{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T04:08:48Z","timestamp":1754021328020,"version":"3.37.0"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Spindle epithelial tumors with thymus\u2010like differentiation (SETTLE) and carcinomas showing thymus\u2010like differentiation (CASTLE) are rare intrathyroid tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study included patients diagnosed with SETTLE, CASTLE, and papillary thyroid carcinoma (PTC) from 2004 to 2020 within the National Cancer Database (NCDB). Demographic, tumor, and treatment characteristics were compared. Overall survival (OS) was analyzed using the Kaplan\u2013Meier method and Cox regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study identified 19 patients with CASTLE, 11 with SETTLE, and 483\u2009474 with PTC. CASTLE and SETTLE patients had larger tumors, lymphovascular invasion, and positive surgical margins. They were rarely treated with radioactive iodine treatment but frequently received external beam radiation and chemotherapy. Five\u2010year OS was significantly lower for CASTLE and SETTLE compared to PTC. SETTLE was associated with an increased risk of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>SETTLE and CASTLE are rare intrathyroid tumors with worse survival compared to PTC, often managed with radiation, chemotherapy, and surgery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.27969","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T05:35:07Z","timestamp":1730784907000},"page":"899-905","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Thyroid Malignancies With Thymic Differentiation: Outcomes of Rare <scp>SETTLE<\/scp> and <scp>CASTLE<\/scp> Tumors"],"prefix":"10.1002","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2689-1377","authenticated-orcid":false,"given":"Iulia","family":"Tapescu","sequence":"first","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail","family":"Kohler","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neel R.","family":"Sangal","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3492-0679","authenticated-orcid":false,"given":"Jason A.","family":"Brant","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Wisconsin  Madison Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6639-8830","authenticated-orcid":false,"given":"Robert M.","family":"Brody","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0186-2265","authenticated-orcid":false,"given":"Ryan M.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,11,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0046-8177(91)90083-2"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.21511"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2017.00207"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2018.00477"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-013-0560-2"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13044-021-00111-3"},{"issue":"9","key":"e_1_2_9_8_1","article-title":"Thyroid Carcinoma Showing Thymus\u2010Like Differentiation (CASTLE): A Case Report","volume":"12","author":"Stanciu M.","year":"2022","journal-title":"Lifestyles"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-015-0716-5"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13044-023-00189-x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-4339-2"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.919208"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.6905"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-007-9747-3"},{"issue":"3","key":"e_1_2_9_15_1","first-page":"247","article-title":"Surgical Management of Primary and Recurrent Carcinoma Showing Thymous\u2010Like Elements (CASTLE)","volume":"88","author":"Attene F.","year":"2017","journal-title":"Annali Italiani di Chirurgia"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2015.4055"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20150726"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4510"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1234961"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1309\/VM7E52B6U9Q729DQ"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.4174\/astr.2018.94.6.337"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12105-018-0927-1"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23634"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.27969","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T12:28:21Z","timestamp":1739363301000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.27969"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,4]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1002\/hed.27969"],"URL":"https:\/\/doi.org\/10.1002\/hed.27969","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"type":"print","value":"1043-3074"},{"type":"electronic","value":"1097-0347"}],"subject":[],"published":{"date-parts":[[2024,11,4]]},"assertion":[{"value":"2024-07-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}