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Zhang D, Yang M, Frattini F, Cestari A, Li K, Wang H, Chi H, Sui C, Bai K, Lan D, Dionigi G, Sun H. Measuring discrepancies between simple medullary and synchronous medullary/papillary thyroid carcinomas: a comparative cross-sectional study. Front Endocrinol (Lausanne) 2024; 14:1301200. [PMID: 38317715 PMCID: PMC10841576 DOI: 10.3389/fendo.2023.1301200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024] Open
Abstract
Objective To study the clinicopathological characteristics of patients with synchronous medullary and papillary thyroid carcinomas. Methods The clinical data of patients with medullary thyroid carcinoma (MTC) operated in our hospital (Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University) from February 2009 to February 2023 were evaluated using an analytical review approach. They were divided into an observation group (patients with synchronous MTC and papillary thyroid carcinoma PTC) and a control group (simple MTC) according to whether the clinical data were associated with MTC, in order to compare the clinical features, pathological types, stage characteristics and molecular biology characteristics of the two groups and to investigate the follow-up of the two groups. Results The study included 122 MTC, 30 with synchronous MTC/PTC and 92 simple MTC. When the data were compared, the sex ratio, preoperative calcitonin level, preoperative CEA level, presence of calcifications in the MTC lesions, surgical methods, number of MTC lesions, presence of nodular goitre and presence of thyroiditis were higher in the observation group than in the control group. There was a significant difference between the groups when the MTC lesion diameter was ≤1cm in terms of preoperative CEA value (P<0.05); when the MTC lesion diameter was >1cm, there was a statistical difference between the two groups in terms of preoperative Ctn value (P<0.05). Type III was significantly different from the simple group, while type IV was more similar to the simple group. The preoperative serum Ctn value was positively correlated with maximum tumour diameter in both groups, although the correlation was stronger in the easy group. Preoperative CEA was positively correlated with maximum tumour diameter in both groups, with a stronger correlation in the combination group. Preoperative Ctn and CEA were positively correlated with lymph node metastasis in the simple group, whereas there was no apparent correlation with lymph node metastasis in the combination group. The cut-off value of preoperative serum Ctn for cervical lymph node metastases in the simple group was 39.2pg/ml and for lateral cervical lymph node metastases 195.5pg/ml. The cut-off value of preoperative serum Ctn for cervical lymph node metastases in the combination group was 60.79pg/ml and for lateral cervical lymph node metastases 152.6pg/ml. In the simple group, prognosis was significantly worse in the progression group (P<0.001), with no statistical difference between the remission and stable groups. In the combination group, the prognosis of the progression and stable groups was significantly worse than that of the remission group (P<0.001), with no statistical difference between the progression and stable groups. Conclusion In patients with synchronous medullary and papillary thyroid carcinomas, preoperative Ctn and CEA levels, calcifications, solitary lesions, combined goitre or thyroiditis differ significantly from simple MTC. Therefore, clinical management should pay attention to the above factors and early risk screening should be performed to improve prognosis as much as possible.
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Affiliation(s)
- Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
| | - Mingyu Yang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
| | - Francesco Frattini
- Division of Surgery, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Andrea Cestari
- Division of Surgery, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Kunlin Li
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
| | - Hongbo Wang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
| | - Hao Chi
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
| | - Chengqiu Sui
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
| | - Kecheng Bai
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
| | - Dongyuan Lan
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China
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Fallahi P, Patrizio A, Stoppini G, Elia G, Ragusa F, Paparo SR, Balestri E, Mazzi V, Botrini C, Varricchi G, Ulisse S, Ghionzoli M, Antonelli A, Ferrari SM. Simultaneous Occurrence of Medullary Thyroid Carcinoma and Papillary Thyroid Carcinoma: A Case Series with Literature Review. Curr Oncol 2023; 30:10237-10248. [PMID: 38132379 PMCID: PMC10742226 DOI: 10.3390/curroncol30120745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common type of differentiated TC, while medullary TC (MTC) accounts for 4%. The concomitant presence of PTC and MTC is rare. METHODS This is a retrospective, single-center observational study conducted over 16 years (2001-2017). The data were collected from the clinical records of patients who underwent total thyroidectomy at the Endocrine Unit-Department of Medicine of the University Hospital of Pisa, Italy. RESULTS Over 690 analyzed cases, 650 (94.2%) were exclusive DTC, 19 exclusive MTC (2.75%) and 5 PTC/MTC (0.7%). No case of mixed medullary/follicular TC or hereditary MTC (familial MTC/multiple endocrine neoplasia type 2) was found. Among the five PTC/MTC cases, there was a male prevalence (M:F = 3:2), and all PTC components were at stage I, whereas 40% of MTC were at stage I and III and 20% of MTC were at stage II; microPTC (mPTC) was prevalent (80%) and also microMTCs were frequent (40%); 60% of MTC patients recovered, while 40% of patients developed metastatic disease. The search for germline mutations of the RET gene resulted in being negative in all cases. CONCLUSIONS The incidence of PTC/MTC has been increasing over the past 30 years. The etiology of PTC/MTC forms is still unknown, and although this simultaneous occurrence could be only a coincidence, we cannot exclude the hypothesis of a shared genetic origin.
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Affiliation(s)
- Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.F.); (S.R.P.)
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Giulio Stoppini
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Giusy Elia
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Francesca Ragusa
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Sabrina Rosaria Paparo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.F.); (S.R.P.)
| | - Eugenia Balestri
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Valeria Mazzi
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Chiara Botrini
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Gilda Varricchi
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), World Allergy Organization (WAO), Center of Excellence, Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Salvatore Ulisse
- Department of Surgical Sciences, ‘Sapienza’ University of Rome, 00161 Rome, Italy;
| | - Marco Ghionzoli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy;
| | - Alessandro Antonelli
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
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Akgun E, Sager S, Beytur F, Nazari A, Ozturk T, Teksoz S, Sonmezoglu K. Synchronous occurrence of medullary and papillary thyroid cancer and survival rates. Indian J Cancer 2023; 60:556-561. [PMID: 38090963 DOI: 10.4103/ijc.ijc_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/10/2021] [Indexed: 01/24/2024]
Abstract
PURPOSE Concurrence of medullary and papillary thyroid carcinoma (MTC and PTC) represents less than 1% of all thyroid malignancies. We aimed to reveal the demographic and clinical characteristics of this rare pathology and to evaluate the effect of the same or contralateral lobular localization of these two malignancies in clinical and laboratory features. Evaluation of progression-free survival (PFS) in current pathology is one of the important features of our study. METHODS All patients diagnosed with simultaneous MTC and PTC after thyroidectomy were evaluated retrospectively. Data on the following variables were recorded: age, gender, tumor localization (ipsilateral lobe located MTC and PTC-Group I, contralateral lobe located MTC and PTC-Group II), tumor size, cervical lymph node metastasis, distant metastasis, tumor stage, postoperative basal calcitonin, carcinoembryonic antigen, thyroglobulin (Tg), and anti-Tg values. In all our cases, since MTC progressed before PTC, progression was accepted as serum calcitonin values exceeded 150 pg/mL. RESULTS Groups were formed as follows: Group I, four cases where MTC and PTC were localized in different foci in the same lobe; Group II, nine cases where they were localized in different lobes. There was only one case in which two tumors were located in the same focus. The case with dual differentiation was included in Group I (35. 7%). When the PFS of the two groups were compared, no statistically significant difference was found ( P = 0.87). CONCLUSIONS As a result of this analysis, the location of the simultaneously detected PTC in the same or different lobes with the MTC does not make a significant difference in clinical and laboratory features.
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Affiliation(s)
- Elife Akgun
- Department of Nuclear Medicine, Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Sait Sager
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatih Beytur
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Azizullah Nazari
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tulin Ozturk
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serkan Teksoz
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ma T, Wang R, Zhou X, Liu L, Pan A, Wang H, Huang L. Case reports of collision and composite carcinomas of the thyroid: an insight into their origin and clinical significance. BMC Endocr Disord 2023; 23:173. [PMID: 37580706 PMCID: PMC10424338 DOI: 10.1186/s12902-023-01409-z] [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: 10/18/2022] [Accepted: 07/06/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Collision and composite carcinomas of the thyroid are extremely rare, and their clinical and biological characteristics are poorly understood. CASE PRESENTATION The first case was a 41-year-old female patient with a right thyroid nodule. Pathological diagnosis was papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma composite carcinoma. Surgical treatment was right thyroid lobectomy + left partial thyroidectomy + right central neck lymph node dissection. The second case was a 60-year-old female with bilateral thyroid nodules. Total thyroidectomy was performed, and the pathological diagnosis was thyroid collision carcinoma involving follicular thyroid carcinoma on the left side and PTC on the right side. The clinical, histological and gene changes of collision and composite carcinomas of the thyroid are poorly described. With different biological invasion characteristics, the ideal treatment and the prognosis is currently unknown and individualized treatment is necessary. CONCLUSIONS It is recommended that in composite carcinoma, each cancer is evaluated and treated according to the most severe tumor. Collision carcinoma should be treated as two separate synchronous primary tumors. For both collision and composite carcinomas of the thyroid, the follow-up after treatment should be extensive.
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Affiliation(s)
- Tao Ma
- Surgical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750000, Ningxia Province, China
| | - Ruixiao Wang
- Pathological Department, General Hospital of Ningxia Medical University, No.804 Shengli South Street, Xingqing District, Yinchuan, 750000, Ningxia Province, China
| | - Xu Zhou
- Ultrosound Department, General Hospital of Ningxia Medical University, Ningxia Province, Yinchuan, 750000, China
| | - Liqiang Liu
- Surgical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750000, Ningxia Province, China
| | - Aijing Pan
- Clinical Medical College, Ningxia Medical University, Yinchuan, 750000, Ningxia Province, China
| | - Hongmei Wang
- Department of Pharmacology, School of Medicine, Southeast University, Dingjiaqiao 87, Nanjing, 210009, Jiangsu, China.
| | - Lingyan Huang
- Pathological Department, General Hospital of Ningxia Medical University, No.804 Shengli South Street, Xingqing District, Yinchuan, 750000, Ningxia Province, China.
