因为前者预后较好。CD5免疫组化染色有助于鉴别甲状腺CASTLE与其他侵袭性甲状腺肿瘤。由于这种疾病罕见，目前尚无明确的确定性治疗策略。通常首先尝试对CASTLE进行手术切除。淋巴结受累和甲状腺外侵犯是影响患者生存的主要预后因素。因此，完整切除肿瘤对于降低局部复发率和提高长期生存机会至关重要。CASTLE的放射治疗（RT）是一种有效的治疗方法。对于有甲状腺外侵犯和淋巴结转移的病例，应考虑行根治性手术加辅助放疗。通过放疗，肿瘤有可能缩小，局部复发率也可能降低。考虑到这一点，我们报告一例甲状腺手术后三年出现气道压迫症状的CASTLE病例。该患者随后接受了肿瘤减瘤手术和气管切开术。患者拒绝辅助放化疗，在我们的系列随访中，他情况良好且无症状。
