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Kataria K, Yadav R, Sarkar C, Karak AK
Correspondence: Dr Rajni Yadav, drrajniyadav@gmail.com
ABSTRACT
Thyroid tumours with both papillary and medullary carcinoma features are rare and represent less than 1% of all thyroid malignancies. These tumours have a different clinical presentation and biological behaviour from tumours that have only papillary or medullary carcinoma features. The phenomenon of mixed thyroid tumours can be observed in two settings – a mixed tumour showing dual differentiation, or a collision tumour. For a precise diagnosis of this rare mixed thyroid carcinoma, fine needle aspiration cytology results should be correlated with serum calcitonin and thyroglobulin levels. The diagnosis should also be confirmed using immunocytochemistry. Surgery is the treatment of choice, and the role of postoperative radioiodine is controversial. We herein report the case of a 35-year-old man with a mixed medullary-papillary carcinoma of the thyroid, which presented with C-cell hyperplasia, granulomatous inflammation and metastasis to the cervical lymph nodes. The patient was treated with total thyroidectomy and nodal clearance. This case highlights the need for awareness of coexistent entities as they warrant separate treatments.
Keywords: calcitonin, granulomatous, medullary carcinoma, papillary carcinoma, thyroglobulin
Singapore Med J 2013; 54(7): e146–e148; http://dx.doi.org/10.11622/smedj.2013115
REFERENCES
| 1. Rosai J. Handling of thyroid follicular patterned lesions. Endocr Pathol 2005; 16:279-83. http://dx.doi.org/10.1385/EP:16:4:279 | ||||
| 2. Ball DW. Medullary thyroid cancer: therapeutic targets and molecular markers. Curr Opin Oncol 2007; 19:18-23. http://dx.doi.org/10.1097/CCO.0b013e32801173ea | ||||
| 3. Rossi S, Fugazzola L, De Pasquale L, et al. Medullary and papillary carcinoma of the thyroid gland occurring as a collision tumour: report of three cases with molecular analysis and review of the literature. Endocr Relat Cancer 2005; 12:281-9. http://dx.doi.org/10.1677/erc.1.00901 | ||||
| 4. Marsh DJ, Learoyd DL, Andrew SD, et al. Somatic mutations in the RET proto-oncogene in sporadic medullary thyroid carcinoma. Clin Endocrinol (Oxf) 1996; 44:249-57. http://dx.doi.org/10.1046/j.1365-2265.1996.681503.x | ||||
| 5. Gero MJ, Lipper S, Chernys AE, Silver L. Medullary and papillary carcinomas occurring as a collision tumour: report of a case. Clin Nucl Med 1989; 14:171-4. http://dx.doi.org/10.1097/00003072-198903000-00006 | ||||
| 6. Nangue C, Bron L, Portmann L, et al. Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature. Head Neck 2009; 31:968-74. http://dx.doi.org/10.1002/hed.20984 | ||||
| 7. Lax SF, Beham A, Kronberger-Schönecker D, Langsteger W, Denk H. Coexistence of papillary and medullary carcinoma of the thyroid gland-mixed or collision tumour? Clinicopathological analysis of three cases. Virchows Arch 1994; 424:441-7. http://dx.doi.org/10.1007/BF00190568 | ||||
| 8. Papotti M, Negro F, Carney JA, Bussolati G, Lloyd RV. Mixed medullary-follicular carcinoma of the thyroid. A morphological, immunohistochemical and in situ hybridization analysis of 11 cases. Virchows Arch 1997; 430:397-405. http://dx.doi.org/10.1007/s004280050049 | ||||
| 9. Noel M, Delehaye MC, Segond N, et al. Study of calcitonin and thyroglobulin gene expression in human mixed follicular and medullary thyroid carcinoma. Thyroid 1991; 1:249-56. http://dx.doi.org/10.1089/thy.1991.1.249 | ||||
| 10. Holm R, Sobrinho-Simões M, Nesland JM, Sambade C, Johannessen JV. Medullary thyroid carcinoma with thyroglobulin immunoreactivity. A special entity? Lab Invest 1987; 57:258-68. | ||||
| 11. Zhang P, Zuo H, Ozaki T, Nakagomi N, Kakudo K. Cancer stem cell hypothesis in thyroid cancer. Pathol Int 2006; 56:485-9. http://dx.doi.org/10.1111/j.1440-1827.2006.01995.x | ||||
| 12. Burstein DE, Nagi C, Wang BY, Unger P. Immunohistochemical detection of p53 homolog p63 in solid cell nests, papillary thyroid carcinoma, and Hashimoto's thyroiditis: a stem cell hypothesis of papillary carcinoma oncogenesis. Hum Pathol 2004; 35:465-73. http://dx.doi.org/10.1016/j.humpath.2003.10.027 | ||||
| 13. Preto A, Cameselle-Teijeiro J, Moldes-Boullosa J, et al. Telomerase expression and proliferative activity suggest a stem cell role for thyroid solid cell nests. Mod Pathol 2004; 17:819-26. http://dx.doi.org/10.1038/modpathol.3800124 | ||||
| 14. Volante M, Papotti M, Roth J, et al. Mixed medullary follicular thyroid carcinoma: molecular evidence for a dual origin of tumour components. Am J Pathol 1999; 55:1499-509. http://dx.doi.org/10.1016/S0002-9440(10)65465-X | ||||
| 15. Papotti M, Volante M, Komminoth P, Sobrinho-Simões M, Bussolati G. Thyroid carcinomas with mixed follicular and C-cell differentiation patterns. Semin Diagn Pathol 2000; 17:109-19. | ||||