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Trivedi D, George L. An Aggressive Form of Medullary Thyroid Carcinoma-Melanocytic Subtype: A Case Report. Cureus 2023; 15:e50310. [PMID: 38205465 PMCID: PMC10781584 DOI: 10.7759/cureus.50310] [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] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
Medullary thyroid cancer (MTC) represents a small proportion of thyroid cancers. In MTC, melanin production is extremely uncommon. Few case reports have documented this rare variant, and follow-up on these cases has been very limited. Our case studies a 51-year-old female who initially presented with goiter. This tumor recurred multiple times despite surgery with rapid growth and poor response to radiotherapy. Microscopic examination showed high-grade malignant neoplasm with lymphocytic differentiation. Immunohistochemical studies were diffusely positive for S100, SOX10, and Melan-A. Histology confirmed melanocytic medullary carcinoma that had undergone a high-grade transformation with loss of epithelial and neuroendocrine expression. Due to the scarcity and rarity of this subtype, further evaluation and case studies are needed for further categorization and prognostication.
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Affiliation(s)
- Dhaval Trivedi
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Liziamma George
- Pulmonary and Critical Care Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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2
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Subramanian P, Deshmukh A, Kante K, Patil A, Pai T, Kaur R, Rane S, Shetty O, Ankathi SK, Mittal N. HRAS-mutated primary thyroid malignant melanoma or medullary thyroid carcinoma with melanocytic dedifferentiation? A singular case with an ontogeny-phylogeny quandary. Virchows Arch 2023; 483:421-429. [PMID: 37550582 DOI: 10.1007/s00428-023-03619-1] [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: 06/08/2023] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023]
Abstract
Melanotic pigment in the thyroid is practically synonymous with chronic minocycline therapy and rare cases of melanotic medullary thyroid carcinoma. However, primary melanoma of the thyroid has not been reported yet. We report a rare case of a 25-year-old male with a locally aggressive thyroid mass and distant metastases at presentation. Radiologically, a 8.3×7.6-cm nodule was identified in the right thyroid lobe. Fine-needle aspiration cytology (FNAC) showed discohesive atypical plasmacytoid cells with prominent nucleoli and no cytoplasmic pigmentation. Serum calcitonin levels were normal. A trucut biopsy showed a malignant tumor with a similar cytomorphology, including marked nuclear pleomorphism. In addition, intracytoplasmic melanin was seen in <1% of cells. Tumor cells were immunonegative for AE1/AE3, TTF1, synaptophysin, and chromogranin while positive for SOX10, S100P, HMB45, and Melan A, confirming the diagnosis of malignant melanoma, without any detectable MTC component in the biopsy. An HRAS G13R mutation was detected on NGS, which, intriguingly, is a known mutation in MTC, and exceedingly rare in melanocytic lesions. No other clinically or radiologically apparent primary lesion was identified elsewhere in the patient. The unusual histology and hitherto unreported molecular findings make this case of primary thyroid melanocytic neoplasm worth reporting. Abstruse origin of melanoma cells in the thyroid gland with molecular signature suggestive of MTC in our case raises a nomenclature and management conundrum, prompting us to revisit the "ontogeny recapitulates phylogeny" theory.
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Affiliation(s)
- Priyadarsani Subramanian
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
| | - Anuja Deshmukh
- Homi Bhabha National Institute, Mumbai, India
- Department of Head and Neck Surgical oncology, Tata Memorial Center, Parel, Mumbai, 400012, India
| | - Katha Kante
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Ramandeep Kaur
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
| | - Swapnil Rane
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Omshree Shetty
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Suman Kumar Ankathi
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Center, Mumbai, 400012, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India.
- Homi Bhabha National Institute, Mumbai, India.
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India.