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Miani C, Locatello LG, Rugiu MG, Antonio JK, Di Loreto C, Pegolo E. The protean role of Val804Met RET mutation in thyroid neoplasms: An example of a "MEN2C" syndrome? Pathol Res Pract 2023; 244:154388. [PMID: 36889173 DOI: 10.1016/j.prp.2023.154388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Val804Met RET is one of the most common genetic alterations in Multiple Endocrine Neoplasia 2 and is considered to confer only a moderate risk for familial medullary thyroid carcinoma (MTC). The associated phenotype can however be much more complex in some cases. METHODS A clinical, genetic, and pathological analysis was conducted on a family cluster of thyroid neoplasms associated with Val804Met RET mutation. RESULTS All the kindreds who are carriers of the mutated RET received total thyroidectomy + /- VI level dissection. The proband presented with a pT1bN0 MTC, her 29-yo brother showed a concomitant papillary thyroid carcinoma (PTC) and MTC, their father had a pT1a PTC plus a follicular adenoma, while the uncle of the proband showed C-cell hyperplasia. None had clinical or biochemical evidence of parathyroid disorders or pheochromocytoma. CONCLUSIONS In the presence of Val804Met RET several types of thyroid premalignant and malignant should be screened for, and without limiting to MTC.
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Affiliation(s)
- Cesare Miani
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; University of Udine, Department of Medicine (DAME), Via Colugna 50, 33100 Udine, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy.
| | - Maria Gabriella Rugiu
- Department of Otorhinolaryngology, Sant'Antonio Abate Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33028 Tolmezzo, Italy
| | - Jamile Karina Antonio
- Department of Otorhinolaryngology, San Polo Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, 34074, Monfalcone, Italy
| | - Carla Di Loreto
- Institute of Anatomic Pathology, Academic Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; University of Udine, Department of Medicine (DAME), Via Colugna 50, 33100 Udine, Italy
| | - Enrico Pegolo
- Institute of Anatomic Pathology, Academic Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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Thyroid Collision Tumors: The Presence of the Medullary Thyroid Carcinoma Component Negatively Influences the Prognosis. Diagnostics (Basel) 2023; 13:diagnostics13020285. [PMID: 36673095 PMCID: PMC9857660 DOI: 10.3390/diagnostics13020285] [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: 12/14/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Thyroid collision tumors (TCTs) are rare pathological findings, representing <1% of thyroid cancers. This study aimed to compare the main pathological features of TCTs containing medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) components with MTC-only tumors and PTC-only tumors. Methods: The retrospective study included 69 cases diagnosed with TCTs (with simultaneous MTC and PTC components), MTC and PTC. All tumors were comparatively assessed for the classical histopathological prognostic features, including a new grading system for MTC. Results: The main component of TCTs had more frequent microscopic extrathyroidal extension (mETE) (p = 0.000), lymphovascular invasion (LVI) (p = 0.000), perineural invasion (PNI) (p = 0.044), and lymph node metastasis (p = 0.042). Additionally, the TCTs’ MTC component presented with more frequent LVI (p = 0.010). Comparing TCTs’ MTC and PTC components with MTC-only tumors and PTC-only tumors revealed that only the TCTs’ MTC components had statistically significant more frequent mETE (p = 0.010) than MTC-only tumors. When applied to the MTC component of TCTs, the pathological parameters of the new grading system of MTC showed no correlations with other microscopic or clinical aspects. Conclusion: Using classical pathological prognostic features, the comparative analysis revealed that the main TCTs’ component was more aggressive than the minor one. Contrary to PTCs, in TCTs, the medullary component was more aggressive than the papillary one, but also more aggressive than MTC-only tumors.
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Zhang D, Yang M, Zhang X, Wang C, Li K, Wang H, Chi H, Sui C, Dionigi G, Sun H. Thirty synchronous medullary and papillary thyroid carcinomas. Front Endocrinol (Lausanne) 2023; 14:1153248. [PMID: 37065753 PMCID: PMC10102529 DOI: 10.3389/fendo.2023.1153248] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
SYNOPSIS FOR TABLE OF CONTENTS An exceptional number of synchronous MTC/PTC in the same thyroid gland is presented. This may be the most numerous case series reported in the literature. Synchronous PTC/MTC in the same thyroid gland were classified into 4 subtypes and the clinical and pathological aspects as well as the results are presented. BACKGROUND AND OBJECTIVES The synchronous occurrence of multiple neoplastic processes in the thyroid gland is unusual. We investigated the clinicopathological features of 30 medullary thyroid carcinomas (MTC) in association with papillary (PTC). METHOD Retrospective analysis of operated patients for thyroid tumors. Synchronous PTC/MTC in the same thyroid gland were classified into 4 subtypes: (type I) True mixed MTC/PTC, MTC and PTC closely intermingled. (Type II) Collision MTC/PTC, i.e. tumors that meet at the same site, invade each other and appear as a single mass in the thyroid gland, i.e. MTC and PTC merge. (Type III) Synchronous anatomically separate tumors in the same thyroid lobe, i.e. separated from each other by non-tumorous thyroid parenchyma. (Type IV) Synchronous tumors occurring in separate anatomical lobes or in the isthmus. Clinical and pathological data were reviewed. Location: Department of thyroid surgery, China-Japan Union Hospital, Jilin University. Time frame: 14 years (June 2008-November 2022). RESULTS Thirty patients were identified with an overall prevalence of 28621 (0.1%). 17 (56.7%) were male, 13 (43.3%) female, mean age 51.3 ± 11.0 years, mean BMI 23.6 ± 3.6kg/m2. Mean duration of symptoms was 11.2 ± 18.4 months. Mean calcitonin level was 133.7 ± 196.4 pg/ml. Fine needle aspiration (FNA) was offered in 21 cases: 9 (42.9%) were suspected carcinoma, 9 (42.9%) PTC, 1 (4.8%) MTC, 2 (9.4%) MTC/PTC. Pathology revealed type I 4 (13.3%), type II 2 (6.7%), type III 14 (46.7%), type IV 10 (33.3%). The mean diameter of MTC was 1.6 ± 2.0cm, 18 (60%) were micro-MTC. The mean diameter of PTC was 0.9 ± 1.9 cm, 26 (86.7%) were micro-PTC. In 16 (53.3%) micro-PTC/-MTC occurred in synchronous sequence. Four patients had a recurrence: 2 had to be re-operated due to MTC recurrence, 2 died due to distant metastases (bone, liver). CONCLUSION We report an exceptional number of MTC/PTC in the same thyroid gland. This may be the most numerous case series reported in the literature. The clinical and pathological aspects as well as the results are presented.
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Affiliation(s)
- Daqi Zhang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Mingyu Yang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xin Zhang
- Division of Pathology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Cheng Wang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Kunlin Li
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Hongbo Wang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Hao Chi
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Chengqiu Sui
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Gianlorenzo Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Surgery, Istituto Auxologico Italiano Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Hui Sun
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
- *Correspondence: Hui Sun,
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Bellini MI, Lori E, Forte F, Lauro A, Tripodi D, Amabile MI, Cantisani V, Varanese M, Ferent IC, Baldini E, Ulisse S, D’Andrea V, Pironi D, Sorrenti S. Thyroid and renal cancers: A bidirectional association. Front Oncol 2022; 12:951976. [PMID: 36212468 PMCID: PMC9538481 DOI: 10.3389/fonc.2022.951976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022] Open
Abstract
There is a deep interrelation between the thyroid gland and the kidney parenchyma, with dysfunction of the first leading to significant changes in renal metabolism and vice versa. Given the recognition of cancer as a systemic disease, the raise of thyroid tumors and the common association of several malignancies, such as breast cancer, prostate cancer, colorectal cancer, and other, with an increased risk of kidney disease, public health alert for these conditions is warranted. A systematic review of the current evidence on the bidirectional relationship between thyroid and renal cancers was conducted including 18 studies, highlighting patient’s characteristics, histology, time for secondary malignancy to develop from the first diagnosis, treatment, and follow-up. A total of 776 patients were identified; median age was 64 years (range: 7–76 years). Obesity and family history were identified as the most common risk factors, and genetic susceptibility was suggested with a potential strong association with Cowden syndrome. Controversy on chemo and radiotherapy effects was found, as not all patients were previously exposed to these treatments. Men were more likely to develop kidney cancer after a primary thyroid malignancy, with 423/776 (54%) experiencing renal disease secondarily. Median time after the first malignancy was 5.2 years (range: 0–20 years). With the advancement of current oncological therapy, the prognosis for thyroid cancer patients has improved, although there has been a corresponding rise in the incidence of multiple secondary malignancy within the same population, particularly concerning the kidney. Surgery can achieve disease-free survival, if surveillance follow-up allows for an early localized form, where radical treatment is recommended.
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Affiliation(s)
- Maria Irene Bellini
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Maria Irene Bellini,
| | - Eleonora Lori
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Flavio Forte
- Department of Urology, M. G. Vannini Hospital, Rome, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Tripodi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Vito Cantisani
- Department of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marzia Varanese
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Enke Baldini
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore Ulisse
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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9
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Koh HH, Oh YL. Papillary and medullary thyroid carcinomas coexisting in the same lobe, first suspected based on fine-needle aspiration cytology: a case report. J Pathol Transl Med 2022; 56:301-308. [PMID: 36128867 PMCID: PMC9510044 DOI: 10.4132/jptm.2022.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Because different types of thyroid malignancies have distinct embryological origins, coexisting tumors are rarely observed. We describe a coexisting papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) first suspected by fine-needle aspiration cytology (FNAC). A 57-year-old female presented with an irregular mass in the right thyroid lobe. The cytopathologic findings of fine-needle aspiration showed two components: a papillary-like arrangement consisting of cells with pale enlarged nuclei indicative of PTC and loose clusters comprised of oval cells with granular chromatin indicative of MTC. The diagnosis of a coexisting PTC and MTC was initially confirmed by calcitonin immunocytochemistry and later after total thyroidectomy. Although some surgical case reports of PTC and MTC coexisting in either the same or different lobes have been documented, a case suspected by FNAC before the surgery has rarely been reported. Because appropriate treatment and prognosis of PTC and MTC are different, cytopathologists should be aware of this rare entity.
