Possibilities and limitations of tumor-scintigraphy for follow up of medullary thyroid cancer

Medullary thyroid cancer is a rare type of neuroendocrine tumour that arises from the parafollicular cells (C cells) of the thyroid gland. It accounts for 3%–5% of thyroid cancer cases. Close to 25% of cases are familial, and 75% are considered sporadic. Familial cases are associated with a germline RET mutation; 43%–65% of sporadic cases harbour a somatic event in the gene. Germline RET mutations are associated with the autosomal-dominant inherited multiple endocrine neoplasia (men) 2a and 2b syndromes and the isolated familial medullary thyroid cancer syndrome. More than 100 RET codon mutations have been reported to date, with genotype–phenotype correlations that include the extent and aggressiveness of the medullary thyroid cancer and the presence of other features of the men2 syndromes. The latter include pheochromocytoma–paraganglioma, hyperparathyroidism, cutaneous lichen amyloidosis, and Hirschsprung disease. In this narrative review, we focus on RET proto-oncogene physiology and pathogenesis induced by germline and somatic RET mutations, the genotype–phenotype correlation, and the management and follow-up of patients with germline-mutated medullary thyroid cancer.

Download Full-text

Faculty Opinions recommendation of Prognostic significance of somatic RET oncogene mutations in sporadic medullary thyroid cancer: a 10-year follow-up study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1104639.559451 ◽

2008 ◽

Author(s):

Georg Brabant

Keyword(s):

Thyroid Cancer ◽

Medullary Thyroid Cancer ◽

Prognostic Significance ◽

Medullary Thyroid ◽

Follow Up Study ◽

Ret Oncogene

Download Full-text

Prognostic Significance of Somatic RET Oncogene Mutations in Sporadic Medullary Thyroid Cancer: A 10-Year Follow-Up Study

Yearbook of Pathology and Laboratory Medicine ◽

10.1016/s1077-9108(08)79021-2 ◽

2009 ◽

Vol 2009 ◽

pp. 144-146 ◽

Cited By ~ 1

Author(s):

R. Seethala

Keyword(s):

Thyroid Cancer ◽

Medullary Thyroid Cancer ◽

Prognostic Significance ◽

Medullary Thyroid ◽

Follow Up Study ◽

Ret Oncogene

Download Full-text

Biochemical Markers in the Follow-up of Medullary Thyroid Cancer

Thyroid ◽

10.1089/thy.2006.16.1163 ◽

2006 ◽

Vol 16 (11) ◽

pp. 1163-1170 ◽

Cited By ~ 33

Author(s):

Jan Willem B. de Groot ◽

Ido P. Kema ◽

Henk Breukelman ◽

Eveline van der Veer ◽

Theo Wiggers ◽

...

Keyword(s):

Thyroid Cancer ◽

Biochemical Markers ◽

Medullary Thyroid Cancer ◽

Medullary Thyroid

Download Full-text

Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer

Cancers ◽

10.3390/cancers13225842 ◽

2021 ◽

Vol 13 (22) ◽

pp. 5842

Author(s):

Jinyoung Kim ◽

Jun Park ◽

Hyunju Park ◽

Min Sun Choi ◽

Hye Won Jang ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Medullary Thyroid Cancer ◽

Lymph Node Ratio ◽

Serum Calcitonin ◽

Free Survival ◽

Medullary Thyroid ◽

Node Ratio ◽

Postoperative Serum

The lymph node ratio (LNR) has been investigated as a prognostic factor in many different types of cancers, including differentiated thyroid cancer; however, reports regarding medullary thyroid cancer (MTC) are limited. Therefore, this study aims to evaluate LNR as a risk factor for structural recurrence in patients with MTC. Medical records of patients treated for MTC in a single tertiary center between 1995 and 2017 were retrospectively reviewed. LNR is defined as the number of metastatic lymph nodes or lymph node metastases (LNM) divided by the number of retrieved lymph nodes or lymph node yield (LNY). In the survival analysis, recurrence-free survival was defined as the time from the date of total thyroidectomy to recurrence or last follow-up. To identify risk factors influencing structural recurrence, univariable and multivariable Cox proportional hazard models were used. A total of 132 patients were enrolled. The mean age of study participants was 49.7 years, and 86 patients (65%) were women. Structural recurrence was identified in 39 patients at the end of the study period, and the median follow-up period was 8.7 years. In univariable analyses, gross extra thyroidal extension, N stage, postoperative serum calcitonin and carcinoembryonic antigen (CEA) levels, and LNR were significant (p < 0.05) predictors of structural recurrence. In multivariable analysis, postoperative serum calcitonin, postoperative serum CEA, and LNR were identified as a predictor of disease-free survival (p < 0.05). LNR can potentially predict structural recurrence as a quantitative evaluation tool for lymph node metastasis in patients with MTC.

Download Full-text

Late-Onset Medullary Thyroid Cancer in a Patient with a Germline RET Codon C634R Mutation

Diagnostics ◽

10.3390/diagnostics11081448 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1448

Author(s):

Agnieszka Walczyk ◽

Kajetan Zgubieński ◽

Grzegorz Chmielewski ◽

Kinga Hińcza-Nowak ◽

Artur Kowalik ◽

...

Keyword(s):

Thyroid Cancer ◽

High Risk ◽

Germline Mutation ◽

Medullary Thyroid Cancer ◽

Response To Therapy ◽

American Thyroid Association ◽

Prophylactic Thyroidectomy ◽

Serum Calcitonin ◽

Medullary Thyroid

Background: Multiple endocrine neoplasia type 2A (MEN2A) is a rare, hereditary syndrome resulting from a germline mutation in the RET proto-oncogene and characterized primarily by medullary thyroid cancer (MTC), pheochromocytoma (PHEO), and hyperparathyroidism. Types of RET mutation have been associated with age at onset, clinical outcomes of MTC, and the penetrance of other components. Patients classified as ‘high-risk’ by the American Thyroid Association (ATA), based on the aggressiveness of MTC and the penetrance of other components, are recommended to undergo early prophylactic thyroidectomy at age ≤ 5 years and to be screened for PHEO at age ≥ 11 years. Patients with RET codon C634R mutations have been classified as high-risk. Case presentation: The present study describes a 71-year-old woman newly diagnosed with hereditary MTC related to a RET C634R germline mutation. Her basal serum calcitonin level was high, but there was no evidence of distant metastases. Surgery revealed bilateral MTC with two metastatic lymph nodes. Because microscopic resection was incomplete and extranodal extension was observed, the patient underwent adjuvant external beam radiotherapy. Response to therapy was excellent. Follow-up after 1.5 years showed no evidence of disease or other manifestations of MEN2A. Conclusion: Despite RET C634R carriers being classified as high-risk by the ATA, this patient did not present with either distant MTC or PHEO until her seventies. To our knowledge, only one other patient has shown a similar late identification of a RET C634R mutation, but MTC could not be diagnosed because the patient was lost to follow-up. Further research is required to develop optimal protocols that could allow patients requiring prophylactic thyroidectomy to be differentiated from those who can be monitored closely without early surgery.

Download Full-text