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3
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Al‐Harake A, Dandache I, Moukadem H, Saliba M, Chahine J, Yazbeck H, Abdel‐Sater F, Karnib H, Younes MH. Malignant carcinoma and skin melanoma neoplasms concomitantly in the thyroid. Clin Case Rep 2021; 9:e04790. [PMID: 34552737 PMCID: PMC8443434 DOI: 10.1002/ccr3.4790] [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: 12/26/2020] [Revised: 07/25/2021] [Accepted: 08/15/2021] [Indexed: 12/05/2022] Open
Abstract
Malignant melanomas metastatic to the thyroid gland are uncommon. Based on microscopy and DNA methylation profile, we report a rare coexistence of neoplasms in the thyroid, presumably in our case, with relapse-free condition on adjuvant therapy.
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Affiliation(s)
- Ali Al‐Harake
- Department of SurgeryAl Rassoul Al Aazam HospitalBeirutLebanon
| | - Israa Dandache
- Department of Life and Earth SciencesFaculty of Sciences ILebanese UniversityBeirutLebanon
| | - Hiba Moukadem
- Department of OncologySaint George HospitalBaabdaLebanon
| | - Marwan Saliba
- Medical Research CenterAl Rassoul Al Aazam HospitalBeirutLebanon
| | - Jimmy Chahine
- Department of SurgeryAl Rassoul Al Aazam HospitalBeirutLebanon
| | - Hosni Yazbeck
- Medical Research CenterAl Rassoul Al Aazam HospitalBeirutLebanon
| | - Fadi Abdel‐Sater
- Department of BiochemistryFaculty of Sciences ILebanese UniversityBeirutLebanon
| | - Hussein Karnib
- Medical Research CenterAl Rassoul Al Aazam HospitalBeirutLebanon
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4
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Dubal SB, Pathuthara S, Yadav S, Rekhi B. Diagnosis of a rare case of malignant metastatic tumor on fine-needle aspiration of cervical lymph nodes and subcutaneous nodules. Cytojournal 2021; 18:29. [PMID: 33500692 PMCID: PMC8645513 DOI: 10.25259/cytojournal_69_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/22/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sanjivani B. Dubal
- Department of Cytopathology and Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Saleem Pathuthara
- Department of Cytopathology and Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Subhash Yadav
- Department of Cytopathology and Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Cytopathology and Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
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5
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Figueroa Rodriguez F, Uddin A, Nasr J. Primary Pulmonary Malignant Melanoma Found While Evaluating New Onset Cough: A Case Presentation and Literature Review. Case Rep Pulmonol 2019; 2019:3867831. [PMID: 31093406 PMCID: PMC6481098 DOI: 10.1155/2019/3867831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/09/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
Malignant melanoma is a nonepithelial neoplasm of melanocytes. It is tremendously rare for this condition to primarily involve the respiratory tract, accounting only for 0.01% of the lung malignancies. It often presents as a solitary nodule provoking mass effect and/or obstructive symptom. It most commonly affects patients 50 years old and older, with no gender predilection. Complete surgical excision is the treatment of choice; nevertheless, chemotherapy or radiation might be necessary depending on tumor location and/or metastasis status. Recently, biochemotherapy and immunotherapy have emerged as promising treatment modalities. We present a case of Primary Pulmonary Malignant Melanoma (PPMM) in a 76-year-old male with no previous personal or family history of cancer who presented with new onset nonproductive cough. We also present an analysis with high yield points summarizing clinical features, diagnostic workup, and management of PPMM. Finally, we post a table summarizing all the cases ever reported in English literature.