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Affiliation(s)
- Hyun Hee Koh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Awadalla AS, Al Saleem MA, Al Nemer AM, Ahmed A, Al Bisher E, Al Bisher HM. Collision tumor of the thyroid gland: Follicular carcinoma and papillary microcarcinoma. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Abdullah AM, Qaradakhy AJ, Ahmed MM, Salih AM, Omar SS, Kakamad FH, Rahim HM, Abdulla BA, Mohammed SH, Ahmed SF, Baba HO, Ishaac RH. Thyroid collision tumors; A case series with literature review. Ann Med Surg (Lond) 2022; 76:103444. [PMID: 35299940 PMCID: PMC8921309 DOI: 10.1016/j.amsu.2022.103444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/19/2022] [Accepted: 02/27/2022] [Indexed: 12/24/2022] Open
Abstract
Background Collision tumors are two histologically distinct types of malignancies within the same mass and organ. The aim of this study is to present a case series of thyroid collisions. Methods This was a multicenter retrospective case series study. The participants were consecutive in order. Socio-demographic and clinical data were obtained from hospital records. Results The study included eight cases comprising six (75%) females and two (25%) males. The patients had different presentations, including neck swelling, dyspnea, and dizziness. The pathology was successfully determined through fine-needle aspiration. Four patients (50%) underwent lobectomy, whereas the other half (four patients) underwent total thyroidectomy. Conclusion Collision tumors of papillary thyroid cancer (PTC) and follicular thyroid carcinoma (FTA) or medullary thyroid carcinoma (MTC) and FTA are exceedingly rare phenomena that most commonly affect females. Complete or partial thyroidectomy is the ideal management of choice for these cases and is associated with good survival. Collision tumors are two distinct types of malignancies with dissimilar cellular lineages and genetic origins within the same mass. Patients with thyroid collision tumors have rarely been observed in the literature. Most thyroid collision tumors consisting of papillary and medullary carcinoma. In this study, several cases of thyroid collision tumors have been discussed.
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12
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Bojoga A, Stănescu L, Badiu C. Collision tumors of the thyroid. A special clinical and pathological entity. Arch Clin Cases 2022; 8:84-90. [PMID: 34984231 PMCID: PMC8717004 DOI: 10.22551/2021.33.0804.10191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Thyroid collision tumors are rare entities that designate two histologically and morphologically distinct tumors that occur simultaneously or as metastases from other organs within the thyroid. Medullary and papillary carcinoma co-occurrence is the most frequent. Several theories tried to explain the pathogenic mechanisms underlining collision tumors, including the theory which assumes that one tumor predisposes the other, stem cell theory, and random effect theory, but their combination better explains the origin of these tumors. Hypotheses about common genetic behavior responsible for the pathogenesis have also been suggested, such as the involvement of germline mutation of RET (Rearranged during Transfection) proto-oncogene in medullary thyroid carcinoma and papillary thyroid carcinoma coexistence, but there is controversy on this topic. Management of thyroid collision tumors is challenging owing to the presence of two distinct tumors with different biological aggressiveness, treatments options, and prognosis, and needs to be individualized.
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Affiliation(s)
- Andreea Bojoga
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Laura Stănescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Corin Badiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
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13
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Abstract
Objective. Medullary (MTC) and papillary (PTC) thyroid carcinoma are two different types of thyroid carcinoma with significant differences in origin. Their co-occurrence in a patient is a rare phenomenon. We report a patient with simultaneous presentation of both MTC and PTC. Case presentation. A 62-year-old euthyroid woman with a cervical mass was evaluated, underwent total thyroidectomy, and neck dissection. The examination revealed a MTC large nodule as well as a small nodule of the tall cell variant of PTC, along with the concomitant cervical lymph node metastases. Subsequently, the genetic analysis showed BRAF mutations. Adjuvant treatments including radioiodine and thyroid hormone replacement therapies were performed for the patient. Conclusions. The cooccurrence of MTC and PTC in the same patient is a rare phenomenon. The clinical manifestations and biological behavior of these cancers are completely different. Since the therapeutic strategy and prognosis are very different in these patients, accurate diagnosis of this coexistence is very important.
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14
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Guerreiro V, Costa C, Oliveira J, Santos AP, Farinha M, Jácome M, Freitas P, Carvalho D, Torres I. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: A case report. Clin Case Rep 2021; 9:e04165. [PMID: 34084509 PMCID: PMC8142802 DOI: 10.1002/ccr3.4165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 01/02/2023] Open
Abstract
Mixed medullary-follicular-derived carcinoma is a very rare event. It is extremely important to make the correct diagnosis, due to prognostic and treatment implications. A genetic study of these patients is advisable to exclude the presence of MEN 2.
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Affiliation(s)
- Vanessa Guerreiro
- Serviço de EndocrinologiaDiabetes e Metabolismo do Centro Hospitalar Universitário de São João EPEPortoPortugal
- Faculdade de Medicina da Universidade do PortoPortoPortugal
- Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
| | - Cláudia Costa
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto Francisco GentilPortoPortugal
| | - Joana Oliveira
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto Francisco GentilPortoPortugal
| | - Ana Paula Santos
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto Francisco GentilPortoPortugal
| | - Mónica Farinha
- Serviço de Anatomia Patológica do Instituto Português de Oncologia do Porto Francisco GentilPortoPortugal
| | - Manuel Jácome
- Serviço de Anatomia Patológica do Instituto Português de Oncologia do Porto Francisco GentilPortoPortugal
| | - Paula Freitas
- Serviço de EndocrinologiaDiabetes e Metabolismo do Centro Hospitalar Universitário de São João EPEPortoPortugal
- Faculdade de Medicina da Universidade do PortoPortoPortugal
- Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
| | - Davide Carvalho
- Serviço de EndocrinologiaDiabetes e Metabolismo do Centro Hospitalar Universitário de São João EPEPortoPortugal
- Faculdade de Medicina da Universidade do PortoPortoPortugal
- Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
| | - Isabel Torres
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto Francisco GentilPortoPortugal
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15
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Thomas A, Mittal N, Rane SU, Bal M, Patil A, Ankathi SK, Vaish R. Papillary and Medullary Thyroid Carcinomas Presenting as Collision Tumors: A Case Series of 21 Cases at a Tertiary Care Cancer Center. Head Neck Pathol 2021; 15:1137-1146. [PMID: 33840044 PMCID: PMC8633268 DOI: 10.1007/s12105-021-01323-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022]
Abstract
Collision tumor is the occurrence of two histologically and morphologically distinct tumors within the same organ with no histological admixture. Collision tumors of the thyroid are extremely rare constituting < 1% of all thyroid tumors. Clinical profiles and pathological features of Medullary thyroid carcinoma (MTC) and Papillary thyroid carcinoma (PTC) presenting as Collision tumors of thyroid, diagnosed between 2009 and 2019, at a tertiary care cancer center were retrospectively analyzed. Collision tumors comprised 4.7% of all MTC cases diagnosed over 10 years. A total of 21 cases (11males, 11 females, M:F = 1) were retrieved with the mean age of patients being 45.33 years (range 26-77 years). More than half of PTCs involved the right lobe of the thyroid (66.6%). About half (53.4%) of MTCs affected the left lobe. Imaging done pre-operatively failed to identify the smaller second tumor in 60% of the cases with both tumours in separate lobes. Pre-operative FNAC showed only MTC in all 8 cases in which it was done. Papillary microcarcinoma (m-PTC) was seen in 85.7% cases, with one case of multifocal m-PTC. MTC (mean size 3.12 cm), on an average, was 3 times larger than the PTC (mean size 0.91 cm). The histological variants of MTC included-oncocytic (1/21, 4.7%), spindle cell (1/21, 4.7%), epithelial (3/21, 14.2%) and classical (16/21, 76.2%) and of PTC included classic PTC (12/21, 57.14%), Hurthle cell (2/21, 9.52%), tall cell (1/21, 4.76%) and follicular variant of PTC (6/21, 28.57%). The microscopic extrathyroidal extension (ETE) due to MTC and PTC component was 42.8% and 9.5% respectively. Lymph node metastasis was seen in 16 (76.2%) cases; 87.5% (14/16) of which were contributed by MTC, 12.5% (2/16) by PTC alone, and 12.5% (2/16) cases showed metastasis from both MTC and PTC. MTC had a higher stage than PTC in 85.5% of cases. Collision tumors of the thyroid are exceedingly rare, and possibly underdiagnosed due to variation in sampling techniques, especially of the grossly "normal lobe". The low incidence in our cohort is in favor of the "Chance theory" of co-occurrence. This diagnosis is important due to its therapeutic and prognostic implications.
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Affiliation(s)
- Ann Thomas
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra 400012 India ,Homi Bhabha National Institute, Mumbai, 400012 India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra 400012 India ,Homi Bhabha National Institute, Mumbai, 400012 India
| | - Swapnil U. Rane
- Homi Bhabha National Institute, Mumbai, 400012 India ,Department of Pathology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra 400012 India ,Homi Bhabha National Institute, Mumbai, 400012 India
| | - Asawari Patil
- Homi Bhabha National Institute, Mumbai, 400012 India ,Department of Pathology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Suman Kumar Ankathi
- Homi Bhabha National Institute, Mumbai, 400012 India ,Department of Radiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra 400012 India
| | - Richa Vaish
- Homi Bhabha National Institute, Mumbai, 400012 India ,Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra 400012 India
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16
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Samarasinghe S, Yuksel S, Mehrotra S. Intermixed medullary and papillary thyroid cancer in a patient with renal cell carcinoma. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200025. [PMID: 32538376 PMCID: PMC7354741 DOI: 10.1530/edm-20-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/30/2020] [Indexed: 01/19/2023] Open
Abstract
SUMMARY We report a rare case of concurrent medullary thyroid cancer (MTC) and papillary thyroid cancer (PTC) with intermixed disease in several of the lymph node (LN) metastases in a patient who was subsequently diagnosed with clear cell renal cell carcinoma (RCC). A 56 year old female presented with dysphagia and was found to have a left thyroid nodule and left superior cervical LN with suspicious sonographic features. Fine needle aspiration biopsy (FNAB) demonstrated PTC in the left thyroid nodule and MTC in the left cervical LN. Histopathology demonstrated multifocal PTC with 3/21 LNs positive for metastatic PTC. One LN in the left lateral neck dissection exhibited features of both MTC and PTC within the same node. In the right lobe, a 0.3 cm focus of MTC with extra-thyroidal extension was noted. Given persistent calcitonin elevation, a follow-up ultrasound displayed an abnormal left level 4 LN. FNAB showed features of both PTC and MTC on the cytopathology itself. The patient underwent repeat central and left radical neck dissection with 3/6 LNs positive for PTC in the central neck and 2/6 LNs positive for intermixed PTC and MTC in the left neck. There was no evidence of distant metastases on computed tomography and whole body scintigraphy, however a 1.9 x 2.5 cm enhancing mass within the right inter-polar kidney was discovered. This lesion was highly suspicious for RCC. Surgical pathology revealed a 2.5 cm clear cell RCC, Fuhrman grade 2/4, with negative surgical margins. She continues to be observed with stable imaging of her triple malignancies. LEARNING POINTS Mixed medullary-papillary thyroid neoplasm is characterized by the presence of morphological and immunohistochemical features of both medullary and papillary thyroid cancers within the same lesion. Simultaneous occurrence of these carcinomas has been previously reported, but a mixed disease within the same lymph node is an infrequent phenomenon. Prognosis of mixed medullary-papillary thyroid carcinomas is determined by the medullary component. Therefore, when PTC and MTC occur concurrently, the priority should be given to the management of MTC, which involves total thyroidectomy and central lymph node dissection. Patients with thyroid cancer, predominantly PTC, have shown higher than expected rates of RCC. To our knowledge, this is the first report describing the combination of MTC, PTC, and RCC in a single patient.
