직장암과 동반된 갑상선의 CASTLE 1예

Synchronous Carcinoma Showing Thymus-like Elements (CASTLE) of the Thyroid Combined with Rectal Carcinoma: Report of a Case and Review of the Literature

CASTLE은 갑상선에서 발생하는 드문 종양이다. 이 종양은 이소성 갑상선 조직이나 갑상선 주위 또는 갑상선에서 가슴샘 발생과 관련된 잔류물에서 발생하며 일반적으로 갑상선 하부 2/3부위에 위치한다. 환자는 66세 남자환자로 직장암 수술을 위해 입원하였다. 과거력에서 35년 전에 폐결핵으로 우상부 폐엽절제술을 받았다. 수술 전 시행한 흉부 전산화 단층촬영에서 갑상선 결절이 우연히 발견되었다. 결절 흡인세포검사에서 역형성암종이 의심되었다. 원발성 종양에 대해 저위전방절제술과 갑상선 일엽절제술을 시행하였다. 최종 병리진단에서 CASTLE로 진단되어 잔여 갑상선 절제술, 중심구획 임파선 곽청술 및 방사선 치료를 시행하였다. 수술 후 15개월간 재발은 없었다. (Korean J Endocrine Surg 2008;8:266-268)

Carcinoma showing thymus-like elements (CASTLE) is a rare neoplasm arising from the thyroid gland. This tumor is thought to originate from ectopic thymic tissue or remnants related to thymic development in or adjacent to the thyroid gland and usually located in the lower two-thirds of the thyroid gland. The patient was a 66-year-old man admitted to our hospital with rectal carcinoma for surgery. He had undergone a right upper lobectomy of the lung for the pulmonary tuberculosis 35 years previously. He underwent a chest computed tomography (CT) pre-operatively, and an incidental nodule of the thyroid gland was detected. Based on aspiration cytology of the nodule, the lesion was suspected to be an anaplastic carcinoma. He underwent a low anterior resection and thyroid lobectomy for a double primary neoplasm. On the final pathologic examination, the thyroid lesion was shown to be CASTLE. Therefore, completion thyroidectomy with lymph node dissection of the central compartment and radiotherapy were performed, and there was no evidence of recurrence 15 months post- operatively. (Korean J Endocrine Surg 2008;8:266-268)