Endocrinology & Metabolic Syndrome
Open Access
ISSN: 2161-1017
ISSN: 2161-1017
Mohamed Mansour
South Tees Hospital, NHS Foundation trust, United Kingdom
Scientific Tracks Abstracts: Endocrinol Metab Syndr
Introduction: Papillary and medullary thyroid carcinomas are two different types of thyroid carcinoma with significant different histology. Synchronous occurrence of these two carcinomas is uncommon. We report two cases with concurrent presence of MTC and PTC. Case Report 1: A 54-year old patient presented with multiple thyroid nodules and cervical lymphadenopathy. FNAC from the LNs revealed metastatic thyroid neoplasm. Pre-operative Calcitonin and CEA levels were markedly elevated. The patient underwent total thyroidectomy with selective neck dissection. Final histology confirmed mixed MTC and PTC. No known genetic mutation was found. No recurrence was detected on 3 years of follow-up. Case Report 2: A 68-year old patient presented with suspicious bilateral thyroid nodules with right cervical lymphadenopathy. FNAC from the enlarged cervical LNs was consistent with medullary carcinoma. Pre-operative calcitonin level was markedly elevated. The patient underwent total thyroidectomy with selective neck dissection. Final histology showed multifocal medullary and papillary micro-carcinoma. RET mutation was found. Local recurrence was detected after 3 years and treated with local excision. The patient is still undergoing regular follow-ups. Discussion: The simultaneous occurrence of MTC and PTC is a rare phenomenon that can occur either as a mixed tumor showing dual differentiation or a collision tumor (tumor with two separate and different components). Distant metastases were described mostly in the mediastinum, lung, liver, and bone. Initial evaluation is usually by clinical examination, US+FNAC +/- CT scan to determine the extent of the disease and any distant metastasis. Conclusion: Co-existence of MTC and PTC is a rare condition that can occur either as a mixed tumor showing dual differentiation or a collision tumor. The prognosis of PTC is usually better than that of MTC. In MTC, regular calcitonin level monitoring is important to detect early recurrence.
Mohamed Mansour is a General Surgery Registrar, in James Cool University Hospitals, in UK. He has done his Master’s degree in general surgery, from Cairo University, in Egypt. He has a Membership of the Royal College of Surgeons, MRCS, in England, Uk. He is also having a Fellowship of the American College of Surgeons, FACS, USA.