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Affiliation(s)
| | - Ahsan Uddin
- Department of Internal Medicine-Pediatrics, Beaumont Health, Royal Oak, MI, USA
| | - Justine Nasr
- Department of Internal Medicine, Beaumont Health, Royal Oak, MI, USA
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Wang C, Yun T, Wang Z, Meng N, Fan N, Lv X, Li F. Pathological characteristics and genetic features of melanin-producing medullary thyroid carcinoma. Diagn Pathol 2018; 13:86. [PMID: 30424779 PMCID: PMC6234577 DOI: 10.1186/s13000-018-0764-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To study the clinicopathological characteristics and genetic features of melanin-producing medullary thyroid carcinoma (MP-MTC). METHODS The immunophenotype of MP-MTC was studied using the immunohistochemical method, and its genetic features were assayed using an amplification refractory mutation system or PCR method. RESULTS A 71-year-old man presented with a slowly growing 5-cm mass on the left side of the neck for approximately two months. The cut surface of the neoplasm was brown and black. Melanin was found in the cytoplasm of tumor cells or the extracellular matrix. The tumor cells were positive for AE1/AE3, S-100 protein, melan A, HMB-45, synaptophysin, calcitonin, chromogranin A, melanoma, and thyroid transcription factor-1 (TTF-1) and negative for thyroglobulin. No typical genetic features were observed in this case. The patient showed no symptoms and recurrence at 12 months after the operation. CONCLUSIONS The tumor cells of MP-MTC were positive for melanin biomarkers, TTF-1 and exhibited no genetic features. Histopathology and immunohistochemistry of the tumor cells will aid accurate diagnosis.
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Affiliation(s)
- Changsong Wang
- Department of Pathology, 150th Hospital of PLA, Luoyang, Henan, 471000, People's Republic of China.
| | - Tian Yun
- Department of Pathology, 150th Hospital of PLA, Luoyang, Henan, 471000, People's Republic of China
| | - Zhicheng Wang
- Department of Pathology, 153th Hospital of PLA, Zhengzhou, Henan, 450042, People's Republic of China
| | - Nianlong Meng
- Department of Pathology, 150th Hospital of PLA, Luoyang, Henan, 471000, People's Republic of China
| | - Naijun Fan
- Department of Pathology, 150th Hospital of PLA, Luoyang, Henan, 471000, People's Republic of China
| | - Xuexia Lv
- Department of Pathology, 150th Hospital of PLA, Luoyang, Henan, 471000, People's Republic of China
| | - Fulin Li
- Department of Pathology, 150th Hospital of PLA, Luoyang, Henan, 471000, People's Republic of China
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7
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Primary Pulmonary Malignant Melanoma: Report of an Important Entity and Literature Review. Case Rep Oncol Med 2017; 2017:8654326. [PMID: 28352484 PMCID: PMC5352873 DOI: 10.1155/2017/8654326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 01/08/2023] Open
Abstract
Malignant melanoma involving the respiratory tract is nearly always metastatic in origin, and primary tumors are extremely rare. Published data on primary pulmonary malignant melanomas are limited. Up to now 40 relevant cases have been reported in the English literature. Herein, we report a case of a 56-year-old female patient who presented with intracranial metastases due to primary pulmonary melanoma. She underwent bronchoscopy and died 5 months after the initial diagnosis despite the administered biochemotherapy and subsequent immunotherapy. To establish the diagnosis of primary pulmonary malignant melanoma, any extrapulmonary origin was excluded by detailed examination and radiographic imaging. Moreover, an extensive review of the literature regarding this rare entity has been performed.
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8
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Agarwalla PK, Koch MJ, Mordes DA, Codd PJ, Coumans JV. Pigmented Lesions of the Nervous System and the Neural Crest: Lessons From Embryology. Neurosurgery 2016; 78:142-55. [PMID: 26355366 DOI: 10.1227/neu.0000000000001010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Neurosurgeons encounter a number of pigmented tumors of the central nervous system in a variety of locations, including primary central nervous system melanoma, blue nevus of the spinal cord, and melanotic schwannoma. When examined through the lens of embryology, pigmented lesions share a unifying connection: They occur in structures that are neural crest cell derivatives. Here, we review the important progress made in the embryology of neural crest cells, present 3 cases of pigmented tumors of the nervous system, and discuss these clinical entities in the context of the development of melanoblasts. Pigmented lesions of the nervous system arise along neural crest cell migration routes and from neural crest-derived precursors. Awareness of the evolutionary clues of vertebrate pigmentation by the neurosurgical and neuro-oncological community at large is valuable for identifying pathogenic or therapeutic targets and for designing future research on nervous system pigmented lesions. When encountering such a lesion, clinicians should be aware of the embryological basis to direct additional evaluation, including genetic testing, and to work with the scientific community in better understanding these lesions and their relationship to neural crest developmental biology.
