Int J Thyroidol.  2024 Nov;17(2):309-313. 10.11106/ijt.2024.17.2.309.

Medullary Thyroid Carcinoma with Normal Calcitonin Level

• Chang MC
• Lee W

• KMID: 2561613
• DOI: http://doi.org/10.11106/ijt.2024.17.2.309

Abstract

Calcitonin is an important tumor marker for medullary thyroid carcinoma. Serum calcitonin is increased in most cases of medullary thyroid carcinoma. However, medullary thyroid carcinoma with normal calcitonin level has been reported very rarely. 1.2 cm sized solid thyroid nodule was suspicious for medullary thyroid carcinoma in fine needle aspiration cytology, but serum calcitonin was within the normal range. The final pathology after surgery was medullary thyroid carcinoma with positive calcitonin immunohistochemical staining. The authors present a case of calcitonin-negative medullary thyroid cancer with reviews of the mechanism, diagnosis, treatment, prognosis and follow-up of this case.

Keyword

Calcitonin; Thyroid carcinoma; Medullary carcinoma

Figure

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  Fig. 1 Sonography shows 1.0×0.7×1.2 cm sized mild hypoechogenic solid nodule with microlobulation in right middle thyroid.

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  Fig. 2 Histologic slides. (A) Thyroid nodule is well circumscribed, encapsulated (Hematoxylin-Eosin staining [H&E], ×12.5). (B) Tumor shows a nest-like pattern surrounded by richly vascular septa (H&E, ×100). (C) The tumor cells have granular cytoplasm and ovoid nuclei with delicate chromatin distribution. Psammoma bodies are seen within the tumor (H&E, ×200).

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  Fig. 3 Immunohistochemistry shows (A) positive to calcitonin (calcitonin immunostaining, ×200), (B) positive to CEA (CEA immunostaining, ×200), (C) positive to TTF-1 (TTF-1 immunostaining, ×200), (D) positive to chromogranin A (chromogranin A immunostaining, ×200), (E) positive to synaptophysin (synaptophysin immunostaining, ×200), (F) negative to S100 (S100 immunostaining, ×200).

Reference

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