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Please use this identifier to cite or link to this item: http://hdl.handle.net/10087/5563

Title: 甲状腺の胸腺様分化を示す癌(CASTLE)の1例
Other Titles: A case of thyroid carcinoma showing thymus-like differentiation (CASTLE)
Authors: 堀越, 美枝子
石原, 力
渋沢, 信行
石井, 英昭
伊古田, 勇人
柏原, 賢治
城下, 尚
村上, 正巳
Keywords: Thyroid
aspiration cytology
Carcinoma showing thymus-like differentiation(CASTLE)
Case report
Issue Date: 22-Oct-2007
Publisher: 日本臨床細胞学会
Citation: 日本臨床細胞学会雑誌 46(6), 350-354 (2007)
Abstract: 背景:甲状腺の胸腺様分化を示す癌は非常にまれな腫瘍である.今回,われわれは穿刺吸引細胞診標本では組織型診断をしえなかったが,既存の穿刺吸引細胞診標本を転写法にて分割作成し,免疫細胞化学的検索を行うことで,CASTLEと診断しえた症例を経験したので報告する.症例:63歳,女性.平成18年,咽頭痛,背部痛にて近医を受診.甲状腺の超音波検査を施行したところ右葉甲状腺下極に腫瘍を指摘された.当院内分泌内科外来を受診し,甲状腺穿刺吸引細胞診検査が施行された.悪性所見を示す上皮性細胞の島状集塊を認めたが,腫瘍細胞は甲状腺腫瘍に特徴的な所見はみられず,細胞診標本での組織型推定は困難であった.当院にて同年に腫瘍摘出術が行われた.硝子化した結合織に囲まれて,島状ないし索状に分割された腫瘍であった.免疫組織化学的染色でCD5陽性,サイログロブリン,カルシトニン陰性を呈したことから病理組織学的に甲状腺のCASTLEと診断された.結論:甲状腺のCASTLEは非常にまれな腫瘍であり,細胞学的に組織型推定をすることは困難である.しかし,このような組織型を念頭におくことや,免疫細胞化学的検索を行うことで診断可能となる. Background: We report a tumor difficult to distinguish cytologically from, e.g., anaplastic carcinoma, metastatic carcinoma, or thymoma, and which was finally identified by conventional histology and immunohistochemistry as thyroid carcinoma showing thymus-like differentiation (CASTLE). Case: A 63-year-old woman reporting sore throat and dorsalgia was found in echography to have a mass in the inferior portion of the right thyroid lobe. Aspiration cytology showed no characteristics often associated with malignant thyroid tumors, so we could not diagnose her case beyond its malignancy. The mass, resected two months later, was diagnosed as CASTLE after conventional histological observation and immunohistochemistry findings. Conclusion: CASTLE is very rare and displays few, if any, distinguishing characteristics, making it difficult to diagnose using cytology, alone. A diagnosis of CASTLE should be suspected if findings include positive CD5 and both negative thyroglobulin and carcitonin in immunohistochemistry, in addition to findings of irregularly accumulated lymphocytes.
URI: http://hdl.handle.net/10087/5563
ISSN: 03871193
Appears in Collections:学術雑誌論文

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