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Affiliation(s)
- Pankaj K Agarwalla
- Departments of *Neurosurgery and‡Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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9
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Chigurupati MV, Madiraju V, Chigurupati N, Shinkar PG, Dhagam S, Prabhakar Rao VVS. Great cervical venous tumoral thrombosis of melanotic medullary carcinoma thyroid: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography enabled diagnosis and radiotherapy planning. Indian J Nucl Med 2016; 31:45-8. [PMID: 26917895 PMCID: PMC4746842 DOI: 10.4103/0972-3919.172361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The authors report an extremely rare occurrence of a massive tumor thrombus involving right internal and external jugular veins extending into superior vena cava from a still rarer melanotic medullary carcinoma thyroid in the postoperative follow-up. The case was managed by hypofractionated intensity modulated radiotherapy technique with gratifying results.
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Affiliation(s)
| | - Vidya Madiraju
- Department of Radiation Oncology, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - Namrata Chigurupati
- Department of Radiation Oncology, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - Pawan Gulabrao Shinkar
- Department of Radio Diagnosis, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - Snehalatha Dhagam
- Department of Pathology, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - Vatturi Venkata Satya Prabhakar Rao
- Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
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10
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Hirokawa M, Miyauchi A, Otsuru M, Daa T. Malignant melanoma arising in melanin-producing medullary thyroid carcinoma. Int J Surg Case Rep 2016; 20:118-22. [PMID: 26852361 PMCID: PMC4818313 DOI: 10.1016/j.ijscr.2016.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/23/2022] Open
Abstract
A case of malignant melanoma arising in medullary thyroid carcinoma is described. Malignant melanoma cells expressed Melan-A, HMB-45, and S-100 protein. Contrary to expectation, malignant melanoma arising in MTC may have a favorable prognosis.
Introduction We report a case of malignant melanoma arising in medullary thyroid carcinoma that has not yet been described. Presentation of case A 66-year-old woman presented with a mass in her thyroid. The resected mass was black in color, and was composed of a mixture of classic medullary thyroid carcinoma and pleomorphic atypical cells containing melanin pigments. The pleomorphic atypical cells were morphologically consistent with malignant melanoma, and expressed Melan-A, HMB-45, and S-100 protein as determined by immunohistochemistry. Some of these cells were also positive for calcitonin and chromogranin A. Although the malignant melanoma metastasized to the lymph nodes, the patient remained free from local recurrence and distant metastasis and the primary malignant melanoma lesion was not identified for up to 11 years after the thyroidectomy. Discussion 11 melanin-producing MTC cases have been reported to date. In the reported cases, the term “malignant melanoma” was not used, likely because the melanin-containing carcinoma cells were not morphologically consistent with malignant melanoma, but with medullary carcinoma. Conclusion Malignant melanoma arising in MTC may have a favorable prognosis.
