Mixed Medullary-Papillary Carcinoma of the Thyroid with Lymph Node Metastases: Report of a Case

Abstract

We report herein the case of a 77-year-old woman found to have mixed medullary-papillary carcinoma in the right thyroid with lymph node metastases 30 years after a left thyroidectomy. The preoperative values of serum calcitonin and carcinoembryonic antigen (CEA) were high, and fine-needle aspiration biopsy revealed class V, which led us to suspect papillary carcinoma. A right thyroidectomy with dissection of the right neck lymph nodes was performed. Histopathological examination of the tumor specimens revealed gradual borders between medullary carcinoma and papillary carcinoma with positive immunohistochemical staining to calcitonin, chromogranin A, CEA, and thyroglobulin. The serum levels of calcitonin and CEA decreased to normal after the operation. The point mutation of the RET proto-oncogene was found to be negative by a DNA analysis of the peripheral leukocytes. This cancer seemed not to be associated with multiple endocrine neoplasia type 2 syndrome. The presence of both medullary and papillary components in the thyroid with lymph node metastases is rare and may suggest that the tumor had arisen from a common stem cell.

Fine Needle Aspiration Biopsy of Mixed Medullary-Follicular Thyroid Carcinoma

“…Reports often deal with only one or several cases due to the rarity of the findings. Reports cover both follicular 2,4,6,7,9,10,[12][13][14]16,19,22,23,25,26 and papillary 1,11,18,19,21 architecture of the follicular cell component. Mixed medullary and follicular carcinoma of the thyroid may be part of multiple endocrine neoplasia 8 and present in a familial form.…”

Concurrent lymph node metastases of medullary and papillary thyroid carcinoma in a case with RET oncogene germline mutation

“…In particular, few papers exist in the literature that describe the coexistence of MTC and PTC in the same patient [5][6][7][8][9][10][11][12], some of these report concurrent lymph node metastases of both tumors [9][10][11].…”

Co-Existence of Medullary and Papillary Carcinomas of Thyroid - Case Report and Brief Review of Literature

“…[4] However, Vantyghem et al reported 17 cases of familial MTC-PTC, but none had RET defects. [9] A few studies like Lax et al in 1994 [10] and Shiroko et al in 2000 [11] have reported that mixed MTC-PTC had arisen from a common stem cell, thus supporting the stem cell theory.…”