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. 2021 Aug 16;14(1):20.
doi: 10.1186/s13044-021-00111-3.

Recurrence of carcinoma showing thymus-like differentiation (CASTLE) involving the thyroid gland

N V Dang  1   2 , L X Son  3 , N T T Hong  4 , N T T Nhung  5 , N T Tung  5 , L V Quang  3
Affiliations

Recurrence of carcinoma showing thymus-like differentiation (CASTLE) involving the thyroid gland

N V Dang et al. Thyroid Res. .

Abstract

Background: Carcinoma showing thymus-like differentiation (CASTLE) in the thyroid gland is a rare disease with generally a favorable prognosis. Treatment with surgery and adjuvant radiotherapy has been shown to improve local control and long-term survival rates. In this report, we present a case of a recurrent thyroid gland CASTLE and review the literature on the diagnosis and treatment of this disease.

Case presentation: A 60-year-old woman, who was diagnosed with a CASTLE thyroid tumor in 2015, had a total thyroidectomy and was maintained on thyroid hormone replacement (levothyroxine). After 5 years, the patient had a recurrence, in an advanced stage unsuitable for surgery. As the patient declined to undergo radiotherapy, she was followed up without intervention and is currently stable after 15 months.

Conclusions: CASTLE is a rare disease, diagnosed based on postoperative pathology and immunohistochemistry analysis, especially upon CD5 marker. In case of relapse, treatment options include surgery and radiotherapy; however conservative management without intervention is an acceptable alternative in some cases.

Keywords: CASTLE; Radiotherapy; Surgery; Thyroid cancer.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
CT scan: The lesion was 16 × 54 mm in size, compressed the trachea
Fig. 2
Fig. 2
PET/CT: A 33 × 39x49 mm mass on the left side of the anterior mediastinum; multiple lymph nodes near the lower trachea, next to the superior vena cava, posterior
Fig. 3
Fig. 3
Result of immunohistochemistry: marker CK7, CK56, p63 ( +); marker CK20, Thyroglobulin, TTFI (-)
See this image and copyright information in PMC

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