scholarly journals Medullary thyroid carcinoma (MTC): unusual metastatic sites

2021 ◽  
Vol 2021 ◽  
Author(s):  
Paraskevi Kazakou ◽  
George Simeakis ◽  
Maria Alevizaki ◽  
Katerina Saltiki
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Kinase Inhibitors ◽  
Distant Metastases ◽  
List Type ◽  
Medullary Thyroid ◽  
First Case ◽  
Disease Stabilization ◽  
Metastatic Sites ◽  
Unusual Metastases

Summary Medullary thyroid carcinoma (MTC) has a varying clinical course; distant metastases are frequently present even at diagnosis. We present two MTC cases with unusual metastatic sites. Two female patients are presented with slow progressive MTC. The first case developed distant metastases 23 years after diagnosis and underwent locoregional therapies. At the same time a breast mass developed representing MTC metastasis. Treatment with vandetanib led to long-term disease stabilization. The second patient is presented with metastases in the pancreas 13 years after diagnosis. Shortly, a painful mass developed in the mandible and metastasis of MTC was diagnosed. Disease progression was recorded 20 months after the initiation of local and systemic therapy. Such cases have only rarely been reported in the literature and highlight the need for prompt recognition of unexpected MTC metastases. Learning points Unusual sites of metastasis may appear in patients with medullary thyroid carcinoma (MTC) years after the initial diagnosis. Although rare, unexpected MTC metastases highlight the need for prompt recognition and appropriate treatment. Local recurrences accompanied by inappropriately low calcitonin levels should prompt further investigation for possible distant metastatic disease. Systemic treatment with tyrosine kinase inhibitors may be effective even in patients with unusual metastases from MTC.

131I-MIBG as a treatment in medullary thyroid carcinoma with distant metastases.

2018 ◽  
Author(s):  
Nerea Utrilla Uriarte ◽  
Pedro Gonzalez Fernandez ◽  
Alba Esteban Figueruelo ◽  
Marina Nevares Herrero ◽  
Javier Santamaria Sandi
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Distant Metastases ◽  
Medullary Thyroid ◽  
131I Mibg

scholarly journals A Review of the Significance in Measuring Preoperative and Postoperative Carcinoembryonic Antigen (CEA) Values in Patients with Medullary Thyroid Carcinoma (MTC)

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 609
Author(s):  
Ioannis Passos ◽  
Elisavet Stefanidou ◽  
Soultana Meditskou-Eythymiadou ◽  
Maria Mironidou-Tzouveleki ◽  
Vasiliki Manaki ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Carcinoembryonic Antigen ◽  
Medullary Thyroid Carcinoma ◽  
Clinical Significance ◽  
Relevant Literature ◽  
Distant Metastases ◽  
Lymph Node Involvement ◽  
C Cells ◽  
Gastrointestinal Malignancies ◽  
Medullary Thyroid

Background and Objectives: Medullary thyroid carcinoma (MTC) accounts for 1–2% of all thyroid malignancies, and it originates from parafollicular “C” cells. Carcinoembryonic antigen (CEA) is a tumor marker, mainly for gastrointestinal malignancies. There are references in literature where elevated CEA levels may be the first finding in MTC. The aim of this study is to determine the importance of measuring preoperative and postoperative CEA values in patients with MTC and to define the clinical significance of the correlation between CEA and the origin of C cells. Materials and Methods: The existing and relevant literature was reviewed by searching for articles and specific keywords in the scientific databases of PubMedCentraland Google Scholar (till December 2020). Results: CEA has found its place, especially at the preoperative level, in the diagnostic approach of MTC. Preoperative CEA values >30 ng/mL indicate extra-thyroid disease, while CEA values >100 ng/mL are associated with lymph node involvement and distant metastases. The increase in CEA values preoperatively is associated with larger size of primary tumor, presence of lymph nodes, distant metastases and a poorer prognosis. The clinical significance of CEA values for the surgeon is the optimal planning of surgical treatment. In the recent literature, C cells seem to originate from the endoderm of the primitive anterior gut at the ultimobranchial bodies’ level. Conclusions: Although CEA is not a specific biomarker of the disease in MTC, itsmeasurement is useful in assessing the progression of the disease. The embryonic origin of C cells could explain the increased CEA values in MTC.

scholarly journals Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis

2021 ◽  
Vol 12 ◽  
pp. 204201882110496
Author(s):  
Marisa A. Bartz-Kurycki ◽  
Omowunmi E. Oluwo ◽  
Lilah F. Morris-Wiseman
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Distant Metastases ◽  
Hereditary Disease ◽  
Patient Specific ◽  
Medullary Thyroid ◽  
Recent Advances ◽  
Initial Surgery ◽  
Biochemical Testing ◽  
Thyroid Malignancies

Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that represents <5% of all thyroid malignancies and is generally more aggressive than differentiated thyroid cancer. The aim of this study is to provide an update, through review of clinical studies of patients with MTC published between January 1, 2016, and June 1, 2021, on recent advances in the diagnosis and treatment of MTC. This review focuses on updates in biochemical testing, imaging, hereditary disease, surgical management, adjuvant therapies, and prognosis. Recent advances reviewed herein have sought to diagnose MTC at earlier stages of disease, predict when patients with a hereditary syndrome may develop MTC, use functional imaging to assess for distant metastases, perform optimal initial surgery with appropriate lymphadenectomy, employ targeted systemic therapies for patients with progressive metastatic disease, and better predict patient-specific outcomes.

scholarly journals Polymorphisms of cell cycle control genes influence the development of sporadic medullary thyroid carcinoma

2014 ◽  
Vol 171 (6) ◽  
pp. 761-767 ◽  
Author(s):  
R B Barbieri ◽  
N E Bufalo ◽  
R Secolin ◽  
L V M Assumpção ◽  
R M B Maciel ◽  
...  
Keyword(s):  
Cell Cycle ◽  
Regression Analysis ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Cell Cycle Control ◽  
Multivariate Logistic Regression Analysis ◽  
Distant Metastases ◽  
Genetic Profile ◽  
Sporadic Medullary Thyroid Carcinoma ◽  
Medullary Thyroid

BackgroundThe role of key cell cycle regulation genes such as, CDKN1B, CDKN2A, CDKN2B, and CDKN2C in sporadic medullary thyroid carcinoma (s-MTC) is still largely unknown.MethodsIn order to evaluate the influence of inherited polymorphisms of these genes on the pathogenesis of s-MTC, we used TaqMan SNP genotyping to examine 45 s-MTC patients carefully matched with 98 controls.ResultsA multivariate logistic regression analysis demonstrated that CDKN1B and CDKN2A genes were related to s-MTC susceptibility. The rs2066827*GT+GG CDKN1B genotype was more frequent in s-MTC patients (62.22%) than in controls (40.21%), increasing the susceptibility to s-MTC (OR=2.47; 95% CI=1.048–5.833; P=0.038). By contrast, the rs11515*CG+GG of CDKN2A gene was more frequent in the controls (32.65%) than in patients (15.56%), reducing the risk for s-MTC (OR=0.174; 95% CI=0.048–0.627; P=0.0075). A stepwise regression analysis indicated that two genotypes together could explain 11% of the total s-MTC risk. In addition, a relationship was found between disease progression and the presence of alterations in the CDKN1A (rs1801270), CDKN2C (rs12885), and CDKN2B (rs1063192) genes. WT rs1801270 CDKN1A patients presented extrathyroidal tumor extension more frequently (92%) than polymorphic CDKN1A rs1801270 patients (50%; P=0.0376). Patients with the WT CDKN2C gene (rs12885) presented larger tumors (2.9±1.8 cm) than polymorphic patients (1.5±0.7 cm; P=0.0324). On the other hand, patients with the polymorphic CDKN2B gene (rs1063192) presented distant metastases (36.3%; P=0.0261).ConclusionIn summary, we demonstrated that CDKN1B and CDKN2A genes are associated with susceptibility, whereas the inherited genetic profile of CDKN1A, CDKN2B, and CDKN2C is associated with aggressive features of tumors. This study suggests that profiling cell cycle genes may help define the risk and characterize s-MTC aggressiveness.

scholarly journals Medullary Thyroid Carcinoma with Micronodular Lung Metastases: A Case Report with an Emphasis on the Imaging Findings

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Nina Ventura ◽  
Edson Marchiori ◽  
Gláucia Zanetti ◽  
Antonio Muccillo ◽  
Mariana Leite Pereira ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Medullary Thyroid Cancer ◽  
Lung Metastases ◽  
Disease Process ◽  
Distant Metastases ◽  
Diagnostic Tools ◽  
Case Discussion ◽  
Medullary Thyroid ◽  
Rare Malignancy

Medullary thyroid carcinoma is a rare malignancy that arises from calcitonin-producing C-cells and frequently metastasizes to lymph nodes in the neck. Distant metastases may involve bone, lung, and liver. The infrequent number of cases limits the clinical nature and ability to optimize diagnostic tools. Here, we present a case of a micronodular radiographic pattern in metastatic medullary thyroid cancer in order to enhance awareness of the disease process. A case discussion and relevant review of the literature are provided.

scholarly journals Radioactive iodine in the treatment of medullary thyroid carcinoma: a controlled multicenter study

2013 ◽  
Vol 168 (5) ◽  
pp. 779-786 ◽  
Author(s):  
J A A Meijer ◽  
L E H Bakker ◽  
G D Valk ◽  
W W de Herder ◽  
J H W de Wilt ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Multicenter Study ◽  
Radioactive Iodine ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Medullary Thyroid ◽  
Clinical Appearance ◽  
Significant Difference