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Affiliation(s)
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan
| | - Minoru Otsuru
- Department of Surgery, Kobe Ekisaikai Hospital, Kobe, Hyogo, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
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11
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The relationship of melanocytic differentiation with prognostic markers in medullary thyroid carcinomas. Pathol Res Pract 2014; 211:356-60. [PMID: 25475146 DOI: 10.1016/j.prp.2014.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/25/2014] [Accepted: 11/07/2014] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Medullary thyroid carcinoma (MTC) makes up 5-10% of thyroid malignancies. Small cell, squamous, giant cell or melanocytic differentiation can rarely be seen in MTCs. It is important to determine those with the potential to act aggressively such as cases with melanocytic differentiation at the time of diagnosis. MATERIALS AND METHOD A total of 46 MTC cases diagnosed at four different centers between 2002 and 2013 were included in the study. Immunohistochemical (IHC) staining with Melan-A and HMB-45 was performed in all cases. RESULTS Six of the 46 MTC cases were medullary microcarcinomas and three were multicentric medullary carcinomas. There were 34 females and 12 males with a mean age at onset of 51.4 years and mean tumor diameter of 23.2mm. Lymph node metastasis (LNM) was found in 13 of the 38 cases that had data regarding the lymph nodes. Immunohistochemically, Melan A staining was seen in four cases. HMB45 staining was seen in four cases. A statistically significant relationship was found between LNM and diameter, Melan A expression (p=0.02, p=0.03 respectively) but there was no significant relationship with HMB45 expression (p=0.07). General survival data were present for 35 of the 46 cases. All cases without lymph node metastasis survived (21/21) while 8 of 11 cases with lymph node metastasis survived among cases with survival data; one case that was diffuse-strong positive for both HMB45 and Melan A was lost due to distant organ metastasis six months after the diagnosis. DISCUSSION Should the possibility of melanocytic differentiation be evaluated in cases where melanocytic differentiation is not reflected in the morphology (lack of pigment) in MTCs? We did not come across a study on the subject in the English literature. The effect of melanocytic differentiation on the prognosis in MTCs should be investigated in larger series.
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12
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He Q, Zhuang D, Zheng L, Zhou P, Duan S, Jing H. Collision malignant melanoma and medullary carcinoma of the thyroid. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Qingqing He
- Department of Thyroid and Breast Surgery; Jinan Military General Hospital of PLA; Jinan China
| | - Dayong Zhuang
- Department of Thyroid and Breast Surgery; Jinan Military General Hospital of PLA; Jinan China
| | - Luming Zheng
- Department of Thyroid and Breast Surgery; Jinan Military General Hospital of PLA; Jinan China
| | - Peng Zhou
- Department of Thyroid and Breast Surgery; Jinan Military General Hospital of PLA; Jinan China
| | - Songjian Duan
- Department of Thyroid and Breast Surgery; Jinan Military General Hospital of PLA; Jinan China
| | - Hongbiao Jing
- Department of Pathology; Jinan Military General Hospital of PLA; Jinan China
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13
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Das SK, Varshney H, Saha ML, Sen S, Maity AB, Paul R. An unusual presentation of medullary thyroid carcinoma. Indian J Otolaryngol Head Neck Surg 2014; 65:195-8. [PMID: 24427645 DOI: 10.1007/s12070-013-0624-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 01/28/2013] [Indexed: 11/25/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) is extremely uncommon having varied presentations & their prognosis is not exactly known; but as MTC is an aggressive tumor hence it needs to be documented in literature to help to know the behaviour of this variant. We report a rare presentation of medullary carcinoma of thyroid in a 48 years old man who presented with huge swelling at left side of neck extending from parotid to supraclavicular region with normal-sized thyroid gland of long duration. FNAC & incision HPE of this swelling was inconclusive so we had operated this swelling. Immunohistochemistry reported it as metastatic Medullary carcinoma of thyroid; tumor cells express Cytokeratin, Calcitonin, EMA, Synaptophysin, Chromogranin-A. The stroma shows deposits of Amyloid, which have been confirmed by Congo red staining. Post-operatively FNAC from thyroid gland supported the diagnosis of Medullary carcinoma. Post-operatively the residual mass was regressed with chemotherapy & radiotherapy. The calcitonin level also decreased following this treatment. There was no recurrence at 11 months but ultimately patient died with metastasis.
