Carcinoma Showing Thymus-Like Differentiation (Castle) of Thyroid: A Case Report and Literature Review

呈現胸腺樣分化的甲狀腺癌－病例報告

曾良鵬(Leong-Perng Chan) ； 江豐裕(Feng-Yu Chiang) ； 李家和(Ka-Wo Lee) ； 郭文烈(Wen-Rei Kuo)

《The Kaohsiung Journal of Medical Sciences》 24卷11期 (2008/11) Pp. 591-597

摘要

CASTLE為好發於頭頸部及甲狀腺的罕見惡性腫瘤，其發生原因可能是來自異位胸腺組織或胚胎時期胸腺下降遺留的組織產生癌化所引起。臨床表現及影像並不能和源自甲狀腺或胸腺腫瘤區分，但CD 5免疫組織染色呈現陽性反應，可與甲狀腺其他腫瘤區分。一位54歲男性病患，主訴頸部有一無壓痛感之腫瘤已三個月，病人經胸骨切開術，進行左全葉甲狀腺切除術，將腫瘤完整切除。病理組織切片，診斷為carcinoma showing thymus-like differentiation (CASTLE)。病人術後恢復良好，持續門診追蹤36個月後並無復發跡象。當CASTLE侵犯前中隔腔時，使用正中胸骨切開術可以有效將腫瘤完全切除。

關鍵字

CASTLE ； 胸骨切開術 ； 胸腺 ； 甲狀腺

並列摘要

Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignant neoplasm that occurs in the thyroid gland, or head and neck. This tumor arises from either ectopic thymus tissue or remnants of branchial pouches, which retain the potential to differentiate along the thymus line. Clinical presentation and imaging can be consistent with a malignant lesion such as thyroid cancer or thymic carcinoma. Immunohistochemical staining with CD5 can differentiate CASTLE from other malignant thyroid neoplasms. A54-year-old male had initially presented with a painless, left neck mass for 3 months. He underwent left thyroid lobectomy via a median sternotomy approach. Carcinoma showing thymus-like differentiation was the final histopathologic diagnosis. After 36 months of follow-up, no evidence of recurrence was observed. A median sternotomy is an excellent approach for CASTLE with anterior mediastinum involvement. Complete resection is important to improve the long-term survival rate and the locoregional recurrence rate.

並列關鍵字

CASTLE ； sternotomy ； thymus ； thyroid gland