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Affiliation(s)
- Shanika Samarasinghe
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, Illinois, USA
| | - Simge Yuksel
- Division of Internal Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Swati Mehrotra
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois, USA
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17
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Cho YA, Oh YL. Case of medullary thyroid carcinoma with desmoid-type fibromatosis. Pathol Int 2020; 70:364-369. [PMID: 32249519 DOI: 10.1111/pin.12926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 12/20/2022]
Abstract
A 36-year-old man was admitted to hospital for a right thyroid nodule incidentally discovered on a chest computed tomography scan for a rib fracture. He had no history of radiation to the head and neck, no known family history of endocrine disease, and no medical or surgical history. A 17 × 10 mm, well-demarcated, multinodular, whitish nodule with neither necrosis nor hemorrhage was found in the right thyroid. Microscopically, the tumor consisted of epithelial cell nests with oval, plasmacytoid or polygonal cells with speckled chromatin, inconspicuous nucleoli and granular cytoplasm. The surrounding stroma showed amyloid deposition and prominent spindle cell proliferation with myxoid substance. Epithelial cell nests showed an immunoreactive pattern for typical medullary thyroid carcinoma (MTC), and the spindle cell stroma showed nuclear expression of beta-catenin. This may be the first report on histopathologic findings of MTC with desmoid-type fibromatosis. Further studies are necessary to discover the clinicopathologic characteristics and pathogenesis of this rare type of tumor.
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Affiliation(s)
- Yoon Ah Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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18
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Appetecchia M, Lauretta R, Barnabei A, Pieruzzi L, Terrenato I, Cavedon E, Mian C, Castagna MG, Elisei R. Epidemiology of Simultaneous Medullary and Papillary Thyroid Carcinomas (MTC/PTC): An Italian Multicenter Study. Cancers (Basel) 2019; 11:cancers11101516. [PMID: 31600997 PMCID: PMC6826384 DOI: 10.3390/cancers11101516] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022] Open
Abstract
Background: The concomitant presence of papillary thyroid cancer (PTC) and medullary TC (MTC) is rare. In this multicentric study, we documented the epidemiological characteristics, disease conditions and clinical outcome of patients with simultaneous MTC/PTC. Methods: We collected data of patients with concomitant MTC/PTC at 14 Italian referral centers. Results: In total, 183 patients were enrolled. Diagnosis was mostly based on cytological examination (n = 58, 32%). At diagnosis, in the majority of cases, both PTC (n = 142, 78%) and MTC (n = 100, 54%) were at stage I. However, more cases of stage II–IV were reported with MTC (stage IV: n = 27, 15%) compared with PTC (n = 9, 5%). Information on survival was available for 165 patients: 109 patients (66%) were disease-free for both PTC and MTC at the last follow-up. Six patients died from MTC. Median time to progression was 123 months (95% confidence interval (CI): 89.3–156.7 months). Overall, 45% of patients were disease-free after >10 years from diagnosis (125 months); this figure was 72.5% for PTC and 51.1% for MTC. Conclusions: When MTC and PTC are concurrent, the priority should be given to the management of MTC since this entity appears associated with the most severe impact on prognosis.
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Affiliation(s)
- Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy.
| | - Rosa Lauretta
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy.
| | - Agnese Barnabei
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy.
| | - Letizia Pieruzzi
- Endocrinology Unit, University Hospital of Pisa, Pisa 56121, Italy.
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCSS Regina Elena National Institute, Rome 00144, Italy.
| | | | - Caterina Mian
- Istituto Oncologico Veneto, University of Padua, Padua 35100, Italy.
| | | | - Rossella Elisei
- Endocrinology Unit, University Hospital of Pisa, Pisa 56121, Italy.
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19
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Medullary Thyroid Carcinoma and Papillary Thyroid Carcinoma in the Same Patient as a Collision Tumour. Case Rep Endocrinol 2019; 2019:4038628. [PMID: 30993022 PMCID: PMC6434312 DOI: 10.1155/2019/4038628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/07/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022] Open
Abstract
Aim Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are two different types of thyroid carcinoma with significant different clinical and histological findings. Their coexistence in the same patient is a very rare event which demands different clinical approach. Case Report We report a case with concurrent MTC and PTC in the same thyroid having characteristics of a collision tumour. A 35-year-old patient has admitted to endocrinology outpatient department with complaint of pain in the neck. Physical examination revealed 2 cm nodule on the thyroid right lobe. Serum thyroid hormone levels were within normal range. Ultrasonography revealed a 23x15 mm hypoechoic nodule with micro calcifications and cystic areas on the right lobe. Preoperative serum calcitonin was 2 pg/ml (0-11.5). PTK 1.7 cm and MTK 1.8 cm in the same thyroid with healthy tissue in between them were detected on pathological examination. RET gene mutation was negative. She has been followed up to now without any evidence of disease. Conclusion This is a collision tumour since lesions with features of MTC and PTC were detected in two different locations and separated by normal thyroid tissue. Germline point mutation of the RET gene had a potential role in the development of both MTC and PTC. On the other side, familial concurrent MTC and PTC without RET gene mutation was also published. Both RET and BRAF genes had a role in the development of the medullary and papillary collision tumours. We do not know the presence of BRAF gene mutation in this case report yet.
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20
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Cracolici V, Mujacic I, Kadri S, Alikhan M, Niu N, Segal JP, Rosen LE, Sarne DH, Morgan A, Desouky S, Cipriani NA. Synchronous and Metastatic Papillary and Follicular Thyroid Carcinomas with Unique Molecular Signatures. Endocr Pathol 2018; 29:9-14. [PMID: 28710706 DOI: 10.1007/s12022-017-9491-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Despite the relatively high prevalence of thyroid cancer, the occurrence of multiple synchronous, distinct subtypes of primary thyroid carcinoma is uncommon. The incidental finding of papillary thyroid microcarcinoma in a gland with a biologically relevant follicular or medullary carcinoma is more frequent than the synchronous occurrence of multiple clinically significant carcinomas. We report a case of synchronous papillary and follicular thyroid carcinomas metastatic to lymph node and bone, respectively. Next generation sequencing showed BRAF V600E mutation in the primary papillary carcinoma and NRAS Q61R mutation in the primary follicular carcinoma and bony metastasis. To our knowledge, this is the first reported case of synchronous and metastatic primary papillary and follicular carcinomas, and the first report of synchronous BRAF V600E mutated papillary and NRAS mutated follicular carcinoma.
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Affiliation(s)
- Vincent Cracolici
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA.
| | - Ibro Mujacic
- Division of Molecular Pathology, Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Sabah Kadri
- Division of Molecular Pathology, Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Mir Alikhan
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Nifang Niu
- Division of Molecular Pathology, Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Jeremy P Segal
- Division of Molecular Pathology, Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Lauren E Rosen
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - David H Sarne
- Section of Endocrinology, Department of Medicine, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Adam Morgan
- Department of Pathology, St. Mary's Hospital, 700 South Park St, Madison, WI, 53715, USA
| | - Samy Desouky
- Department of Pathology, St. Mary's Hospital, 700 South Park St, Madison, WI, 53715, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
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21
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Austin DC, Wu JS, Spentzos D, Goldsmith JD, Anderson ME. A Collision Tumor Involving a Primary Leiomyosarcoma of the Lower Extremity and a Metastatic Medullary Thyroid Carcinoma: A Case Report. JBJS Case Connect 2017; 7:e90. [PMID: 29286973 DOI: 10.2106/jbjs.cc.17.00041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 49-year-old man presented with a rapidly growing thigh mass. Histologic analyses demonstrated separate regions that were consistent with a collision tumor composed of a primary leiomyosarcoma and a metastatic medullary thyroid carcinoma. After responding to chemotherapy, the patient underwent resection of the tumor and a total thyroidectomy; he was disease-free 9 years after the diagnosis. CONCLUSION A wide diagnostic differential and thorough histologic analysis are necessary in patients presenting with neoplasms of the extremities. A leiomyosarcoma may be a hospitable location for metastatic disease, and the presence of a collision tumor should be considered when pathology findings are equivocal.
