1
|
Nagarjun BR, Mehta S, Gandhi J, Trivedi P, Rathod P. When to settle for SETTLE! A lesson learned from our cases. Thyroid Res 2024; 17:6. [PMID: 38438897 PMCID: PMC10913219 DOI: 10.1186/s13044-023-00189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/27/2023] [Indexed: 03/06/2024] Open
Abstract
Spindle epithelial tumor with thymic like elements (SETTLE) is a biphasic tumor composed of epithelial and spindle cell components. It is an uncommon indolent tumor arising in the thyroid gland and most commonly affects the children and young adults. This entity is mostly overlooked because of its rarity and diagnostic difficulty on morphology. We discuss two cases of SETTLE with varied presentation, diagnostic challenges and lessons learnt from them.SETTLE should be considered as a differential especially when dealing with a thyroid lesion in young and adolescent. The article discusses the histologic details and common mimickers to be borne in mind aiding in arrival at the final diagnosis on biopsy specimens.
Collapse
Affiliation(s)
| | - Shailee Mehta
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - Jahnavi Gandhi
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Priyank Rathod
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| |
Collapse
|
2
|
Lincango Naranjo EP, Cordero-Garate J, Rojas T, Dominguez CM, Solis-Pazmino P, Godoy R, Salazar-Vega J, Dy B, Garcia C. Spindle Epithelial Tumor with Thymus-Like Differentiation: The First Case Report from Ecuador. VideoEndocrinology 2022. [DOI: 10.1089/ve.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eddy P. Lincango Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Department of Teaching and Research, Hospital Vozandes Quito, Quito, Ecuador
| | | | - Tatiana Rojas
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Medical School, Universidad San Francisco de Quito, Quito, Ecuador
| | | | - Paola Solis-Pazmino
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Department Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Richard Godoy
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Head and Neck Department, ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello), Quito, Ecuador
| | - Jorge Salazar-Vega
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Endocrinology Department, Hospital Eugenio Espejo, Quito Ecuador
| | - Benzon Dy
- Division of Endocrine Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cristhian Garcia
- CaTaLiNA Research Initiative (Cancer de tiroides en Latinoamerica), Quito, Ecuador
- Head and Neck Department, ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello), Quito, Ecuador
| |
Collapse
|
3
|
Stevens TM, Morlote D, Swensen J, Ellis M, Harada S, Spencer S, Prieto-Granada CN, Folpe AL, Gatalica Z. Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE): A Next-Generation Sequencing Study. Head Neck Pathol 2018; 13:162-168. [PMID: 29736783 PMCID: PMC6514029 DOI: 10.1007/s12105-018-0927-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/02/2018] [Indexed: 12/27/2022]
Abstract
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a malignant biphasic neoplasm of the thyroid or neck with propensity for late metastasis. Unlike synovial sarcoma, its main morphologic mimic, SETTLE lacks synovial sarcoma-associated translocations. A single case of SETTLE has shown a KRAS mutation but to date no comprehensive next generation sequencing studies of this rare neoplasm have been undertaken. Herein, we subjected 5 well defined cases of SETTLE to direct sequence analysis of 592 genes and fusion gene analysis of 52 genes frequently rearranged in human cancers. We identified one case with two pathogenic variants in the KMT2D gene, one being in an intron splice site (c.674-1A>G) and the other being a frameshift variant (p.M2829fs). This same case also had a pathogenic nonsense variant in the KMT2C gene (p.R1237*). A second case of SETTLE carried a pathogenic NRAS missense variant, Q61R. No other molecular alterations, microsatellite instability, gene fusions or amplifications were identified.
Collapse
Affiliation(s)
- Todd M. Stevens
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave South, Birmingham, AL 35249 USA
| | - Diana Morlote
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave South, Birmingham, AL 35249 USA
| | | | | | - Shuko Harada
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave South, Birmingham, AL 35249 USA
| | - Sharon Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Carlos N. Prieto-Granada
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave South, Birmingham, AL 35249 USA
| | | | | |
Collapse
|
4
|
Abdulrahman AA, Al-Loh Ashi S, Jain M, Hou JS. Spindle epithelial tumor with thymus-like differentiation (SETTLE): Case report with longest follow up & latency to metastasis. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
5
|
Ippolito S, Bellevicine C, Arpaia D, Peirce C, Ciancia G, Vigliar E, Troncone G, Biondi B. Spindle epithelial tumor with thymus-like differentiation (SETTLE): clinical-pathological features, differential pathological diagnosis and therapy. Endocrine 2016; 51:402-12. [PMID: 26289127 DOI: 10.1007/s12020-015-0716-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/07/2015] [Indexed: 11/29/2022]
Abstract
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare tumor of the thyroid gland. An algorithm for the diagnosis and treatment of SETTLE has yet to be established. The aim of this study was to identify all case reports of SETTLE and to compare the clinical-pathological features and therapy of the cases identified. We performed a PubMed search for case reports of SETTLE in English published up to November 2014 in which "SETTLE" and "Spindle epithelial tumor with thymus-like differentiation" were keywords. We identified 35 articles for a total of 42 cases. We found that SETTLE usually occurs in children and adolescents as an asymptomatic neck mass. Thyroid function tests and tumor markers are invariably within normal range in all patients, and fine needle aspiration biopsy is rarely diagnostic for SETTLE. All 42 patients had undergone thyroidectomy. After surgical resection, chemotherapy (adjuvant or first/second-line treatment) and/or radiotherapy were administered to control tumor growth in cases with metastatic involvement. Although SETTLE presents a low-grade malignancy, it can metastasize to lymph nodes, the mediastinum, lung, vertebrae, and kidney even many years after the initial diagnosis. SETTLE may have a good prognosis if appropriately treated at initial presentation and if patients undergo long-term monitoring with regular clinical and morphological evaluations.
