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Yang Y, Zhang J, Wang J. Mixed Medullary-Papillary Thyroid Carcinoma with Mixed Lymph Node Metastases: a Case Report and Review of the Literature. Cancer Manag Res 2024; 16:1285-1291. [PMID: 39345969 PMCID: PMC11438464 DOI: 10.2147/cmar.s464797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 09/06/2024] [Indexed: 10/01/2024] Open
Abstract
Papillary thyroid and medullary thyroid cancers are two distinct types of thyroid neoplasms. Co-occurrence of these cancers is rare, especially in mixed tumours with lymph node metastases. A 66-year-old man presented with a thyroid tumour. Thyroid ultrasonography revealed three separate nodules in the thyroid, suspected to be associated with lymph node metastasis. Although preoperative thyroid function was normal, calcitonin and carcinoembryonic antigen levels were elevated. The patient underwent a total cervical thyroidectomy with bilateral radical dissection. Histological and immunohistochemical analyses identified mixed medullary and papillary thyroid carcinoma (MMPTC) in the nodules in the left lobe of the thyroid and the isthmus. Mixed metastatic spread was observed in several lymph nodes from the neck dissection specimen. Accurate diagnosis of the rare co-occurrences of papillary and medullary thyroid carcinomas is crucial. TSH suppression can be effective for treating papillary thyroid carcinoma, whereas radical surgery is the preferred treatment for medullary thyroid carcinoma. Identifying lymph node metastasis before surgery is a key surgical strategy.
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Affiliation(s)
- Yu Yang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Jingyi Zhang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Jianhua Wang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
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Kadoya M, Suganuma N, Matsubara Y, Takase H, Kumagai E, Toda S, Yamazaki H, Masudo K, Fujii S, Saito A. Selpercatinib for treating recurrent mixed medullary and follicular cell-derived thyroid carcinoma: a case report. Surg Case Rep 2024; 10:92. [PMID: 38647958 PMCID: PMC11035533 DOI: 10.1186/s40792-024-01898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Mixed medullary and follicular cell-derived thyroid carcinoma (MMFCC) is characterized by the coexistence of follicular and C cell-derived tumour cell populations within the same lesion. Due to its rarity, its etiology and clinical course remain unclear, and treatment for advanced or recurrent cases has not been established. CASE PRESENTATION We report a case of MMFCC treated with selpercatinib. The patient was a 69-year-old male presenting with tumors in the right thyroid lobe and in the upper mediastinum. Fine-needle aspiration (FNA) cytology of the right thyroid lobe tumor revealed a medullary carcinoma; germline RET mutations were not detected. After resection of the right thyroid lobe with central node dissection, rapid intraoperative diagnosis of the mediastinal mass confirmed malignancy, leading to total thyroidectomy with excision of the upper mediastinal tumor. Histologically, the tumor in the right thyroid lobe and the pretracheal lymph node revealed a mixture of medullary and follicular carcinoma components, diagnosed as MMFCC. The mediastinal lymph node exhibited only medullary carcinoma components. At 11 months postoperatively, computed tomography scans showed enlargement of the right supraclavicular and upper mediastinal lymph nodes. FNA cytology of the right supraclavicular lymph node suggested the recurrence of medullary thyroid carcinoma. The gene panel testing (The Oncomine Dx Target Test Multi-CDx system®, Thermo Fisher SCIENTIFIC) of metastatic lymph node revealed RET somatic mutation (M918T). Treatment with selpercatinib was initiated, and both the cervical and mediastinal lymph nodes showed a reduction in size. CONCLUSIONS We report a rare case of selpercatinib use for MMFCC. Since RET mutations may occur frequently in MMFCC, selpercatinib could be effective in treating MMFCC.
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Affiliation(s)
- Mei Kadoya
- Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Nobuyasu Suganuma
- Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yuka Matsubara
- Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroki Takase
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Eita Kumagai
- Department of Pathology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Soji Toda
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Haruhiko Yamazaki
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Katsuhiko Masudo
- Department of Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Satoshi Fujii
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Aya Saito
- Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
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Ahuja S, Singh P, Ratnakar A, Zaheer S. Synchronous Papillary and Follicular Carcinoma with Scalp and Nodal Metastasis: A case report with review of literature. Indian J Otolaryngol Head Neck Surg 2024; 76:1147-1152. [PMID: 38440654 PMCID: PMC10908663 DOI: 10.1007/s12070-023-04188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 03/06/2024] Open
Abstract
Collision tumor comprise of existence of two histologically distinct and separate neoplasms in any organ. Thyroid gland is an uncommon site for these tumors, with frequently involved organs being liver, adrenal and stomach. Even among the synchronous tumors of thyroid, papillary and medullary carcinoma are most commonly reported. The present case reports a rare presentation of a collision tumor comprising of papillary and follicular carcinoma with scalp metastasis from the follicular carcinoma and lymph nodal metastasis from the papillary component. It is essential for the clinician to be aware of such an entity so as to guide further treatment and management.
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Affiliation(s)
- Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Priyanka Singh
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ankita Ratnakar
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Lalanda R, Aparício D, Boavida J, Presa DL, Batista L, Miranda L. Synchronous mixed medullary-papillary carcinoma and papillary multifocal carcinoma of the thyroid with cervical lymph node metastases. Clin Case Rep 2023; 11:e7433. [PMID: 37261397 PMCID: PMC10227202 DOI: 10.1002/ccr3.7433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
Key Clinical Message The occurrence of simultaneous multifocal papillary thyroid carcinoma and mixed medullary-papillary carcinoma, as far as we know, has not been previously described. We suggest the surgical approach to be driven by the medullary component. Abstract Patient underwent total thyroidectomy with central compartment lymph node dissection. Histological examination revealed a simultaneous multifocal papillary thyroid carcinoma and mixed medullary-papillary carcinoma. He was disease-free at 1-year-follow-up.
