S138 – Treatment Controversy Incidental Micro-Medullary Carcinoma

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P123-P123
Author(s):  
Jamie M. Swartz ◽  
Thomas Peyton Nowlin
Keyword(s):  
Surgical Treatment ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Previous History ◽  
Treatment Strategies ◽  
Medullary Carcinoma ◽  
Medullary Thyroid ◽  
Appropriate Treatment ◽  
Microscopic Evaluation ◽  
History Of

Objectives 1) Investigate the controversial management dilemma of microscopic foci of medullary thyroid carcinoma found incidentally. 2) Describe appropriate treatment strategies for this rare scenario after critically reviewing the literature. Methods This case is a 33-year-old Caucasian female with a history of a multinodular goiter seen as a referral from an endocrinologist. She had no previous history of parathyroid disease, pheochromocytoma or MEN syndrome. She also had no family history of medullary thyroid carcinoma. The patient underwent total thyroidectomy for multiple nodules with an uneventful operative course and recovery. Results The thyroid was sent for permanent section and evaluated microscopically with an H&E stain. Final microscopic evaluation revealed multiple adenomatous nodules, a 2mm focus of papillary thyroid carcinoma, and a 2 mm focus of medullary thyroid carcinoma. The patient underwent no further surgical treatment. She has undergone chromosomal analysis, evaluation for possible multiple endocrine neoplasia, and serial calcitonin measurements. She is currently disease-free. Conclusions Medullary thyroid carcinoma is a well-described form of thyroid malignancy that typically mandates aggressive surgical treatment; however, there is a paucity of information in the literature concerning sporadic, microscopic foci of medullary thyroid carcinoma. We review the literature and describe appropriate treatment strategies for this rare scenario.

Patient harboring RET D631Y mutation with long history of pheochromocytoma without evident medullary thyroid carcinoma

2018 ◽  
Author(s):  
Liana Khatsimova ◽  
Uliana Tsoy ◽  
Lubov Yanevskaya ◽  
Anna Kostareva ◽  
Anna Dalmatova ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Medullary Thyroid ◽  
History Of

Metastatic Canine Medullary Thyroid Carcinoma: A Case Report

1980 ◽  
Vol 17 (3) ◽  
pp. 323-330 ◽  
Author(s):  
G. G. Long ◽  
R. M. Clemmons ◽  
H. Heath
Keyword(s):  
Case Report ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Distant Metastasis ◽  
Clinical Course ◽  
Medullary Carcinoma ◽  
Neoplastic Tissue ◽  
Medullary Thyroid ◽  
Biochemical Alterations ◽  
Mitotic Figures

A medullary carcinoma of the thyroid in a dog first became evident because of a distant metastasis. The histologic characteristics of the tumor differ from those previously reported in dogs in that this tumor was highly malignant; anaplasia and mitotic figures were common. The diagnosis was substantiated by radioimmunoassay for calcitonin. Serotonin and 5-hydroxytryptophan also were elevated in the neoplastic tissue. The relation of the biochemical alterations to the clinical course was not clear.

scholarly journals Usefulness of preoperative serum calcitonin in patients with nodular thyroid disease without suspicious history or cytology for medullary thyroid carcinoma

2013 ◽  
Vol 57 (4) ◽  
pp. 312-316 ◽  
Author(s):  
Pedro Weslley Rosário ◽  
Gustavo Cancela Penna ◽  
Kamilla Brandão ◽  
Bárbara Érika Souza
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Multiple Endocrine Neoplasia ◽  
Multiple Endocrine Neoplasia Type ◽  
Serum Calcitonin ◽  
Medullary Thyroid ◽  
Endocrine Neoplasia ◽  
Preoperative Serum ◽  
History Of

OBJECTIVE: To evaluate the usefulness of preoperative serum calcitonin (sCT) in patients with nodular disease without suspicion of medullary thyroid carcinoma (MTC) in history or cytology. PATIENTS AND METHODS: sCT was measured before thyroidectomy in 494 patients with nodular disease who had no family history of MTC or multiple endocrine neoplasia type 2, and no cytological suspicion of MTC. RESULTS: Basal sCT was < 10 ng/mL in 482 patients and none of them had MTC. One patient with basal sCT > 100 pg/mL had MTC. Among the 11 patients with basal sCT between 10 and 100 pg/mL, MTC was diagnosed in only one. The two patients with MTC were submitted to total thyroidectomy, combined with elective lymph node dissection indicated exclusively based on hypercalcitoninemia, and sCT was undetectable after six months. CONCLUSIONS: Preoperative sCT is useful for the detection of sporadic MTC in patients with nodular disease, even in the absence of suspicious history or cytology.

