A 74-year-old man was referred to the Endocrinology Unit because of multinodular goiter. The dominant nodule (1.7 × 1.9 × 2.4 cm), at the medium-superior third of the left lobe, was inhomogeneously hypoechoic, with irregular margins, macrocalcifications and intranodular vascularization. Fine-needle aspiration biopsy (FNAB) was performed. The cytological diagnosis was TIR 2, benign, according to the 2013 Italian thyroid cytology classification system. Moderately high serum calcitonin (s-Ct) (61.5 pg/mL, n.r. 0–7.5) and normal CEA were detected. The Ct level in FNAB wash-out fluid (Ct-FNAB) was 1450 pg/mL. Based on s-Ct and Ct-FNAB levels, patient underwent total thyroidectomy. Macroscopically, a dominant circumscribed nodule of 2 ecm was described; the histological and immunohistochemical features identified medullary thyroid carcinoma (MTC) with paraganglioma (PG)-like pattern positive for Ct, CEA and chromogranin and negative for S-100 sustentacular cells (SC). Moreover, papillary carcinoma of 3 mm in the right lobe was also associated. No areas of hyperaccumulation of the tracer were documented at Ga68 PET/CT. No RET-proto-oncogene mutations were found. Post-surgery s-Ct levels were within normal range (4 pg/mL). Two years after thyroidectomy, the patient is still disease-free. We reported a case of sporadic and rare variant of MTC: this is the ninth described case of PG-like MTC. In this case, cytologically benign, the clinical suspicion arose from high Ct values at FNAB wash-out fluid. Even if clinical behavior of this variant seems indolent, additional studies are necessary to understand prognoses and predictive factors.
Concomitant medullary thyroid carcinoma with paraganglioma-like pattern and papillary thyroid carcinoma / Greco, C.; Brigante, G.; Taliani, E.; Corrado, S.; Simoni, M.; Madeo, B.. - In: ENDOCRINOLOGY, DIABETES & METABOLISM CASE REPORTS. - ISSN 2052-0573. - 2019:1(2019), pp. 1-6.
Data di pubblicazione: | 2019 |
Data di prima pubblicazione: | nov-2019 |
Titolo: | Concomitant medullary thyroid carcinoma with paraganglioma-like pattern and papillary thyroid carcinoma |
Autore/i: | Greco, C.; Brigante, G.; Taliani, E.; Corrado, S.; Simoni, M.; Madeo, B. |
Autore/i UNIMORE: | |
Digital Object Identifier (DOI): | http://dx.doi.org/10.1530/EDM-19-0094 |
Rivista: | |
Volume: | 2019 |
Fascicolo: | 1 |
Pagina iniziale: | 1 |
Pagina finale: | 6 |
Codice identificativo ISI: | WOS:000503730600001 |
Codice identificativo Scopus: | 2-s2.0-85076225780 |
Codice identificativo Pubmed: | 31778356 |
Citazione: | Concomitant medullary thyroid carcinoma with paraganglioma-like pattern and papillary thyroid carcinoma / Greco, C.; Brigante, G.; Taliani, E.; Corrado, S.; Simoni, M.; Madeo, B.. - In: ENDOCRINOLOGY, DIABETES & METABOLISM CASE REPORTS. - ISSN 2052-0573. - 2019:1(2019), pp. 1-6. |
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