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Affiliation(s)
- Sudip Kr Das
- Department of Otorhinolaryngology, BSMC & H, Bankura, 722102 India ; 8, Manik Bandhyopadhyay sarani, Kolkata, 700040 India
| | - Himanshu Varshney
- Department of Otorhinolaryngology, Institute of Postgraduate Medical Education & Research (IPGME&R), 244B, Acharya J. C. Bose Road, Kolkata, 700020 India
| | - M L Saha
- Department of Surgery, Institute of Postgraduate Medical Education & Research (IPGME&R), 244B, Acharya J. C. Bose Road, Kolkata, 700020 India
| | - Shubhrakanti Sen
- Department of Otorhinolaryngology, BSMC & H, Bankura, 722102 India
| | | | - Ranjan Paul
- Department of Otorhinolaryngology, Institute of Postgraduate Medical Education & Research (IPGME&R), 244B, Acharya J. C. Bose Road, Kolkata, 700020 India
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14
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Pathological changes in the thyroid gland in crush asphyxia. Forensic Sci Med Pathol 2013; 9:568-72. [DOI: 10.1007/s12024-013-9462-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
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15
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Rishi A, Savona S, Black K, Schulder M, Li JY. Metastatic medullary carcinoma of thyroid presenting as a dural-based mass: case report and review of literature. Endocr Pathol 2013; 24:40-4. [PMID: 23354781 DOI: 10.1007/s12022-013-9233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dural metastasis from medullary thyroid carcinoma (MTC) is not well established in English literature. We present the case report of MTC with unusual clinical presentation as a dural-based mass in a 39-year-old male with no family history of multiple endocrine neoplasia syndrome. Magnetic resonance imaging showed an extra-axial dural-based mass in right frontal lobe with calvarium and soft tissue extension to the right superior orbit. Histopathology showed MTC with variegated morphology and various patterns. Thyroid mass and widespread metastases from medullary thyroid carcinoma were subsequently identified.
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Affiliation(s)
- Arvind Rishi
- Department of Pathology and Laboratory Medicine, North Shore-Long Island Jewish Health System, Hofstra North Shore-LIJ School of Medicine, 6 Ohio Drive, Suite 202, Lake Success, NY 11042, USA
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16
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Amal B, El Fatemi H, Souaf I, Moumna K, Affaf A. A rare primary tumor of the thyroid gland: report a new case of leiomyosarcoma and literature review. Diagn Pathol 2013; 8:36. [PMID: 23445571 PMCID: PMC3599845 DOI: 10.1186/1746-1596-8-36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/20/2013] [Indexed: 02/06/2023] Open
Abstract
Primary leiomyosarcomas of the thyroid gland are extremely rare. we report a case of a 72 year-old women with a painful growing mass of the left neck with skin fistula. The patient underwent a lobectomy. The tumor histology showed spindle-shaped cells arranged in interlacing fascicles that expressed desmine and Hcaldesmone, but were negative for cytokeratins and thyroglobulin. Total body CT scan didnt show any other tumor. The patient died two months after surgery. Primary thyroid leiomyosarcoma may be mistaken for other tumors, such as anaplastic or medullary carcinomas. Therefore, the diagnosis is difficult and requires numerous clinical, radiological, and pathological investigations.
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Affiliation(s)
- Bennani Amal
- Departement of pathology, Hassan II University Hospital, Fez 30000, Morocco.
