Missed Diagnosis of Multiple Endocrine Neoplasia Type 2 B

Multiple endocrine neoplasia type 2B: A report of a rare case

Multiple endocrine neoplasia type 2 (MEN2) is caused by RET proto-oncogene mutations and characterized by the presence of medullary carcinoma of the thyroid, pheochromocytoma, marfanoid features and mucosal neuromas of the tongue, lips, inner cheeks and inner eyelids. MEN type 2B is also known as mucosal neuroma syndrome. Oral presentations are sometimes the earliest signs of this condition. Early identification of this syndrome is important because affected patients often develop medullary thyroid carcinoma and pheochromocytoma. This article reports a 43-year-old male patient with mucosal neuromas and previous history of thyroidectomy due to medullary carcinoma.

MEN2B syndrome presenting as an acute respiratory emergency

An 18-year-old girl presented to the emergency department with a history of noisy breathing and breathlessness progressively increasing for few days. The patient had stridor and tachypnoea. She was tall with a long thin face, wrist sign and high-arched palate suggestive of marfanoid features. X-ray of the neck revealed critical tracheal narrowing. Emergency tracheostomy was performed as a lifesaving procedure. Non-contrast CT neck revealed extratracheal compression by a mass surrounding it. Contrast-enhanced CT scan of the neck revealed heterogeneous mass arising from the right lobe of the thyroid and tracheal deviation with narrowing. Fine-needle aspiration cytology of the mass revealed medullary carcinoma of the thyroid, positive for calcitonin. Calcitonin levels were raised. Apart from the marfanoid features she had localised swellings over the lips, lower eyelid and the lateral aspects of the tongue, clinically suggestive of neuromas. A clinical diagnosis of multiple endocrine neoplasia type 2B syndrome was made. The patient underwent total thyroidectomy with central lymphnode dissection. This case highlights an unusual presentation of a rare disease.