J Korean Thyroid Assoc.  2013 May;6(1):80-84. 10.11106/jkta.2013.6.1.80.

A Case of Concurrent Papillary and Medullary Thyroid Carcinomas Detected as Recurrent Medullary Carcinoma after Initial Surgery for Papillary Carcinoma

• Ahn D
• Sohn JH
• Park JY

• KMID: 1428458
• DOI: http://doi.org/10.11106/jkta.2013.6.1.80

Abstract

As the prevalence of thyroid carcinoma is rapidly increasing, coexisting subtypes of thyroid carcinomas are often found. However, concurrent papillary and medullary carcinomas in the thyroid gland are extremely rare. We report the case of a 50-year-old man with co-occurrence of multiple papillary and medullary thyroid carcinomas; the latter were undetected at initial diagnosis. Sixty-three months after the initial operation performed because of papillary carcinoma diagnosis, a metastatic lymph node was detected in the left level IV region, which was revealed as medullary carcinoma. The histopathologic results from initial surgery were reviewed, and we found multiple coexisting medullary carcinomas that were not identified initially. The incidence of concurrent papillary and medullary thyroid carcinomas will continue to increase as rates of diagnosis of and surgery for thyroid carcinoma increase. Therefore, surgeons and pathologists should be aware of the possible coexistence of subtypes of thyroid carcinomas to avoid missing concurrent lesions.

Keyword

Thyroid cancer; Papillary carcinoma; Medullary carcinoma

MeSH Terms

Carcinoma, Medullary
Carcinoma, Papillary
Incidence
Lymph Nodes
Prevalence
Thyroid Gland
Thyroid Neoplasms

Figure

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  Fig. 1. Initial cervical CT scan shows a 1.4-cm calcified nodule at the mid-posterior portion of the right thyroid gland (A) and a 1.5-cm nodule with egg-shell calcification at the low-lateral portion of the left thyroid gland (B).

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  Fig. 2. Follow-up CT scan indicates a metastatic lymph node (arrow) with obvious enhancement on the posterolateral aspect of the “internal jugular vein” in the left level IV region. Aspiration cytology of this lymph node revealed metastatic medullary thyroid carcinoma.

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  Fig. 3. A suspicious medullary carcinoma nodule (asterisk) was identified just adjacent to a known papillary carcinoma nodule on the re-cut slide. The 2 nodules were separated from each other by their own capsules (Hematoxylin & eosin stain, X20).

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  Fig. 4. Carcinoembryonic antigen (A) and synaptophysin (B) staining indicate positive reactivity on the left nodule (medullary carcinoma) and negative reactivity on the right nodule (papillary carcinoma) (carcinoembryonic antigen and synaptophysin, X200).

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  Fig. 5. Tumor cells in medullary carcinoma reveal diffuse strong cytoplasmic positive reactivity on calcitonin immunohistochemical staining (calcitonin, X100).

Reference

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