The ‘CASTLE’ tumour: An extremely rare presentation of a thyroid malignancy. A case report

Diana Mellisa Dualim, Guo Hou Loo, Shahrun Niza Abdullah Suhaimi, Nani Harlina Md. Latar, Rohaizak Muhammad, Nordashima Abd Shukor

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)57-61
Number of pages5
JournalAnnals of Medicine and Surgery
Volume44
DOIs
Publication statusPublished - 1 Aug 2019

Fingerprint

Thymoma
Thyroid Gland
Thyroid Neoplasms
Neoplasms
Radiotherapy
Adjuvant Chemoradiotherapy
Recurrence
Adjuvant Radiotherapy
Survival
Tracheostomy
Names
Staining and Labeling
Neoplasm Metastasis
Therapeutics

Keywords

  • CASTLE
  • Chemoradiotherapy
  • Debulking surgery
  • Thyroid malignancy

ASJC Scopus subject areas

  • Surgery

Cite this

The ‘CASTLE’ tumour : An extremely rare presentation of a thyroid malignancy. A case report. / Dualim, Diana Mellisa; Loo, Guo Hou; Abdullah Suhaimi, Shahrun Niza; Md. Latar, Nani Harlina; Muhammad, Rohaizak; Abd Shukor, Nordashima.

In: Annals of Medicine and Surgery, Vol. 44, 01.08.2019, p. 57-61.

Research output: Contribution to journalArticle

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