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Simultaneous medullary and papillary thyroid cancer: two case reports.

Dionigi G, Castano P, Bertolini V, Boni L, Rovera F, Tanda ML, Capella C, Bartalena L, Dionigi R - J Med Case Rep (2007)

Bottom Line: Case 1 is unique for different reasons: (a) the patient was affected by both multicentric MTC and PTC; (b) a "composite thyroid carcinoma" with mixed feautures of MTC and PTC carcinomas was found in the istmus of the gland; and (c) these tumors were associated with diffuse lymphocytic-type thyroiditis (LT).Case 2 is notable for the long follow up: 16 years disease free.There are only 16 reports in the English medical literature describing a total of 20 cases of concurrent occurrence of both PTC and MTC in the same thyroid gland.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgical Sciences, University of Insubria, Varese, Italy. gianlorenzo.dionigi@uninsubria.it.

ABSTRACT

Background: Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) have always been considered different from each other; in their incidence, their cell origin and their histopathological features.

Case presentation: This paper describes two rare cases of the simultaneous occurrence of MTC and PTC in the thyroid gland. Case 1 is unique for different reasons: (a) the patient was affected by both multicentric MTC and PTC; (b) a "composite thyroid carcinoma" with mixed feautures of MTC and PTC carcinomas was found in the istmus of the gland; and (c) these tumors were associated with diffuse lymphocytic-type thyroiditis (LT). Case 2 is notable for the long follow up: 16 years disease free.

Conclusion: There are only 16 reports in the English medical literature describing a total of 20 cases of concurrent occurrence of both PTC and MTC in the same thyroid gland. We discuss whether the finding of another cancer in these patients was coincidental or from possible activation of a common tumorigenic pathway for both follicular and parafollicular thyroid cells.

No MeSH data available.


Related in: MedlinePlus

Coexistence of (right) medullary and (left) papillary carcinoma with follicular aspect (H&E, 100×).
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Figure 1: Coexistence of (right) medullary and (left) papillary carcinoma with follicular aspect (H&E, 100×).

Mentions: A 65-year-old man was referred to our Department with a right cervical mass on April 2005. There was no apparent family history of endocrine disorders. The patient had not undergo any previous external radiation therapy. Blood pressure was normal. His serum levels of calcium, thyroid stimulating hormone and free thyroxine were normal. The baseline serum calcitonin level was 294 pg/ml (normal < 100 pg/ml). There were no antithyroid autoantibodies. On physical examination a rough nodule, about 4 cm in size, was palpated on the right side of the neck. The ultrasonography (US) showed a heterogeneous nodule, 4 cm in size, in the right lobe of the thyroid and multiple nodules with accompanying calcifications in the left lobe. A single fine-needle aspiration biopsy of the right lobe nodule revealed giant cells with enlarged nuclei and metachromatic cytoplasmic granules. Abdominal US was negative for adrenal nodules as well as urinary catecholamines and metanephrine levels were within normal limits. Total thyroidectomy plus central compartment lymph node neck dissection were performed. Macroscopically the right thyroid lobe measured 7 × 4 × 3.5 cm, left lobe of the thyroid measured 4.3 × 2.5 × 2 cm. There was a right solitary white well-circumscribed nodule of 4 cm in size, associated with a small nodule of 0.4 in the isthmus and a nodule (diameter 0.5 cm) with fine calcification in the left lobe. Microscopic examination of the right nodule confirmed medullary carcinoma of the thyroid with neoplastic spindle-shaped cells forming nests with pale, abundant granular cytoplasm. Immunohistochemical stain was positive for calcitonin and synaptophysin, and was negative for thyroglobulin and p53. Microscopic examination of the nodule (0.4 cm) of the isthmus revealed co-existence of medullary and papillary carcinomas with follicular aspect (Figure 1). Microscopic appearance of the left lobe thyroid nodule revealed papillary carcinoma with branching papillary structure lined by cells with empty appearing nuclei and characteristic nuclear pseudoinclusions. Finally most of thyroid tissue was accompanied by diffuse lymphocyte-type thyroiditis (LT). 4 our of 19 lymph nodes of the central compartment were positive for metastasis of medullary thyroid cancer. TNM for PTC was pT2, N0 and for MTC was stage 3. The patient was discharged, without complications, on the third postoperative day. The patient underwent radioiodine treatment. Analysis of tumor tissue for the RET oncogene mutations was negative. Six months postoperative serum calcitonin and TG levels were within normal range.