scholarly journals Management Considerations in Ruptured Isolated Radiculopial Artery Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 60-66 ◽  
Author(s):  
A.C.G.M. Van Es ◽  
P.A. Brouwer ◽  
P.W.A. Willems
Keyword(s):  
Surgical Treatment ◽  
Management Strategy ◽  
Clinical Course ◽  
Treatment Strategies ◽  
The Other ◽  
Posterior Spinal Artery ◽  
Appropriate Treatment ◽  
History Of ◽  
Clinical Paradigm ◽  
Slight Growth

Little is known on the natural history of ruptured isolated aneurysms of the posterior spinal artery (PSA). To date, only a few of such cases have been described in the literature. This paper aims to assess the most appropriate management strategy, based on the available literature and two new cases. In one of these, treatment was postponed until day 33, when angiography showed slight growth of the aneurysm. In the other, conservative treatment, requested by the patient, was successful. From these data, we conclude that treatment strategies for ruptured PSA aneurysms may vary. Aside from the recommendation by others to perform prompt surgical treatment, we suggest an alternative clinical paradigm allowing for the evaluation of the early clinical course. This may preclude the unnecessary treatment of spontaneously regressing lesions and still allows for appropriate treatment for persistent lesions.

scholarly journals Medullary Thyroid Carcinoma: Molecular Signaling Pathways and Emerging Therapies

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Karen Gómez ◽  
Jeena Varghese ◽  
Camilo Jiménez
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Prophylactic Treatment ◽  
Molecular Pathways ◽  
Molecular Signaling ◽  
Conventional Chemotherapy ◽  
Medullary Thyroid ◽  
Neck Disease ◽  
Emerging Therapies ◽  
History Of

Research on medullary thyroid carcinoma (MTC) over the last 55 years has led to a good understanding of the genetic defects and altered molecular pathways associated with its development. Currently, with the use of genetic testing, patients at high risk for MTC can be identified before the disease develops and offered prophylactic treatment. In cases of localized neck disease, surgery can be curative. However, once MTC has spread beyond the neck, systemic therapy may be necessary. Conventional chemotherapy has been shown to be ineffective; however, multikinase inhibitors have shown promise in stabilizing disease, and this year will probably see the approval of a drug (Vandetanib) for advanced unresectable or metastatic disease, which represents a new chapter in the history of MTC. In this paper, we explore newly understood molecular pathways and the most promising emerging therapies that may change the management of MTC.

scholarly journals Early diagnosis of multiple endocrine neoplasia type 2B: a challenge for physicians

2008 ◽  
Vol 52 (8) ◽  
pp. 1393-1398 ◽  
Author(s):  
Cleber P. Camacho ◽  
Ana O. Hoff ◽  
Susan C. Lindsey ◽  
Priscila S. Signorini ◽  
Flávia O. F. Valente ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Multiple Endocrine Neoplasia ◽  
Multiple Endocrine Neoplasia Type ◽  
Late Diagnosis ◽  
Medullary Thyroid ◽  
Ret Mutation ◽  
Endocrine Neoplasia ◽  
Endocrine Neoplasia Type ◽  
History Of

BACKGROUND: The hereditary form of medullary thyroid carcinoma may occur isolated as a familial medullary thyroid carcinoma (FMTC) or as part of Multiple Endocrine Neoplasia 2A (MEN2A) and 2B (MEN2B). MEN2B is a rare syndrome, its phenotype may usually, but not always, be noted by the physician. In the infant none of the MEN2B characteristics are present, except by early gastrointestinal dysfunction caused by intestinal neuromas. When available, genetic analysis confirms the diagnosis and guides pre-operative evaluation and extent of surgery. Here we report four cases of MEN2B in which the late diagnosis had a significant impact in clinical evolution and, potentially, in overall survival. CASE REPORT: We report four cases, 2 men and 2 women, with differences in their phenotypes and with a late diagnosis. The first case has a history of severe gastrointestinal obstruction requiring a surgery intervention two days after his birth. The second told had nodules in the oral mucosa and constipation since childhood. The third case referred a history of constipation from birth until 5 months of life. The fourth has had a history of chronic constipation since childhood. DISCUSSION: New concepts have emerged since the RET oncogene was identified in 1993 as the responsible gene for hereditary medullary thyroid carcinoma. The majority of MEN2B individuals have M918T mutation in the exon 16 of RET, with a few cases having a mutation A883F or the association of V804M with E805K, Y806C or S904C mutations. The consensus classifies the RET mutation in codon 918 as of highest risk and recommends total thyroidectomy and central lymph node dissection until 6 months after birth. A fast and precise diagnosis is essential to reach these goals. The identification of early manifestations such as intestinal ganglioneuromatosis and oral mucosal neuromas should prompt the physician to initiate an investigation for multiple endocrine neoplasia type 2B. CONCLUSION: The diagnosis of MEN2B is very important to allow appropriate investigation of associated diseases and to allow counseling and appropriate screening of relatives for a RET mutation. Even patients with MEN2B, which often have typical physical features, may not be properly recognized and be followed as a sporadic case. Based on this, all suspicious cases of multiple endocrine neoplasia should undergo a molecular genetic test.

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