PDF(Pubmed)
Abstract：
Spindle epithelial tumor with thymus-like elements (SETTLE) is a rare malignant neoplasm of the thyroid gland which is believed to arise from intrathyroidal thymic tissue. It predominantly affects young adults and children presenting with a thyroid mass of variable duration and rarely occurs in adults. It has a high overall survival with a tendency for delayed metastasis. SETTLE is a biphasic lobulated tumor composed of spindle shaped cells along with glandular formations seen on histopathological examination. Despite its typical morphology it is commonly misdiagnosed on histopathology due to its rarity and overlapping morphology with other close mimics such as a carcinoma, synovial sarcoma and thymoma. Herein we report such a case occurring in a middle aged female presenting with a neck mass. She had an initial diagnosis of metastatic poorly differentiated squamous cell carcinoma possibly with an orophayngeal primary in view of co expression of CK, p40 and p16 on immunohistochemistry. The patient underwent surgical resection with modified neck dissection. On review at our hospital it was diagnosed as SETTLE and she remains disease free after a follow-up period of 1 year. Diligent histopathological examination espoused with a judicious panel of IHC markers in conjunction with clinicoradiological findings forms the mainstay of diagnosis. Diffuse and strong p16 immunoexpression has not been documented or evaluated in literature so far, and needs to be explored for its diagnostic utility in this rare entity.
摘要：
具有胸腺样元件的梭形上皮肿瘤（SETTLE）是一种罕见的甲状腺恶性肿瘤，据信起源于甲状腺内胸腺组织。它主要影响出现不同持续时间的甲状腺肿块的年轻人和儿童，在成人中很少发生。它具有高的总生存率，并有延迟转移的趋势。SETTLE是一种双相分叶状肿瘤，由梭形细胞和组织病理学检查可见的腺体形成组成。尽管其典型的形态，但由于其稀有性和与其他接近的模拟物（如癌）重叠的形态，通常在组织病理学上被误诊。滑膜肉瘤和胸腺瘤。在此，我们报告了一例发生在颈部肿块的中年女性中的病例。鉴于CK的共同表达，她最初诊断为转移性低分化鳞状细胞癌，可能患有口喉原发性癌，p40和p16的免疫组织化学。患者接受了改良颈清扫术的手术切除。在我们医院的检查中，它被诊断为SETTLE，并且在1年的随访期后她仍然没有疾病。勤奋的组织病理学检查与明智的IHC标记物结合临床放射学检查是诊断的主要依据。到目前为止，在文献中尚未记录或评估弥漫性和强p16免疫表达，并需要探索其在这个罕见实体中的诊断效用。