Collapse
Affiliation(s)
- Serena Ippolito
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudio Bellevicine
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Debora Arpaia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carmela Peirce
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Ciancia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| |
Collapse
|
6
|
Recondo G, Busaidy N, Erasmus J, Williams MD, Johnson FM. Spindle epithelial tumor with thymus-like differentiation: A case report and comprehensive review of the literature and treatment options. Head Neck 2014; 37:746-54. [DOI: 10.1002/hed.23634] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/12/2013] [Accepted: 02/17/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Gonzalo Recondo
- Department of Internal Medicine; Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno; Buenos Aires Argentina
| | - Naifa Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jeremy Erasmus
- Department of Radiology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michelle D. Williams
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Faye M. Johnson
- Department of Thoracic/Head and Neck Medical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
- The University of Texas Graduate School of Biomedical Sciences at Houston; Houston Texas
| |
Collapse
|
7
|
Llamas-Gutierrez FJ, Falcon-Escobedo R, De Anda-Gonzalez J, Angeles-Angeles A. Spindle epithelial tumor with thymus-like differentiation of the thyroid (SETTLE):. Ann Diagn Pathol 2013; 17:217-21. [DOI: 10.1016/j.anndiagpath.2011.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/18/2011] [Indexed: 11/30/2022]
|
8
|
Recurrent Thyroid Nodule: Spindle Epithelial Tumor with Thymus-like Differentiation (SETTLE). Indian Pediatr 2012; 49:482-4. [DOI: 10.1007/s13312-012-0091-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
9
|
Huang TT, Hudson MM, Stokes DC, Krasin MJ, Spunt SL, Ness KK. Pulmonary outcomes in survivors of childhood cancer: a systematic review. Chest 2011; 140:881-901. [PMID: 21415131 PMCID: PMC3904488 DOI: 10.1378/chest.10-2133] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 03/01/2011] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The purpose of this article is to summarize the literature that documents the long-term impact of cancer treatment modalities on pulmonary function among survivors of cancer and to identify potential areas for further research. METHODS Systematic reviews of clinical trials, observational studies, case series, and review articles were conducted. Articles were limited to the studies that discussed pulmonary toxicity or late effects among pediatric cancer survivors and to follow-up investigations that were conducted a minimum of 2 years after completion of cancer-related treatment or 1 year after hematopoietic stem cell transplant. RESULTS Sixty publications (51 clinical studies/reports and nine reviews) published from January 1970 to June 2010 in PubMed met the inclusion criteria. Data showed an association between radiotherapy, alkylating agents, bleomycin, hematopoietic stem cell transplant, and thoracic surgery and pulmonary toxicity, as well as possible interactions among these modalities. CONCLUSIONS Pulmonary toxicity is a common long-term complication of exposure to certain anticancer therapies in childhood and can vary from subclinical to life threatening. Pulmonary function and associated loss of optimal exercise capacity may have adverse effects on long-term quality of life in survivors. Lung function diminishes as a function of normal aging, and the effects of early lung injury from cancer therapy may compound these changes. The information presented in this review is designed to provide a stimulus to promote both observational and interventional research that expands our knowledge and aids in the design of interventions to prevent or ameliorate pulmonary late effects among survivors of childhood cancer.
Collapse
Affiliation(s)
- Tseng-Tien Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Dennis C Stokes
- Department of Pediatric Pulmonary Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Matthew J Krasin
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Sheri L Spunt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
10
|
Magnata Filho LA, Bordallo MAN, Pessoa CHCN, Corbo R, Bulzico DA, Dias FL, Machado AL, Soares AB, Ferman S. Thyroid spindle epithelial tumor with thymus-like differentiation (SETTLE): case report and review. ACTA ACUST UNITED AC 2010; 54:657-62. [PMID: 21085772 DOI: 10.1590/s0004-27302010000700011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 08/21/2010] [Indexed: 11/22/2022]
Abstract
Spindle epithelial tumor with thymus-like element (SETTLE) is a rare malignant neoplasm of the thyroid, occurring predominantly in children, adolescents, and young adults. SETTLE usually presents itself as a thyroid mass, without metastases at diagnosis. It is believed to derive from branchial pouch or thymic remnant tissue showing primitive thymic differentiation. This article reports the clinical, cytological, histological and immunohistochemical features of a SETTLE in a 3-year-old girl. Microscopic exam revealed a nodular, highly cellular neoplasm displayed in the classic biphasic pattern, with mixture of prominent spindle cell component and a minor glandular component lined by mucinous or respiratory-type epithelium. The immunohistochemical study showed strong and diffuse positivity for pan-CK, vimentin and smooth muscle actin. The present case is the first SETTLE case reported in Brazil. To date, the patient described remains without evidence of recurrence or metastasis 5 years after surgery.
Collapse
|