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Affiliation(s)
- Daniel C Austin
- Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jim S Wu
- Departments of Radiology (J.S.W.) and Orthopaedics (M.E.A.) and Divisions of Hematology/Oncology (D.S.) and Anatomic Pathology (J.D.G.), Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dimitrios Spentzos
- Departments of Radiology (J.S.W.) and Orthopaedics (M.E.A.) and Divisions of Hematology/Oncology (D.S.) and Anatomic Pathology (J.D.G.), Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeffrey D Goldsmith
- Departments of Radiology (J.S.W.) and Orthopaedics (M.E.A.) and Divisions of Hematology/Oncology (D.S.) and Anatomic Pathology (J.D.G.), Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Megan E Anderson
- Departments of Radiology (J.S.W.) and Orthopaedics (M.E.A.) and Divisions of Hematology/Oncology (D.S.) and Anatomic Pathology (J.D.G.), Beth Israel Deaconess Medical Center, Boston, Massachusetts
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22
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Saltiki K, Anagnostou E, Simeakis G, Kouki S, Angelopoulou A, Sarika L, Papathoma A, Alevizaki M. Familial MTC with RET exon 8 Gly533Cys mutation: origin and prevalence of second malignancy. Endocr Connect 2017; 6:676-684. [PMID: 28951487 PMCID: PMC5655672 DOI: 10.1530/ec-17-0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/26/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION High prevalence of RET p.Gly533Cys (c.1597G > T) has been found in familial MTC in Greece (exon 8 fMTC). We studied their origin and compared clinical characteristics with non-exon 8 fMTC. METHODS 102 fMTC (FMTC and MEN2A) patients (31.4% males) were followed for 2.9-37 years (median 6 years). Fifty-one carried the RET exon 8 mutation; the remaining were non-exon 8 fMTC (exons 10, 11, 13, 14). Pre-, post-operative calcitonin, disease extent at diagnosis and follow-up and families' place of origin were recorded. RESULTS Exon 8 fMTC were older (42.3 ± 13.3 vs 30.8 ± 17.8 years, P < 0.001), including index cases (P = 0.016). In index cases, the stage at diagnosis was more favorable in exon 8 fMTC compared to non-exon 8 fMTC (stage I and II: 65% vs 23.8%, stage III: 25% vs 57.1%, stage IV: 10% vs 19%, P = 0.025). More favorable outcome was noted in exon 8 fMTCs (remission: 72.5% vs 45.8%, stable disease: 27.5% vs 41.7%, progression: 0.0% vs 12.5%, P = 0.001). Exon 8 fMTC patients carried more frequently a second malignancy (25.5% vs 6.3%, P = 0.009); 69% of these were PTCs. Exon 8 fMTC patients were significantly older at diagnosis compared to non-exon 8 moderate-risk RET carriers and presented more favorable clinical outcome (remission: 72.5% vs 50%, stable disease: 27.5% vs 41.7%, progression: 0.0% vs 8.3%, P = 0.021). This difference remained when only index cases were analyzed. 'Hot spots' in the origin of exon 8 fMTCs families were recognized. No phenotype or outcome differences were found between the exon 8 families from the various regions. CONCLUSIONS In exon 8 fMTCs' older age, favorable disease stage at diagnosis and favorable outcome suggest slow disease progression compared to non-exon 8 fMTC. Compared with moderate-risk RET mutation carriers, exon 8 fMTC patients have a more favorable clinical outcome. The higher prevalence of second malignancies, especially PTC, not previously reported, merits further investigation. Increased awareness for inherited disease is required for patients with apparently sporadic MTC originating from recognized 'hot spots', as the age at presentation is usually delayed.
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Affiliation(s)
- Katerina Saltiki
- Endocrine UnitDepartment of Medical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Elli Anagnostou
- Endocrine UnitDepartment of Medical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - George Simeakis
- Endocrine UnitDepartment of Medical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Sofia Kouki
- Endocrine UnitDepartment of Medical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Anastasia Angelopoulou
- Endocrine UnitDepartment of Medical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Leda Sarika
- Endocrine UnitDepartment of Medical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Alexandra Papathoma
- Endocrine UnitDepartment of Medical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Maria Alevizaki
- Endocrine UnitDepartment of Medical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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23
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Ciampi R, Romei C, Pieruzzi L, Tacito A, Molinaro E, Agate L, Bottici V, Casella F, Ugolini C, Materazzi G, Basolo F, Elisei R. Classical point mutations of RET, BRAF and RAS oncogenes are not shared in papillary and medullary thyroid cancer occurring simultaneously in the same gland. J Endocrinol Invest 2017; 40:55-62. [PMID: 27535135 DOI: 10.1007/s40618-016-0526-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/27/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Papillary (PTC) and medullary (MTC) thyroid carcinomas represent two distinct entities, but quite frequently, they may occur simultaneously. AIM To provide genetic analysis of PTC and MTC occurring in the same patient (PTC/MTC) to elucidate their origin. METHODS Sequencing analysis of RAS, BRAF and RET oncogenes hot spots mutations in tumoral and normal tissues of 24 PTC/MTC patients. RESULTS Two of 24 patients (8.3 %) were affected by familial MTC (FMTC) harboring RET germline mutations in all tissues. Eight of 22 (36.4 %) sporadic cases did not show any somatic mutation in the three tissue components. Considering the MTC component, 10/22 (45.4 %) patients did not show any somatic mutation, 7 of 22 (31.8 %) harbored the M918T RET somatic mutation and 4/22 (18.2 %) presented mutations in the H-RAS gene. In an additional case (1/22, 4.6 %), H-RAS and RET mutations were simultaneously present. Considering the PTC component, 1 of 24 (4.2 %) patients harbored the V600E BRAF mutation, 1 of 24 (4.2 %) the T58A H-RAS mutation and 1 of 24 (4.2 %) the M1T K-RAS mutation, while the remaining PTC cases did not show any somatic mutation. In one case, the MTC harbored a RET mutation and the PTC a BRAF mutation. None of the mutations found were present in both tumors. CONCLUSIONS To our knowledge, this is the first study analyzing a possible involvement of RET, BRAF and RAS oncogene mutations in PTC/MTC. These data clearly suggest that the classical activating mutations of the oncogenes commonly involved in the pathogenesis of PTC and MTC may not be responsible for their simultaneous occurrence.
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Affiliation(s)
- R Ciampi
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy.
| | - C Romei
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy
| | - L Pieruzzi
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy
| | - A Tacito
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy
| | - E Molinaro
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy
| | - L Agate
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy
| | - V Bottici
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy
| | - F Casella
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy
| | - C Ugolini
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University-Hospital of Pisa, Pisa, Italy
| | - G Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University-Hospital of Pisa, Pisa, Italy
| | - F Basolo
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University-Hospital of Pisa, Pisa, Italy
| | - R Elisei
- Department of Clinical and Experimental Medicine (Endocrine Unit), Univesity-Hospital of Pisa, Pisa, Italy
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24
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Nilsson M, Williams D. On the Origin of Cells and Derivation of Thyroid Cancer: C Cell Story Revisited. Eur Thyroid J 2016; 5:79-93. [PMID: 27493881 PMCID: PMC4949372 DOI: 10.1159/000447333] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/01/2016] [Indexed: 12/14/2022] Open
Abstract
We will highlight and put into perspective new lineage tracing data from genetic studies in mice indicating that the genuine progenitors to C cells arise in the endoderm germ layer. This overturns the current concept of a neural crest origin of thyroid C cells referred to in every textbook and dedicated paper to this very day. As will become apparent, except for a single experiment, the neural crest theory has little or no support when the evolution and development of calcitonin-producing cells in the entire chordate family are considered. Instead, a unifying origin of all cells of the ultimobranchial bodies reopens questions on the histogenesis of certain thyroid pathologies previously difficult to explain. On this aspect, medullary thyroid cancer shows a stronger connection to gut neuroendocrine tumours than previously recognized. It is envisaged that novel factors implicated in C cell-derived tumour growth and progression will be discovered as the mechanisms that regulate lineage expansion of embryonic C cell precursors from pharyngeal endoderm are uncovered. We will not discuss why C cells go to the bother of burying themselves in the thyroid - this remains a mystery.
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Affiliation(s)
- Mikael Nilsson
- Sahlgrenska Cancer Center, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- *Mikael Nilsson, Sahlgrenska Cancer Center, Institute of Biomedicine, University of Gothenburg, Box 425, SE-40530 Gothenburg (Sweden), E-Mail
| | - Dillwyn Williams
- Department of Public Health, University of Cambridge, Cambridge, UK
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25
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Febrero B, Rodríguez JM, Ríos A, Portillo P, Parrilla P. Papillary thyroid carcinoma and multiple endocrine neoplasia type 2. J Endocrinol Invest 2015; 38:1233-7. [PMID: 25903693 DOI: 10.1007/s40618-015-0290-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 04/08/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Papillary thyroid carcinoma (PTC) is exceptional in MEN 2. RESULTS The analysis in 135 patients revealed two PTC, without C-cell pathology; both being positive for V804M mutation (RET proto-oncogene). CONCLUSIONS Few data are available about PTC in MEN 2, and without C-cell pathology is even less common. More studies are needed to correlate genetics and histology, and even for assessing PTC as only manifestation of MEN 2.
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Affiliation(s)
- B Febrero
- Service of General Surgery, Unit of Endocrine Surgery, Instituto Murciano de Investigaciones Biomédicas (IMIB), Virgen de la Arrixaca Clinical Universitary Hospital, Crta./Madrid-Cartagena, s/n. El Palmar, 30120, Murcia, Spain.
| | - J M Rodríguez
- Service of General Surgery, Unit of Endocrine Surgery, Instituto Murciano de Investigaciones Biomédicas (IMIB), Virgen de la Arrixaca Clinical Universitary Hospital, Crta./Madrid-Cartagena, s/n. El Palmar, 30120, Murcia, Spain
| | - A Ríos
- Service of General Surgery, Unit of Endocrine Surgery, Instituto Murciano de Investigaciones Biomédicas (IMIB), Virgen de la Arrixaca Clinical Universitary Hospital, Crta./Madrid-Cartagena, s/n. El Palmar, 30120, Murcia, Spain
| | - P Portillo
- Service of Endocrinology, Virgen de la Arrixaca Clinical Universitary Hospital, Crta./Madrid-Cartagena, s/n. El Palmar, 30120, Murcia, Spain
| | - P Parrilla
- Service of General Surgery, Unit of Endocrine Surgery, Instituto Murciano de Investigaciones Biomédicas (IMIB), Virgen de la Arrixaca Clinical Universitary Hospital, Crta./Madrid-Cartagena, s/n. El Palmar, 30120, Murcia, Spain
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26
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Kung FP, Chen CC. Mixed medullary and papillary carcinoma of the thyroid: A case report. Tzu Chi Med J 2015. [DOI: 10.1016/j.tcmj.2015.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ryan N, Walkden G, Lazic D, Tierney P. Collision tumors of the thyroid: A case report and review of the literature. Head Neck 2015; 37:E125-9. [PMID: 25491252 DOI: 10.1002/hed.23936] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Collision tumors of the thyroid are a rare pathology that present a diagnostic and treatment challenge. In this report, we present an interesting case and a review of the current literature as to inform management. METHODS AND RESULTS An 88-year-old woman presented with acute airway compromise and vocal cord paralysis. CT identified a thyroid mass and widespread metastasis. Histopathology identified the lesion as a collision tumor consisting of a squamous cell carcinoma (SCC) and papillary thyroid carcinoma. The patient was managed with surgery and palliative radiotherapy. However, she died from complications of a lower respiratory tract infection. We also present a review of the literature with 33 cases reviewed. CONCLUSION Management of collision tumors is complex because of the duality of the pathology. They should be managed in a multidisciplinary team setting and treatment should be patient specific. Generally, the most aggressive neoplasm should guide treatment. We recommend surgical management with adjunct therapy.
