Diagnostic challenges of FNA cytology of SETTLE: a case report and review of the literature
Abstract Background Spindle epithelial tumor with thymus-like differentiation or elements (SETTLE) is a rare and malignant biphasic tumor of the thyroid that has proven challenging to diagnose by cytology. Case presentation A 20-year-old-male presented with a large left neck nodule and neck tightnes...
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| Format: | Article |
| Language: | English |
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BMC
2025-07-01
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| Series: | Diagnostic Pathology |
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| Online Access: | https://doi.org/10.1186/s13000-025-01682-7 |
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| author | Evelyn O. Ilori Hanan Hamdan Venetia Sarode Iram Hussain Ana Islam Justin A. Bishop |
| author_facet | Evelyn O. Ilori Hanan Hamdan Venetia Sarode Iram Hussain Ana Islam Justin A. Bishop |
| author_sort | Evelyn O. Ilori |
| collection | DOAJ |
| description | Abstract Background Spindle epithelial tumor with thymus-like differentiation or elements (SETTLE) is a rare and malignant biphasic tumor of the thyroid that has proven challenging to diagnose by cytology. Case presentation A 20-year-old-male presented with a large left neck nodule and neck tightness. Laboratory tests were normal. Computed Tomography (CT) of the neck revealed a thyroid mass involving the isthmus and entire left lobe. Ultrasound-guided fine needle aspiration of the mass demonstrated sheets and clusters of oval to spindle cells with associated fibrovascular cores. The cells had moderately pleomorphic nuclei with stippled chromatin, inconspicuous nucleoli, and minimal cytoplasm, and a diagnosis of medullary thyroid carcinoma was made. A total thyroidectomy and neck dissection was performed. Morphological and immunohistochemical evaluation of the specimen resulted in a diagnosis of SETTLE with angioinvasion and involved lymph nodes. Conclusion SETTLE has several mimics cytologically, such as medullary thyroid carcinoma, that makes accurate pre-operative diagnosis challenging. We present a review of cytology information from literature, highlighting features that differentiates SETTLE from its mimics. |
| format | Article |
| id | doaj-art-9ed321ef78954d588ec8ca2da744ae7f |
| institution | Kabale University |
| issn | 1746-1596 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Diagnostic Pathology |
| spelling | doaj-art-9ed321ef78954d588ec8ca2da744ae7f2025-08-20T03:42:23ZengBMCDiagnostic Pathology1746-15962025-07-012011610.1186/s13000-025-01682-7Diagnostic challenges of FNA cytology of SETTLE: a case report and review of the literatureEvelyn O. Ilori0Hanan Hamdan1Venetia Sarode2Iram Hussain3Ana Islam4Justin A. Bishop5Department of Pathology, University of Texas Southwestern Medical CenterDepartment of Pathology, University of Texas Southwestern Medical CenterPropathDepartment of Internal Medicine, University of Texas Southwestern Medical CenterDepartment of Surgery, University of Texas Southwestern Medical CenterDepartment of Pathology, University of Texas Southwestern Medical CenterAbstract Background Spindle epithelial tumor with thymus-like differentiation or elements (SETTLE) is a rare and malignant biphasic tumor of the thyroid that has proven challenging to diagnose by cytology. Case presentation A 20-year-old-male presented with a large left neck nodule and neck tightness. Laboratory tests were normal. Computed Tomography (CT) of the neck revealed a thyroid mass involving the isthmus and entire left lobe. Ultrasound-guided fine needle aspiration of the mass demonstrated sheets and clusters of oval to spindle cells with associated fibrovascular cores. The cells had moderately pleomorphic nuclei with stippled chromatin, inconspicuous nucleoli, and minimal cytoplasm, and a diagnosis of medullary thyroid carcinoma was made. A total thyroidectomy and neck dissection was performed. Morphological and immunohistochemical evaluation of the specimen resulted in a diagnosis of SETTLE with angioinvasion and involved lymph nodes. Conclusion SETTLE has several mimics cytologically, such as medullary thyroid carcinoma, that makes accurate pre-operative diagnosis challenging. We present a review of cytology information from literature, highlighting features that differentiates SETTLE from its mimics.https://doi.org/10.1186/s13000-025-01682-7SETTLEThyroid tumorFNACytology |
| spellingShingle | Evelyn O. Ilori Hanan Hamdan Venetia Sarode Iram Hussain Ana Islam Justin A. Bishop Diagnostic challenges of FNA cytology of SETTLE: a case report and review of the literature Diagnostic Pathology SETTLE Thyroid tumor FNA Cytology |
| title | Diagnostic challenges of FNA cytology of SETTLE: a case report and review of the literature |
| title_full | Diagnostic challenges of FNA cytology of SETTLE: a case report and review of the literature |
| title_fullStr | Diagnostic challenges of FNA cytology of SETTLE: a case report and review of the literature |
| title_full_unstemmed | Diagnostic challenges of FNA cytology of SETTLE: a case report and review of the literature |
| title_short | Diagnostic challenges of FNA cytology of SETTLE: a case report and review of the literature |
| title_sort | diagnostic challenges of fna cytology of settle a case report and review of the literature |
| topic | SETTLE Thyroid tumor FNA Cytology |
| url | https://doi.org/10.1186/s13000-025-01682-7 |
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