ObjectiveRadioactive iodine (RAI) therapy in medullary thyroid carcinoma (MTC) is applied in some centers, based on the assumption that cross-irradiation from thyroid follicular cells may be beneficial. However, no systematic studies on the effect of RAI treatment in MTC have been performed. The aim of this study was to analyze the effect of RAI treatment on survival in MTC patients.DesignRetrospective multicenter study in eight University Medical Centers in The Netherlands.MethodsTwo hundred and ninety three MTC patients without distant metastases who had undergone a total thyroidectomy were included between 1980 and 2007. Patients were stratified by clinical appearance, hereditary stage, screening status, and localization. All patients underwent regular surgical treatment with additional RAI treatment in 61 patients. Main outcome measures were disease-free survival (DFS) and disease-specific survival (DSS). Cure was defined as biochemical and radiological absence of disease.ResultsIn multivariate analysis, stratification according to clinical appearance (P=0.72), hereditary stage (P=0.96), localization (P=0.69), and screening status (P=0.31) revealed no significant effects of RAI treatment on DFS. Multivariate analysis showed no significant difference in DSS for the two groups stratified according to clinical appearance (P=0.14). Owing to limited number of events, multivariate analysis was not possible for DSS in the other groups of stratification.ConclusionsBased on the results of the present analysis, we conclude that RAI has no place in the treatment of MTC.

The dilemma of metastatic medullary thyroid carcinoma: when to start systemic treatment

2019 ◽  
Vol 105 (6) ◽  
pp. NP28-NP31
Author(s):  
Marco Siano ◽  
Salvatore Alfieri ◽  
Roberta Granata ◽  
Giuseppina Calareso ◽  
Ester Orlandi ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Medullary Thyroid Carcinoma ◽  
Systemic Therapy ◽  
Kinase Inhibitors ◽  
Locally Advanced ◽  
Tumor Burden ◽  
Bone Lesions ◽  
Progression Rate ◽  
Medullary Thyroid

Purpose: Two tyrosine kinase inhibitors (TKIs), vandetanib and cabozantinib, have been approved for recurrent/metastatic (R/M) medullary thyroid carcinoma (MTC). To date, it is still debated when and which TKI has to be started in R/M MTC patients. This is due to 1) TKI-related toxicity burden, 2) no overall survival benefit for either TKI, and 3) progression-free survival improvement in MTC subgroups ( RETM918T and RAS mutations) treated with cabozantinib. Herein, we present a case of R/M MTC with a discordant disease behavior because of spontaneous regression of some parenchymal sites along with progression of bone metastases, putting into the question the best timing for starting TKIs in R/M MTC. Methods: We report a 46-year-old man with relapse (lymph nodes in the neck and mediastinum) after curative treatment (total thyroidectomy plus central compartment and right neck dissection) for a locally advanced MTC with only somatic RETM918T mutation. Considering the low tumor burden, absence of symptoms, as well as the potential TKI-related side effects, we decided not to start systemic therapy when metastases first appeared. Results: Some lymph nodes spontaneously regressed, while new symptomatic bone lesions appeared with need for palliative radiotherapy. In total, first-line systemic therapy (cabozantinib) was started after 2 years since first distant metastases appearance. Conclusions: Radiologic progression of disease alone seems not to be adequate for MTC patients’ selection to be treated. The progression rate, the tumor burden, and the site of disease should also be taken into account for the clinical decision process.

Medullary Thyroid Carcinoma (MTC); unusual metastatic sites: Two case reports

2019 ◽  
Author(s):  
Paraskevi Kazakou ◽  
George Simeakis ◽  
Maria Alevizaki ◽  
Katerina Saltiki
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Case Reports ◽  
Medullary Thyroid ◽  
Metastatic Sites

Update on the Treatment of Medullary Thyroid Carcinoma in Patients with Multiple Endocrine Neoplasia Type 2

2020 ◽  
Vol 52 (08) ◽  
pp. 588-597 ◽  
Author(s):  
Maran Ilanchezhian ◽  
Sophia Khan ◽  
Christian Okafor ◽  
John Glod ◽  
Jaydira Del Rivero
Keyword(s):  
Thyroid Carcinoma ◽  
Tyrosine Kinase ◽  
Medullary Thyroid Carcinoma ◽  
Tyrosine Kinase Inhibitors ◽  
Multiple Endocrine Neoplasia ◽  
Kinase Inhibitors ◽  
Multiple Endocrine Neoplasia Type ◽  
Medullary Thyroid ◽  
Endocrine Neoplasia ◽  
Endocrine Neoplasia Type

AbstractMedullary Thyroid Carcinoma (MTC) is a rare neuroendocrine cancer that accounts for 1–2% of thyroid cancers in the United States (U.S.). While most cases are sporadic, 25% of MTC cases are hereditary. These hereditary cases occur in the setting of Multiple Endocrine Neoplasia Type 2A (MEN2A) or 2B (MEN2B) driven by mutations in the Rearranged during Transfection RET proto-oncogene. This article discusses hereditary MTC in the setting of MEN2 and the treatment options available for it. The first line treatment for this disease is typically a total thyroidectomy and tyrosine kinase inhibitors. Two tyrosine kinase inhibitors, vandetanib and cabozantinib, have been approved for treatment of advanced MTC, but options beyond those are limited. However, several promising treatments are being studied, which are discussed in this review.

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