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Affiliation(s)
- Neil Ryan
- United Bristol Healthcare NHS Trust, ENT Bristol, United Kingdom
| | - Graham Walkden
- North Bristol NHS Trust, Surgery Bristol, United Kingdom
| | - Darko Lazic
- Great Western Hospital, Histopathology Swindon, United Kingdom
| | - Paul Tierney
- United Bristol Healthcare NHS Trust, ENT Bristol, United Kingdom
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28
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Jain M, Verma D, Thomas S, Chauhan R. Mixed medullary - papillary carcinoma thyroid: an uncommon variant of thyroid carcinoma. J Lab Physicians 2014; 6:133-5. [PMID: 25328343 PMCID: PMC4196364 DOI: 10.4103/0974-2727.141520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Manjula Jain
- Department of Pathology, Senior Resident, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Deepti Verma
- Department of Pathology, Senior Resident, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Shaji Thomas
- Department of Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Richa Chauhan
- Department of Pathology, Senior Resident, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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29
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Fibbi B, Pinzani P, Salvianti F, Rossi M, Petrone L, De Feo ML, Panconesi R, Vezzosi V, Bianchi S, Simontacchi G, Mangoni M, Pertici M, Forti G, Pupilli C. Synchronous occurrence of medullary and papillary carcinoma of the thyroid in a patient with cutaneous melanoma: determination of BRAFV600E in peripheral blood and tissues. Report of a case and review of the literature. Endocr Pathol 2014; 25:324-31. [PMID: 24858900 DOI: 10.1007/s12022-014-9303-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this study is to describe a case of concurrent medullary and papillary thyroid carcinoma (MTC and PTC) and cutaneous melanoma and to analyze BRAF(V600E) mutation in plasma and tissues. We report the clinical history and the laboratory, imaging, and histopathological findings of a 47-year-old man affected by multinodular goiter. BRAF(V600E)-mutated DNA was quantified in plasma samples and in cancer sections by quantitative real-time polymerase chain reaction (qPCR). At ultrasound examination, the dominant right nodule of the thyroid was weakly hyperechoic and hypervascularized, while the left one was hypoechoic without internal vascularization. Regional lymphadenomegalia was not detected. Basal plasma calcitonin was elevated, and the patient underwent total thyroidectomy and resection of central cervical lymph nodes. Histopathological examination identified two distinct foci of MTC and PTC and micrometastasis of well-differentiated carcinoma in one of the six resected lymph nodes. RET proto-oncogene germline mutations were not detected. Cutaneous melanoma of the thorax was subsequently diagnosed. BRAF(V600E) tissue DNA was detected in PTC and melanoma but not in MTC. The cell-free plasma percentage of BRAF(V600E) DNA was detected in pre-thyroidectomy peripheral blood and was drastically reduced after cancer treatments. This study confirms the occurrence of synchronous MTC and PTC and is the first evidence of the co-existence of melanoma and distinct thyroid cancers of different origin. BRAF(V600E) allele was detected in PTC and melanoma but not in MTC tissues. BRAF(V600E) molecular quantification in pre- and post-treatment blood supports our previous data, suggesting its possible role in diagnosis and follow-up of BRAF-positive tumors.
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Affiliation(s)
- Benedetta Fibbi
- Endocrinology Unit, Careggi Hospital and University of Florence, Florence, Italy
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30
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Association of synchronous medullary and papillary thyroid carcinomas with primary hyperparathyroidism: first case report and literature review. The Journal of Laryngology & Otology 2014; 128:565-8. [PMID: 24877696 DOI: 10.1017/s002221511400108x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We report a case of a patient with symptomatic primary hyperparathyroidism who was found, through a thorough radiological investigation, to also have papillary and medullary thyroid carcinomas. CASE REPORT A 59-year-old female was diagnosed with primary hyperparathyroidism. A further radiological investigation found suspicious areas within both thyroid lobes that were later diagnosed as foci of papillary and medullary thyroid carcinomas. Appropriate treatment was commenced. Reports of similar occurrences of synchronous thyroid and parathyroid pathologies are discussed. CONCLUSION To our knowledge, this is the first reported case of two synchronous thyroid cancers occurring in the context of primary hyperparathyroidism. We strongly recommend a thorough radiological investigation of all patients with primary hyperparathyroidism to prevent missing concurrent thyroid cancers.
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31
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Alevizaki M, Kyratzoglou E, Bamias A, Tzanela M, Dimopoulos MA, Saltiki K. Metachronous appearance of second malignancies in medullary thyroid carcinoma (MTC) patients: a diagnostic challenge and brief review of the literature. Endocrine 2013; 44:610-5. [PMID: 23608930 DOI: 10.1007/s12020-013-9961-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/10/2013] [Indexed: 02/07/2023]
Abstract
Medullary thyroid carcinoma (MTC) is a rare tumour which frequently occurs in the context of the multiple endocrine neoplasia syndromes, where it coexists with other usually benign tumours. The clinical picture varies and distant metastases are frequently present at diagnosis. Calcitonin levels are elevated in the presence of metastatic disease. Two MTC cases are presented, which had elevated postoperative calcitonin levels. Imaging revealed lung lesions which were originally attributed to metastatic disease from the MTC. However, at follow-up, these cases presented unusual features. The rapid increase in the lung lesions and the development of hypercalcaemia in the first patient suggested a second unrelated tumour. Biopsy of the lung lesion was compatible with lung adenocarcinoma. In the second patient, the appearance of a liver mass, although calcitonin levels remained stable, led to biopsy of the lesion: this was negative for calcitonin and compatible with metastatic lung adenocarcinoma. These MTC cases show that further malignancies may coexist with MTC and may obscure the clinical picture and influence the therapeutic decisions, especially in the case of metastatic disease. Features such as unusual imaging characteristics and the development of hypercalcemia, never encountered in MTC outside the MEN2 syndromes, as well as 'disproportionately' low calcitonin levels, incompatible with extensive metastatic disease, were the factors that led to further work-up. Both the cases subsequently proved to carry an unsuspected second malignancy. It is crucial to discriminate the metastatic lesion attributed to MTC from another coexisting primary malignancy, because different therapeutic strategies are needed for each setting.
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Affiliation(s)
- Maria Alevizaki
- Endocrine Unit, Department of Medical Therapeutics, Alexandra Hospital, Athens University School of Medicine, 80, Vas Sofias ave, 11528, Athens, Greece
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32
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Kataria K, Yadav R, Sarkar C, Karak AK. Simultaneous medullary carcinoma, papillary carcinoma and granulomatous inflammation of the thyroid. Singapore Med J 2013; 54:e146-8. [DOI: 10.11622/smedj.2013115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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33
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Wong RL, Kazaure HS, Roman SA, Sosa JA. Simultaneous medullary and differentiated thyroid cancer: a population-level analysis of an increasingly common entity. Ann Surg Oncol 2012; 19:2635-42. [PMID: 22526904 DOI: 10.1245/s10434-012-2357-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Simultaneous medullary thyroid carcinoma (MTC) and differentiated thyroid carcinoma (DTC) is a rare entity. This is the first population-level analysis of the characteristics and outcomes of simultaneous MTC/DTC. METHODS In the Surveillance, Epidemiology, and End Results (SEER) database (1988-2008), patients with simultaneous MTC/DTC were retrospectively compared with those with MTC alone using χ(2), ANOVA, log-rank tests, Cox multivariate regression, and Kaplan-Meier analyses. RESULTS A total of 162 patients had simultaneous MTC/DTC; 1,699 had MTC alone. MTC was diagnosed first in 67.9 % of simultaneous MTC/DTC cases. Simultaneous MTC/DTC increased from 2.7 % of all MTCs in 1988-1997 to 12.3 % in 2003-2008. Compared with MTC alone, simultaneous MTC/DTC had smaller mean MTC tumor size (2.9 vs. 2.2 cm; p = 0.005) and lower rates of MTC extrathyroidal extension (25.4 vs. 16.8 %; p = 0.015) and distant metastases (15.7 vs. 9.3 %; p = 0.032). Patients diagnosed with DTC first had smaller mean MTC tumor sizes (p = 0.01), whereas patients diagnosed with MTC first had tumor sizes similar to those of MTC alone. Compared with MTC alone, patients with simultaneous MTC/DTC were more likely to receive thyroidectomy (84.7 vs. 93.2 %; p = 0.003) and radioisotopes (4.4 vs. 25 %; p < 0.001). On Kaplan-Meier analysis, disease-specific survival rates were higher for simultaneous MTC/DTC than for MTC alone (10-year survival rates 87 vs. 81 %; p = 0.056). CONCLUSIONS Simultaneous MTC/DTC is diagnosed earlier in tumor development than MTC alone, with a trend toward better prognosis. This entity likely represents a primary tumor with an incidental pathologic finding of a second malignancy. Each malignancy should be treated according to its respective stage and current guidelines.
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Affiliation(s)
- Risa L Wong
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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34
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Plauche V, Dewenter T, Walvekar RR. Follicular and papillary carcinoma: a thyroid collision tumor. Indian J Otolaryngol Head Neck Surg 2012; 65:182-4. [PMID: 24427641 DOI: 10.1007/s12070-011-0450-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 12/26/2011] [Indexed: 12/19/2022] Open
Abstract
The objective of this study was to report a collision tumor of papillary and follicular carcinoma of the thyroid. Case report and review of the literature was studied. A 62 year old female presented with a thyroid mass diagnosed the year prior. Physical exam revealed a 6 × 4 cm predominantly left sided thyroid mass that was confirmed on imaging as well. Thyroid function tests were within normal limits. Ultrasound-guided fine needle aspiration suggested a follicular neoplasm. Consequently, the patient underwent a left hemi-thyroidectomy. The pathology was reported as being collision tumor with a combination of follicular and papillary carcinoma. A completion thyroidectomy was performed followed by post operative radio-iodine therapy. Collision tumors are rare involving two or more histologically distinct neoplastic morphologies separated by normal tissue in one or more organ systems. This is to our knowledge the first report of a collision tumor of the thyroid involving a follicular and papillary carcinoma.