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17
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Gong L, Liu XY, Zhang WD, Zhu SJ, Yao L, Han XJ, Lan M, Li YH, Zhang W. Primary pulmonary malignant melanoma: a clinicopathologic study of two cases. Diagn Pathol 2012; 7:123. [PMID: 22992473 PMCID: PMC3502413 DOI: 10.1186/1746-1596-7-123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 09/15/2012] [Indexed: 12/03/2022] Open
Abstract
Abstract Malignant melanoma involving the respiratory tract is nearly always metastatic in origin, and primary tumors are very rare. To our knowledge, about 30 cases have been reported in the English literature, one of which involved multiple brain metastases. Here, we report two cases of primary pulmonary malignant melanoma. The first case, which occurred in a 52-year-old Chinese female patient who died 4 months after the initial diagnosis, involved rapid intrapulmonary and intracranial metastases. The second patient, a 65-year-old female, underwent surgical excision, and clinical examination, histopathological characteristics, and immunohistochemical features supported the diagnosis of pulmonary malignant melanoma. No evidence for recurrence and/or metastasis has been found more than one year after the initial surgery. To establish the diagnosis of primary pulmonary malignant melanoma, any extrapulmonary origin must be excluded by detailed examination. Moreover, the tumor should be removed surgically whether it occurs as a single lesion or multiple lesions. Virtual slide The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1480477335765055.
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Affiliation(s)
- Li Gong
- The Helmholtz Sino-German Laboratory for Cancer Research, Department of Pathology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, PR China
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18
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Mohamad I, Zainuddin N, Zawawi N, Naik VR. Melanocytic Variant of Medullary Thyroid Carcinoma in a Previously Treated Papillary Carcinoma Patient. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n6p300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Irfan Mohamad
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
| | - Nazli Zainuddin
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
| | - Norzaliana Zawawi
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
| | - Venkatesh R Naik
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
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19
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Abstract
On histopathologic examination, many non-neoplastic conditions mimic benign or malignant neoplasms. Alternatively, some benign and malignant neoplasms can also mimic non-neoplastic lesions. This is true of all organ systemsskin is no exception. Examples of these mimickers can be found in skin lesions of almost all tissue types, including those that are melanocytic, lymphoid, epithelial, neural, vascular, neuroendocrine, and fibrohistiocytic. Melanocytic neoplasms are particularly important as it's challenging to differentiate them as being benign or malignant, and it's difficult to tell them apart from non-melanocytic neoplasms. This review illustrates examples of non-melanocytic lesions that disguise themselves as melanocytic.
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Affiliation(s)
- Jag Bhawan
- Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA.
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20
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Kaushal S, Iyer VK, Mathur SR, Ray R. Fine needle aspiration cytology of medullary carcinoma of the thyroid with a focus on rare variants: a review of 78 cases. Cytopathology 2011; 22:95-105. [DOI: 10.1111/j.1365-2303.2010.00747.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Koljenović S, Van Eijck CHJ, Den Bakker MA. Pigmented black neuroendocrine tumour of the pancreas diagnosed by fine needle aspiration cytology. Cytopathology 2009; 21:270-2. [DOI: 10.1111/j.1365-2303.2009.00702.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Temmim L, Sinowatz F, Hussein WI, Al-Sanea O, El-Khodary H. Intrathyroidal parathyroid carcinoma: a case report with clinical and histological findings. Diagn Pathol 2008; 3:46. [PMID: 19032735 PMCID: PMC2627811 DOI: 10.1186/1746-1596-3-46] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 11/25/2008] [Indexed: 11/10/2022] Open
Abstract
The chance of an intrathyroidal occurrence of a parathyroid gland is about 1–3%. Among the causes of hyperparathyroidism, parathyroid cases occur in less than 1% of patients. Here we present the case of a 63 year old Saudi female suffering from an intrathryroidal parathyroid carcinoma. The suspicion coming from the clinical investigations that the removed tumor tissue may be a parathyroid carcinoma could be confirmed by histology. Additionally non-radioactive in situ hybridization to localize mRNA transcripts for Cyclin D1 and immunohistochemical localization of Cyclin D1 was performed. Although parathyroid adenoma and carcinoma have disparate natural history, it can be difficult to differentiate between the two entities. Clinical presentation, operative findings may raise suspicion, but may not be conclusive especially if there is no evidence of invasion or metastasis, especially if the gland was intrathyroidal.
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Affiliation(s)
- Labiba Temmim
- Institute of Histology & Embryology, University of Munich, Germany.
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