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Affiliation(s)
- Raquel Lalanda
- General Surgery Department – Endocrine Surgery – Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - David Aparício
- General Surgery Department – Endocrine Surgery – Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - João Boavida
- Pathology Department – Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Dolores Lopes Presa
- Pathology Department – Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Lucas Batista
- General Surgery Department – Endocrine Surgery – Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Luís Miranda
- General Surgery Department – Endocrine Surgery – Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
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Dai Q, Fu X, Ding Y, He Q, Qiu X. Clinicopathological features and prognostic factors analysis of multiple synchronous distinct subtypes of primary thyroid carcinoma. Endocrine 2023; 79:491-501. [PMID: 36399310 DOI: 10.1007/s12020-022-03243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the clinicopathological features, diagnosis, treatment, and prognosis of multiple synchronous distinct subtypes of primary thyroid carcinomas. METHODS The clinical data of 68 cases of synchronous carcinomas of the thyroid (STC) admitted to the Department of Thyroid Surgery in our hospital from January 2013 to December 2021 were reviewed. According to the pathological type, they were divided into the Synchronous differentiated and differentiated thyroid Carcinoma (SDDTC) group (42 cases), the Synchronous medullary and differentiated thyroid Carcinoma (SMDTC) group (18 cases), and the Synchronous Anaplastic and differentiated thyroid Carcinoma (SADTC)group (8 cases). The diagnosis, treatment, and survival of patients in each group were analyzed. RESULTS Women with coexisting thyroid cancer were predominant (59 cases). Most of the symptoms were found on physical examination (47.1%) and neck mass (45.6%). The median age of patients in the SDDTC group, SADTC group, and SMDTC group was 47.5 (28-74) years old, 68.5 (26-75) years old, and 56.5 (39-74) years old. The age of the SADTC group and SMDTC group was older than that of the SDDTC group (P = 0.04, P = 0.03), and the rate of lymph node metastasis in groups SADTC (62.5%) and SMDTC (55.6%) was higher than in group SDDTC (21.4%). The disease course time, tumor location, clinical stage, and mortality of the SADTC group were significantly different from those of the SDDTC group and SMDTC group (P < 0.05). The overall survival of patients with synchronous carcinomas of the thyroid was 6-105 months, and the median overall survival was 38.5 months. The tumor-free survival was 0-90 months, 19.1% of patients developed distant metastasis, 11.8% of patients had postoperative recurrence, as well as the survival rate was estimated 91.18%. Cox model multivariate analysis showed that cervical lateral lymph node metastasis and tumor stage III/IV were independent risk factors for progression-free survival(PFS). The comparison results of the survival curves showed that the overall survival (OS)of the patients in the SADTC group was significantly worse (P < 0.01), while there was no significant difference in the PFS of different pathological types (χ2 = 5.024, P = 0.081).The OS of different treatment methods was significantly different (P = 0.002), but there was no significant difference in OS between local recurrence and distant metastases with or without surgery (χ2 = 0.954, P = 0.329). CONCLUSIONS The STC has relatively unique clinical characteristics, and most patients can get a better prognosis after radical surgery. Pathological type, lateral cervical lymph node metastasis, tumor stage, and treatment are important factors which affect the prognosis of the disease. Since there are two distinct tumors with different aggressiveness, treatment options, and prognosis, individualized management is required.
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Affiliation(s)
- Quanwei Dai
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jian She Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Xinghao Fu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jian She Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Yalei Ding
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jian She Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Qi He
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jian She Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Xinguang Qiu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jian She Road, Zhengzhou, Henan, 450052, People's Republic of China.
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Features of mixed medullary thyroid tumors: An NCDB analysis of clinicopathologic characteristics and survival. Am J Surg 2023:S0002-9610(23)00058-2. [PMID: 36775791 DOI: 10.1016/j.amjsurg.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/28/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Mixed medullary-papillary thyroid carcinoma (MMPTC) and mixed medullary-follicular thyroid carcinoma (MMFTC) are rare variants with little known regarding behavior and prognosis. METHODS Using the National Cancer Database (NCDB), demographics, clinicopathologic features, treatment, and overall survival (OS) from patients with MMPTC and MMFTC were compared to more prevalent subtypes. RESULTS There were 296,101 patients: 421 MMPTC (0.14%), 133 MMFTC (0.04%), 263,140 PTC (88.87%), 24,208 FTC (8.18%) and 8,199 MTC (2.77%). Compared to PTC, MMPTC and MMFTC patients were older (p < 0.001) with a higher Charlson-Deyo comorbidity index (p < 0.001). Mixed tumors exhibited lower rates of nodal disease but more distant metastases compared to PTC (p < 0.001). MMPTC demonstrated lower estimated 10-year OS than PTC and FTC (76.04%vs 89.04% and 81.95%,p < 0.001), yet higher than MTC (70.29%,p < 0.001). MMFTC had a worse OS compared to all groups (63.32%,p < 0.001). CONCLUSION Patients with MMFTC had significantly worse OS compared to DTC, portending a worse prognosis.
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