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Affiliation(s)
- Virginia Plauche
- Department of Otolaryngology Head Neck Surgery, LSU Health Sciences Center, 533 Bolivar Street, Suite 566, New Orleans, LA USA
| | - Tracy Dewenter
- Department of Pathology, LSU Health Sciences Center, New Orleans, LA USA
| | - Rohan R Walvekar
- Department of Otolaryngology Head Neck Surgery, LSU Health Sciences Center, 533 Bolivar Street, Suite 566, New Orleans, LA USA
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35
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Sadat Alavi M, Azarpira N. Medullary and papillary carcinoma of the thyroid gland occurring as a collision tumor with lymph node metastasis: A case report. J Med Case Rep 2011; 5:590. [PMID: 22185367 PMCID: PMC3284582 DOI: 10.1186/1752-1947-5-590] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 12/20/2011] [Indexed: 12/21/2022] Open
Abstract
Introduction Papillary thyroid carcinoma and medullary thyroid carcinoma are two different thyroid neoplasia. The simultaneous occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma as a collison tumor with metastases from both lesions in the regional lymph nodes is a rare phenomenon. Case presentation A 32-year-old Iranian man presented with a fixed anterior neck mass. Ultrasonography revealed two separate thyroid nodules as well as a suspicious neck mass that appeared to be a metastatic lesion. The results of thyroid function tests were normal, but the preoperative calcitonin serum value was elevated. Our patient underwent a total thyroidectomy with neck exploration. Two separate and ill-defined solid lesions grossly in the right lobe were noticed. Histological and immunohistochemical studies of these lesions suggested the presence of medullary thyroid carcinoma and papillary thyroid carcinoma. The lymph nodes isolated from a neck dissection specimen showed metastases from both lesions. Conclusions The concomitant occurrence of papillary thyroid carcinoma and medullary thyroid carcinoma and the exact diagnosis of this uncommon event are important. The treatment strategy should be reconsidered in such cases, and genetic screening to exclude multiple endocrine neoplasia 2 syndromes should be performed. For papillary thyroid carcinoma, radioiodine therapy and thyroid-stimulating hormone suppressive therapy are performed. However, the treatment of medullary thyroid carcinoma is mostly radical surgery with no effective adjuvant therapy.
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Affiliation(s)
- Mehr Sadat Alavi
- Department of Pathology, Organ Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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36
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Huang L, Zhang Y. Merged histological types of malignant thyroid tumor: experience and controversy. Med Oncol 2011; 29:285-93. [PMID: 21203862 DOI: 10.1007/s12032-010-9784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
Abstract
Malignant tumors of the thyroid that consist of merged histological types are a rare clinical entity, with an obscure pathogenesis and no consensus of opinion on nomenclature. Eight patients with merged histological types of thyroid malignant tumor at a single medical center were enrolled between January 1977 and December 2009. These patients were surgically treated and were followed postoperatively from 1 month to 34 years. Preoperative patient characteristics, B-type ultrasonography, computed tomography scan, thyroid function tests, postoperative pathology, immunohistochemistry, and prognosis data were collected. Merged histological types of thyroid malignant tumor accounted for 0.12% of all thyroid malignant tumors treated during this period. Preoperative imageology and laboratory data have no specific value toward diagnosis of merged histological types of thyroid malignant tumor. Merged histological types of thyroid carcinoma that had undergone radical resection in combination with hormonal therapy and I(131) radiotherapy achieved a satisfactory outcome, while other merged thyroid malignant tumors were usually associated with a poor prognosis. Prognosis depended on the highest grade among an individual group of malignant tumors.
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Affiliation(s)
- Liang Huang
- Department of Thyroid & Neck Tumor, Cancer Hospital, Tianjin Medical University, Huanhu West Road, Hexi District, Tianjin 300060, People's Republic of China
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Ueki I, Ando T, Haraguchi A, Horie I, Imaizumi M, Hayashi T, Uga T, Usa T, Kawakami A. A case of mixed medullary and follicular cell carcinoma of the thyroid. Intern Med 2011; 50:1313-6. [PMID: 21673468 DOI: 10.2169/internalmedicine.50.4749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A medullary thyroid carcinoma is a malignant tumor derived from the C-cells of the thyroid. Despite their distinct embryological origin, medullary thyroid carcinomas are exceptionally accompanied by a tumor derived from the follicular cells; this is defined as mixed medullary and follicular cell carcinoma. There have been controversies regarding the origin of this rare mixed thyroid carcinoma questioning whether or not a mixed carcinoma originates from a common cancer stem cell. We present a case of mixed medullary and follicular cell carcinoma in which two thyroid carcinomas were found intermingled in the thyroid as well as in the metastatic cervical lymph nodes. We examined the tumor by immunostaining with thyroglobulin, calcitonin, and thyroid transcription factor-1, and also reviewed the literature and discuss the origin of this rare mixed thyroid carcinoma.
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Affiliation(s)
- Ikuko Ueki
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Coexistent Familial Nonmultiple Endocrine Neoplasia Medullary Thyroid Carcinoma and Papillary Thyroid Carcinoma Associated With RET Polymorphism. Am J Med Sci 2010; 340:60-3. [DOI: 10.1097/maj.0b013e3181dfb245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Tumors of the thyroid are subclassified based on the cell of origin and commonly include follicular-derived tumors and C-cell-derived tumors. The most common follicular-derived tumors are papillary carcinoma and follicular carcinoma, whereas the malignant C-cell-derived tumor is medullary thyroid carcinoma. Rare cases in the literature describe patients who have follicular-derived and C-cell-derived tumors in the same thyroid gland. These can be synchronous but anatomically separate carcinomas, or they can show some mixing of the 2 components. The mixture may be at an interface, as in collision tumors, or can be throughout the entire lesion, as in true mixed medullary-follicular-derived carcinomas. The clinical, histologic, and molecular features of these mixed tumors and the classification guidelines are reviewed.
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Griffith C, Zhang S, Mukhopadhyay S. Synchronous metastatic medullary and papillary thyroid carcinomas in a patient with germline RET mutation: case report, molecular analysis, and implications for pathogenesis. Endocr Pathol 2010; 21:115-9. [PMID: 20369307 DOI: 10.1007/s12022-010-9117-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The occurrence of medullary thyroid carcinoma (MTC) in patients with germline RET mutation is well established, but the occasional occurrence of papillary thyroid carcinoma (PTC) in this setting remains unexplained. We report a case of synchronous MTC and PTC in a patient with germline RET mutation, and investigate the molecular pathogenesis of these two tumors. A 48-year-old man presented with cervical lymphadenopathy and was found to have metastatic MTC involving cervical and mediastinal lymph nodes. He underwent thyroidectomy and debulking of metastatic disease. The resected thyroid showed bilateral MTC and a 1-cm PTC. His lymph node metastases were predominantly MTC along with a small focus of metastatic PTC. Molecular testing using peripheral blood revealed a germline RET point mutation (Val804Met). Both tumors were analyzed for the BRAF (Val600Glu) mutation and the RET/PTC1 translocation. The PTC was positive for the BRAF mutation but negative for RET/PTC1. The MTC was negative for both abnormalities. We conclude that the MTC was caused by the germline RET mutation, while the PTC was caused by a somatic BRAF mutation. The occurrence of PTC in patients with germline RET mutations appears to be purely coincidental.
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Affiliation(s)
- Christopher Griffith
- Department of Pathology, State University of New York Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA
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Kim WG, Gong G, Kim EY, Kim TY, Hong SJ, Kim WB, Shong YK. Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental. Clin Endocrinol (Oxf) 2010; 72:256-63. [PMID: 20447064 DOI: 10.1111/j.1365-2265.2009.03622.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The simultaneous occurrence of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) in the same thyroid gland is documented. In this study, we evaluated the prevalence and characteristics of patients with concurrent MTC and PTC. Design Retrospective analysis of patients with MTC in a single centre and review of the literature. PATIENTS AND MEASUREMENTS Patients with MTC who underwent initial surgical treatment between 1996 and 2006 at Asan Medical Centre, Seoul, Korea were enrolled. We additionally reviewed the medical records of patients who initially underwent surgery for Graves' disease (GD) or follicular thyroid carcinoma (FTC) during the same period. The concurrent occurrence rate of PTC in MTC patients was compared with that in GD and FTC patients. RESULTS Ten of 53 (19%) MTC patients displayed the concomitant PTC. In all 10 cases, the MTC and PTC components were separated by normal thyroid tissue, with the maximal diameters of PTC being less than 1.0 cm in the majority of patients. The rates of concurrent PTC in patients with MTC, GD and FTC were 19%, 15% and 19%, respectively, which were not significantly different. CONCLUSIONS Our results suggest that the occurrence of concurrent MTC/PTC is generally a simple reflection of incidental papillary microcarcinoma.
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Affiliation(s)
- Won Gu Kim
- Department of Endocrinology and Metabolism, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea
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Calva D, O'Dorisio TM, Sue O'Dorisio M, Lal G, Sugg S, Weigel RJ, Howe JR. When is prophylactic thyroidectomy indicated for patients with the RET codon 609 mutation? Ann Surg Oncol 2009; 16:2237-44. [PMID: 19472011 DOI: 10.1245/s10434-009-0524-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/28/2009] [Accepted: 04/29/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mutations in the RET proto-oncogene cause multiple endocrine neoplasia type 2A (MEN2A), and prophylactic thyroidectomy has generally been recommended before the age of 5 years. Patients with codon 609 mutations develop MTC at a later age and therefore the timing of prophylactic thyroidectomy is less clear. We report a three-generation family with C609Y RET mutation where members having prophylactic or therapeutic thyroidectomy call the current recommendations for age at thyroidectomy into question. METHODS Sixteen family members underwent thyroidectomy, for which clinical, laboratory, and pathological data were analyzed. A literature review of RET codon 609 mutations was carried out. RESULTS Data were collected from 16 patients from this 38-member kindred. None of these affected members had pheochromocytoma, and one had a parathyroid adenoma. Nine of 16 patients had MTC (mean age 44.7 years, range 29-59 years) and elevated basal calcitonin levels; 6 of these 9 had lymph node metastases. Two patients had C-cell hyperplasia (CCH) at ages 18 and 37 years, and five patients had normal thyroid pathology (mean age 16 years, range 5-37 years). In the literature, a family with C609Y mutation was reported, with 15 members having MTC (mean age 42 years, range 21-59 years), and 6 with CCH (mean age 24 years, range 15-37 years). CONCLUSION The youngest patient with C609Y RET mutation and MTC was 21 years old, and the youngest patient with CCH was 15 years old at diagnosis. These data suggest that patients with RET C609Y mutations can delay thyroidectomy until 10-15 years of age, with annual calcitonin screening prior to thyroidectomy.
