title: Management of thyroid carcinoma showing thymus-like differentiation (CASTLE) invading the trachea.
abstract: OBJECTIVE
  To define the clinicopathological features and discuss the optimal management of carcinoma showing thymus-like differentiation (CASTLE).
  
  
  METHODS
  We retrospectively analyzed six patients with CASTLE.
  
  
  RESULTS
  The subjects comprised two men and four women (average age at initial diagnosis, 61 years, range 47-75 years). Preoperative biopsy yielded a correct diagnosis in two patients. Five patients underwent surgery and one was treated with radiation therapy alone. Four had extrathyroidal invasion and three had lymph node metastasis. During the clinical course, tracheal invasion was detected in five patients, the upper extent of the tumor being the lower half of the first tracheal ring. Two of these patients underwent tracheal sleeve resection. Two patients received postoperative radiotherapy for nodal metastasis, and one, after palliative surgery. The median follow-up period was 67 months (range 38-129). Recurrence was found 10 years post-therapy in the patient treated with radiation therapy only, resulting in death soon after. Although local recurrence was not found in the remaining five patients, new pulmonary metastases were diagnosed in the patient who underwent non-curative surgery.
  
  
  CONCLUSIONS
  CASTLE can be diagnosed preoperatively by core needle biopsy and CD5 staining. Curative resection with neck dissection followed by radiotherapy can yield a good outcome. Larynx-sparing complete resection may be more feasible for CASTLE, even though it has a higher incidence of tracheal invasion than differentiated thyroid carcinoma.
authors.affiliation: Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, htsutsui@sd.dcns.ne.jp.
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Tsutsui
authors.forename: Masae
authors.initials: M
authors.lastname: Hoshi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kubota
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suzuki
authors.forename: Nobuki
authors.initials: N
authors.lastname: Nakamura
authors.forename: Jitsuo
authors.initials: J
authors.lastname: Usuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shibuya
authors.forename: Kuniharu
authors.initials: K
authors.lastname: Miyajima
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ohira
authors.forename: Koichi
authors.initials: K
authors.lastname: Ito
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D002454:Cell Differentiation; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013945:Thymoma / Q000473:pathology; D013950:Thymus Gland / Q000473:pathology; D013953:Thymus Neoplasms / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D013965:Thyroidectomy / Q000379:methods; D014132:Trachea / Q000601:surgery; D014134:Tracheal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome
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