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Mixed medullary - papillary carcinoma thyroid: an uncommon variant of thyroid carcinoma.

Jain M, Verma D, Thomas S, Chauhan R - J Lab Physicians (2014)

Bottom Line: Serum calcitonin levels were elevated.Histopathologically, the diagnosis of mixed medullary-papillary carcinoma of the thyroid was made.It is important to know about this entity due to its prognostic implications and to prevent any diagnostic dilemmas.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Senior Resident, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.

ABSTRACT
Mixed medullary-papillary carcinoma of the thyroid, a variant of medullary carcinoma is a rare thyroid malignancy accounting for less than 1% of the thyroid malignancies. We are presenting a case of 57-year-old lady with complaints of gradually increasing thyroid swelling for 1½ months. Fine-needle aspiration was suggestive of medullary carcinoma. Serum calcitonin levels were elevated. The patient underwent total thyoidectomy with regional cervical lymph node excision. Histopathologically, the diagnosis of mixed medullary-papillary carcinoma of the thyroid was made. It is important to know about this entity due to its prognostic implications and to prevent any diagnostic dilemmas.

No MeSH data available.


Related in: MedlinePlus

Gross findings of the thyroidectomy specimen: A circumscribed, infiltrative, solid, gray-white mass measuring 4.5 cm × 4 cm × 3.5 cm involving the left lobe and the isthmus. The residual normal thyroid can be seen compressed at the periphery of the tumor. The right lobe was unremarkable
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Figure 1: Gross findings of the thyroidectomy specimen: A circumscribed, infiltrative, solid, gray-white mass measuring 4.5 cm × 4 cm × 3.5 cm involving the left lobe and the isthmus. The residual normal thyroid can be seen compressed at the periphery of the tumor. The right lobe was unremarkable

Mentions: A 57-year-old lady presented to surgery outpatient department with a gradually increasing thyroid swelling since one and half months which was soft and nontender involving central and left lobe of the thyroid. Ultrasonographically, a 4 cm × 3.2 × 3 cm left solitary thyroid nodule with hypervascularity was noted. The thyroid function test was normal. The fine-needle aspiration (FNA) suggested the possibility of medullary carcinoma, thyroid. The serum calcitonin levels thus performed were elevated (450 pg/ml). Patient underwent total thyroidectomy with regional cervical lymph node excision. The specimen showed a circumscribed, solid, nodular, gray-white mass measuring 4.5 cm × 4 cm × 3.5 cm in the left lobe, also involving the isthmus [Figure 1]. The right lobe was unremarkable. Histopathologically, tumor comprised of papillary fronds [Figure 2a] with fibrovascular core; these were lined by cuboidal cells having round to oval nuclei with nuclear clearing, overlapping, and grooving. Few nuclei showed pseudoinclusions [Figure 2b]. Interspersed between these papillae were nodules separated from each other by fibrous septae. These nodules [Figure 3a] composed of dispersed cell population of round to polyhedral to plasmacytoid cells having moderate to abundant granular cytoplasm. Foci of pink amorphous amyloid-like material were also seen. The presence of dual tumor population was confirmed on immunohistochemistry. The thyroglobulin was positive while calcitonin was negative in the papillary component [Figure 2c]; thus suggestive of papillary carcinoma. The presence of calcitonin [Figure 3b], NSE, CEA and chromogranin and the absence of thyroglobulin [Figure 3c] in the nodular component suggested a simultaneous medullary carcinoma. The resected cervical lymph node showed metastatic deposits from the medullary component. Thus, a diagnosis of mixed medullary-papillary thyroid carcinoma with cervical metastasis was established.


Mixed medullary - papillary carcinoma thyroid: an uncommon variant of thyroid carcinoma.

Jain M, Verma D, Thomas S, Chauhan R - J Lab Physicians (2014)

Gross findings of the thyroidectomy specimen: A circumscribed, infiltrative, solid, gray-white mass measuring 4.5 cm × 4 cm × 3.5 cm involving the left lobe and the isthmus. The residual normal thyroid can be seen compressed at the periphery of the tumor. The right lobe was unremarkable
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4196364&req=5

Figure 1: Gross findings of the thyroidectomy specimen: A circumscribed, infiltrative, solid, gray-white mass measuring 4.5 cm × 4 cm × 3.5 cm involving the left lobe and the isthmus. The residual normal thyroid can be seen compressed at the periphery of the tumor. The right lobe was unremarkable
Mentions: A 57-year-old lady presented to surgery outpatient department with a gradually increasing thyroid swelling since one and half months which was soft and nontender involving central and left lobe of the thyroid. Ultrasonographically, a 4 cm × 3.2 × 3 cm left solitary thyroid nodule with hypervascularity was noted. The thyroid function test was normal. The fine-needle aspiration (FNA) suggested the possibility of medullary carcinoma, thyroid. The serum calcitonin levels thus performed were elevated (450 pg/ml). Patient underwent total thyroidectomy with regional cervical lymph node excision. The specimen showed a circumscribed, solid, nodular, gray-white mass measuring 4.5 cm × 4 cm × 3.5 cm in the left lobe, also involving the isthmus [Figure 1]. The right lobe was unremarkable. Histopathologically, tumor comprised of papillary fronds [Figure 2a] with fibrovascular core; these were lined by cuboidal cells having round to oval nuclei with nuclear clearing, overlapping, and grooving. Few nuclei showed pseudoinclusions [Figure 2b]. Interspersed between these papillae were nodules separated from each other by fibrous septae. These nodules [Figure 3a] composed of dispersed cell population of round to polyhedral to plasmacytoid cells having moderate to abundant granular cytoplasm. Foci of pink amorphous amyloid-like material were also seen. The presence of dual tumor population was confirmed on immunohistochemistry. The thyroglobulin was positive while calcitonin was negative in the papillary component [Figure 2c]; thus suggestive of papillary carcinoma. The presence of calcitonin [Figure 3b], NSE, CEA and chromogranin and the absence of thyroglobulin [Figure 3c] in the nodular component suggested a simultaneous medullary carcinoma. The resected cervical lymph node showed metastatic deposits from the medullary component. Thus, a diagnosis of mixed medullary-papillary thyroid carcinoma with cervical metastasis was established.

Bottom Line: Serum calcitonin levels were elevated.Histopathologically, the diagnosis of mixed medullary-papillary carcinoma of the thyroid was made.It is important to know about this entity due to its prognostic implications and to prevent any diagnostic dilemmas.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Senior Resident, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.

ABSTRACT
Mixed medullary-papillary carcinoma of the thyroid, a variant of medullary carcinoma is a rare thyroid malignancy accounting for less than 1% of the thyroid malignancies. We are presenting a case of 57-year-old lady with complaints of gradually increasing thyroid swelling for 1½ months. Fine-needle aspiration was suggestive of medullary carcinoma. Serum calcitonin levels were elevated. The patient underwent total thyoidectomy with regional cervical lymph node excision. Histopathologically, the diagnosis of mixed medullary-papillary carcinoma of the thyroid was made. It is important to know about this entity due to its prognostic implications and to prevent any diagnostic dilemmas.

No MeSH data available.


Related in: MedlinePlus