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Affiliation(s)
- Daniel Calva
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, University of Iowa College of Medicine, Iowa City, IA, USA
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Etit D, Faquin WC, Gaz R, Randolph G, DeLellis RA, Pilch BZ. Histopathologic and Clinical Features of Medullary Microcarcinoma and C-Cell Hyperplasia in Prophylactic Thyroidectomies for Medullary Carcinoma: A Study of 42 Cases. Arch Pathol Lab Med 2008; 132:1767-73. [DOI: 10.5858/132.11.1767] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Prophylactic thyroidectomies are increasingly performed on patients at risk for developing medullary thyroid carcinoma (MTC); consequently, pathologists are more commonly encountering these specimens in routine practice.
Objective.—To describe the detailed clinicopathologic features of prophylactic thyroidectomies for medullary carcinoma.
Design.—We present a retrospective series of 42 prophylactic thyroidectomies for MTC performed for one or more of the following: family history of multiple endocrine neoplasia (MEN) or MTC, elevated serum calcitonin level, or detection of a RET proto-oncogene mutation.
Results.—Patients included 22 men and 20 women (mean age, 26.2 years). Among those with known RET proto-oncogene mutations, affected sites included exons 10, 11, 14, and 16. In 93% (n = 39) of cases, either C-cell hyperplasia (n = 36), medullary microcarcinoma (MMC; n = 29), or medullary macrocarcinoma (n = 1) was found. C-cell hyperplasia was often multifocal (n = 30) and bilateral (n = 23) and included both nonnodular and nodular patterns. A total of 94% of C-cell hyperplasia cases and all MMC cases were microscopically detectable using hematoxylin-eosin stains. The MMCs were characterized by a complex microarchitectural pattern with a desmoplastic stromal response (n = 29) and focal amyloid deposition (n = 12). Most MMCs exhibited a solid pattern (n = 24) of round, polygonal, spindled, or plasmacytoid-shaped cells. Only 1 case of MMC showed evidence of metastatic disease to a pretracheal lymph node.
Conclusions.—Based upon our clinicopathologic findings and review of the literature, we conclude that thyroidectomies in at-risk patients are very frequently associated with C-cell hyperplasia and/or MMC; however, the clinical prognosis for these patients is very good.
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Affiliation(s)
- Demet Etit
- From the Departments of Pathology (Drs Etit, Faquin, and Pilch) and Surgery (Drs Gaz and Randolph), Massachusetts General Hospital, and the Massachusetts Eye and Ear Infirmary, Harvard Medical School (Drs Faquin, Gaz, Randolph, and Pilch), Boston; and the Department of Pathology, Rhode Island Hospital, Brown University Medical School, Providence (Dr DeLellis). Dr Etit is now with the Department o
| | - William C. Faquin
- From the Departments of Pathology (Drs Etit, Faquin, and Pilch) and Surgery (Drs Gaz and Randolph), Massachusetts General Hospital, and the Massachusetts Eye and Ear Infirmary, Harvard Medical School (Drs Faquin, Gaz, Randolph, and Pilch), Boston; and the Department of Pathology, Rhode Island Hospital, Brown University Medical School, Providence (Dr DeLellis). Dr Etit is now with the Department o
| | - Randall Gaz
- From the Departments of Pathology (Drs Etit, Faquin, and Pilch) and Surgery (Drs Gaz and Randolph), Massachusetts General Hospital, and the Massachusetts Eye and Ear Infirmary, Harvard Medical School (Drs Faquin, Gaz, Randolph, and Pilch), Boston; and the Department of Pathology, Rhode Island Hospital, Brown University Medical School, Providence (Dr DeLellis). Dr Etit is now with the Department o
| | - Gregory Randolph
- From the Departments of Pathology (Drs Etit, Faquin, and Pilch) and Surgery (Drs Gaz and Randolph), Massachusetts General Hospital, and the Massachusetts Eye and Ear Infirmary, Harvard Medical School (Drs Faquin, Gaz, Randolph, and Pilch), Boston; and the Department of Pathology, Rhode Island Hospital, Brown University Medical School, Providence (Dr DeLellis). Dr Etit is now with the Department o
| | - Ronald A. DeLellis
- From the Departments of Pathology (Drs Etit, Faquin, and Pilch) and Surgery (Drs Gaz and Randolph), Massachusetts General Hospital, and the Massachusetts Eye and Ear Infirmary, Harvard Medical School (Drs Faquin, Gaz, Randolph, and Pilch), Boston; and the Department of Pathology, Rhode Island Hospital, Brown University Medical School, Providence (Dr DeLellis). Dr Etit is now with the Department o
| | - Ben Z. Pilch
- From the Departments of Pathology (Drs Etit, Faquin, and Pilch) and Surgery (Drs Gaz and Randolph), Massachusetts General Hospital, and the Massachusetts Eye and Ear Infirmary, Harvard Medical School (Drs Faquin, Gaz, Randolph, and Pilch), Boston; and the Department of Pathology, Rhode Island Hospital, Brown University Medical School, Providence (Dr DeLellis). Dr Etit is now with the Department o
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López JI, Ruiz A, Ugarte E, Paja M, Ereño C, Gaafar A. Synchronous occurrence of macroscopic papillary and medullary thyroid carcinomas. Hematol Oncol Stem Cell Ther 2008; 1:193-6. [PMID: 20063552 DOI: 10.1016/s1658-3876(08)50030-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jose I López
- Department of Anatomic Pathology, Hospital de Basurto, Vizcaya, Spain.
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Dionigi G, Castano P, Bertolini V, Boni L, Rovera F, Tanda ML, Capella C, Bartalena L, Dionigi R. Simultaneous medullary and papillary thyroid cancer: two case reports. J Med Case Rep 2007; 1:133. [PMID: 17997826 PMCID: PMC2194707 DOI: 10.1186/1752-1947-1-133] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 11/12/2007] [Indexed: 11/10/2022] Open
Abstract
Background Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) have always been considered different from each other; in their incidence, their cell origin and their histopathological features. Case presentation This paper describes two rare cases of the simultaneous occurrence of MTC and PTC in the thyroid gland. Case 1 is unique for different reasons: (a) the patient was affected by both multicentric MTC and PTC; (b) a "composite thyroid carcinoma" with mixed feautures of MTC and PTC carcinomas was found in the istmus of the gland; and (c) these tumors were associated with diffuse lymphocytic-type thyroiditis (LT). Case 2 is notable for the long follow up: 16 years disease free. Conclusion There are only 16 reports in the English medical literature describing a total of 20 cases of concurrent occurrence of both PTC and MTC in the same thyroid gland. We discuss whether the finding of another cancer in these patients was coincidental or from possible activation of a common tumorigenic pathway for both follicular and parafollicular thyroid cells.
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Rekhi B, Badhe RR, Desouza MA, Chaukar D, D'Cruz AK, Arya S, Kane SV. A unique RET EXON 11 (G691S) polymorphism in an Indian patient with a collision tumor of the thyroid. Diagn Pathol 2007; 2:39. [PMID: 17939859 PMCID: PMC2164940 DOI: 10.1186/1746-1596-2-39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 10/16/2007] [Indexed: 01/29/2023] Open
Abstract
Background Collision tumors of the thyroid are rare, with occasional reports dealing with their genetic analysis. Case presentation A 59 year old lady presented with a neck mass, associated with hoarseness of voice of 5 years duration. Radiological examination revealed nodular masses in the left lobe of her thyroid, along with one in the isthmus, extending into the right lobe and associated with enlarged neck nodes. FNAC from the left thyroid showed features of medullary carcinoma. On total thyroidectomy, 2 distinct tumor nodules were identified in the left lobe with another in the isthmus, showing features of medullary carcinoma (MTC), papillary carcinoma and follicular variant of papillary carcinoma, respectively, accompanied with nodal metastasis. Subsequently, she underwent radioablation. RET gene analysis of the patient, her 2 daughters and a grandson revealed a unique G691S polymorphism on Exon 11. Conclusion This unique case of a collision tumor of thyroid, including component of an MTC deals with the value of RET gene analysis and therapeutic implications in the index case and in family members.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
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Collision tumor of thyroid: metastatic lung adenocarcinoma plus papillary thyroid carcinoma. Am J Otolaryngol 2007; 28:218-20. [PMID: 17499145 DOI: 10.1016/j.amjoto.2006.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Collision tumors are rare entities wherein 2 separate, distinct histologic malignant neoplasms occur in adjacent anatomic proximity. The 2 malignancies may originate from the same organ or occur as metastases from other sites. We present a case of a collision tumor of metastatic lung adenocarcinoma and papillary thyroid carcinoma occurring in the thyroid gland of a 63-year-old woman who presented with a multinodular central neck mass. After excision and histopathologic examination, this tumor was identified as a collision tumor. This is the first report of this unique combination of tumors occurring in the thyroid gland. This case report emphasizes the role of detailed histopathologic analysis and the use of immunohistochemistry in better identifying rare thyroid neoplasms.
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Tang GC, Piao YS, Zhao L, Lu DH. Lung adenocarcinoma metastasizing to cerebellopontine angle schwannoma (collision tumor). Acta Neurochir (Wien) 2007; 149:87-90; discussion 90. [PMID: 17131066 DOI: 10.1007/s00701-006-1049-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 09/28/2006] [Indexed: 11/27/2022]
Abstract
Collision tumors are composed of two histologically distinct neoplasms which present at one location. Collision of a malignant tumor originating outside the central nervous system with a primary intracranial neoplasm is a rare event. Here we report on a CPA schwannoma containing a metastasis of adenocarcinoma in a 57-years old woman. Searching for the primary tumor resulted in the detection of a carcinoma in the superior lobe of the left lung.
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Affiliation(s)
- G-C Tang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
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