Simultaneous medullary and papillary thyroid cancer: two case reports.

Dionigi G, Castano P, Bertolini V, Boni L, Rovera F, Tanda ML, Capella C, Bartalena L, Dionigi R - J Med Case Rep (2007)

Coexistence of (right) medullary and (left) papillary carcinoma with follicular aspect (H&E, 100×).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2194707&req=5

Figure 1: Coexistence of (right) medullary and (left) papillary carcinoma with follicular aspect (H&E, 100×).
Mentions: A 65-year-old man was referred to our Department with a right cervical mass on April 2005. There was no apparent family history of endocrine disorders. The patient had not undergo any previous external radiation therapy. Blood pressure was normal. His serum levels of calcium, thyroid stimulating hormone and free thyroxine were normal. The baseline serum calcitonin level was 294 pg/ml (normal < 100 pg/ml). There were no antithyroid autoantibodies. On physical examination a rough nodule, about 4 cm in size, was palpated on the right side of the neck. The ultrasonography (US) showed a heterogeneous nodule, 4 cm in size, in the right lobe of the thyroid and multiple nodules with accompanying calcifications in the left lobe. A single fine-needle aspiration biopsy of the right lobe nodule revealed giant cells with enlarged nuclei and metachromatic cytoplasmic granules. Abdominal US was negative for adrenal nodules as well as urinary catecholamines and metanephrine levels were within normal limits. Total thyroidectomy plus central compartment lymph node neck dissection were performed. Macroscopically the right thyroid lobe measured 7 × 4 × 3.5 cm, left lobe of the thyroid measured 4.3 × 2.5 × 2 cm. There was a right solitary white well-circumscribed nodule of 4 cm in size, associated with a small nodule of 0.4 in the isthmus and a nodule (diameter 0.5 cm) with fine calcification in the left lobe. Microscopic examination of the right nodule confirmed medullary carcinoma of the thyroid with neoplastic spindle-shaped cells forming nests with pale, abundant granular cytoplasm. Immunohistochemical stain was positive for calcitonin and synaptophysin, and was negative for thyroglobulin and p53. Microscopic examination of the nodule (0.4 cm) of the isthmus revealed co-existence of medullary and papillary carcinomas with follicular aspect (Figure 1). Microscopic appearance of the left lobe thyroid nodule revealed papillary carcinoma with branching papillary structure lined by cells with empty appearing nuclei and characteristic nuclear pseudoinclusions. Finally most of thyroid tissue was accompanied by diffuse lymphocyte-type thyroiditis (LT). 4 our of 19 lymph nodes of the central compartment were positive for metastasis of medullary thyroid cancer. TNM for PTC was pT2, N0 and for MTC was stage 3. The patient was discharged, without complications, on the third postoperative day. The patient underwent radioiodine treatment. Analysis of tumor tissue for the RET oncogene mutations was negative. Six months postoperative serum calcitonin and TG levels were within normal range.

Bottom Line: Case 1 is unique for different reasons: (a) the patient was affected by both multicentric MTC and PTC; (b) a "composite thyroid carcinoma" with mixed feautures of MTC and PTC carcinomas was found in the istmus of the gland; and (c) these tumors were associated with diffuse lymphocytic-type thyroiditis (LT).Case 2 is notable for the long follow up: 16 years disease free.There are only 16 reports in the English medical literature describing a total of 20 cases of concurrent occurrence of both PTC and MTC in the same thyroid gland.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgical Sciences, University of Insubria, Varese, Italy. gianlorenzo.dionigi@uninsubria.it.

ABSTRACT

Background: Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) have always been considered different from each other; in their incidence, their cell origin and their histopathological features.

Case presentation: This paper describes two rare cases of the simultaneous occurrence of MTC and PTC in the thyroid gland. Case 1 is unique for different reasons: (a) the patient was affected by both multicentric MTC and PTC; (b) a "composite thyroid carcinoma" with mixed feautures of MTC and PTC carcinomas was found in the istmus of the gland; and (c) these tumors were associated with diffuse lymphocytic-type thyroiditis (LT). Case 2 is notable for the long follow up: 16 years disease free.

Conclusion: There are only 16 reports in the English medical literature describing a total of 20 cases of concurrent occurrence of both PTC and MTC in the same thyroid gland. We discuss whether the finding of another cancer in these patients was coincidental or from possible activation of a common tumorigenic pathway for both follicular and parafollicular thyroid cells.

No MeSH data available.


Related in: MedlinePlus