scholarly journals Identification of occult metastases of medullary thyroid carcinoma by calcitonin measurement in washout fluid from fine needle aspiration of cervical lymph node

2009 ◽  
Vol 53 (4) ◽  
pp. 479-481 ◽  
Author(s):  
Debora Siqueira ◽  
Andreia Possati Rocha ◽  
Marcia Khaled Puñales ◽  
Ana Luiza Maia
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Residual Disease ◽  
Needle Aspiration ◽  
Illustrative Case ◽  
Serum Calcitonin ◽  
Medullary Thyroid ◽  
Fine Needle

Medullary thyroid carcinoma (MTC) may occur sporadically or as a manifestation of an autosomal-dominant inherited syndrome, the multiple endocrine neoplasia type 2. DNA-based RET genotype analysis gained worldwide acceptance in the identification of asymptomatic gene carrier. MTC synthesize and secrete calcitonin, a well established tumor marker and postoperative level of serum calcitonin, indicates whether residual disease was left behind and whether reintervention is necessary. However, management is difficult when routine imaging studies for MTC are negative. This paper brings a report of an illustrative case of a patient with MTC diagnosed by molecular screening, who persisted with detectable levels of serum calcitonin after surgical procedure. After 48 months, an increase in serum calcitonin impelled us to investigate the disease focus. Cervical-US and calcitonin measurement in washout fluid from fine needle aspiration was successfully used to identify MCT metastasis in a lymph node, allowing appropriated reintervention and illustrating the potential clinical applicability of this method.

scholarly journals Concomitant medullary thyroid carcinoma with paraganglioma-like pattern and papillary thyroid carcinoma

2019 ◽  
Vol 2019 ◽  
Author(s):  
C Greco ◽  
G Brigante ◽  
E Taliani ◽  
S Corrado ◽  
M Simoni ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
List Type ◽  
Serum Calcitonin ◽  
Medullary Thyroid ◽  
Fine Needle ◽  
Additional Tool ◽  
Post Surgery

Summary A 74-year-old man was referred to the Endocrinology Unit because of multinodular goiter. The dominant nodule (1.7 × 1.9 × 2.4 cm), at the medium-superior third of the left lobe, was inhomogeneously hypoechoic, with irregular margins, macrocalcifications and intranodular vascularization. Fine-needle aspiration biopsy (FNAB) was performed. The cytological diagnosis was TIR 2, benign, according to the 2013 Italian thyroid cytology classification system. Moderately high serum calcitonin (s-Ct) (61.5 pg/mL, n.r. 0–7.5) and normal CEA were detected. The Ct level in FNAB wash-out fluid (Ct-FNAB) was 1450 pg/mL. Based on s-Ct and Ct-FNAB levels, patient underwent total thyroidectomy. Macroscopically, a dominant circumscribed nodule of 2 ecm was described; the histological and immunohistochemical features identified medullary thyroid carcinoma (MTC) with paraganglioma (PG)-like pattern positive for Ct, CEA and chromogranin and negative for S-100 sustentacular cells (SC). Moreover, papillary carcinoma of 3 mm in the right lobe was also associated. No areas of hyperaccumulation of the tracer were documented at Ga68 PET/CT. No RET-proto-oncogene mutations were found. Post-surgery s-Ct levels were within normal range (4 pg/mL). Two years after thyroidectomy, the patient is still disease-free. We reported a case of sporadic and rare variant of MTC: this is the ninth described case of PG-like MTC. In this case, cytologically benign, the clinical suspicion arose from high Ct values at FNAB wash-out fluid. Even if clinical behavior of this variant seems indolent, additional studies are necessary to understand prognoses and predictive factors. Learning points: Several unusual histological variants of medullary thyroid carcinoma (MTC) have been described such as spindle cell, giant cell, clear cell, melanotic, squamous, angiosarcoma-like variants; even rarer is the paraganglioma (PG)-like pattern. We here describe a case of medullary PG-like thyroid carcinoma in a 74-year-old man. This is a rare histological variant of MTC hardly diagnosed by cytology, since immunohistochemical investigations are necessary. Measurement of calcitonin both in serum and in wash-out fluid from fine-needle aspiration could be an additional tool for an early and non-invasive identification of these variants.

Diagnostic Challenges of Medullary Thyroid Carcinoma

Oncology ◽  
2021 ◽  
pp. 1-11
Author(s):  
Robert D. Leimbach ◽  
Thanh D. Hoang ◽  
Mohamed K.M. Shakir
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Autosomal Dominant ◽  
Needle Aspiration ◽  
Definitive Treatment ◽  
Serum Calcitonin ◽  
Medullary Thyroid ◽  
Fine Needle ◽  
Laboratory Technology

<b><i>Background:</i></b> Medullary thyroid carcinoma (MTC) comprises 1–2% of all thyroid cancers, yet 15% of all thyroid cancer-related deaths. While up to 20% of cases may be predicted due to autosomal dominant germline mutations, 80% of cases are sporadic. However, due to non-specific presenting symptoms and diagnostic imaging, prompt diagnosis and treatment has remained elusive. This article will further investigate the limitations of MTC diagnosis and look into future areas for diagnostic improvement. <b><i>Methods:</i></b> Relevant articles were identified using a systematic PubMed and Google Scholar search. <b><i>Results:</i></b> Prophylactic total thyroidectomy for the 20% of MTC cases that are present in autosomal dominant disorder provides definitive treatment. Serum calcitonin (Ctn) screening has several technical limitations due to population variability and laboratory assay interference, but advances in laboratory technology and combined use with fine needle aspiration increase its sensitivity. Other serum assays such as carcinoembryonic antigen and procalcitonin have limited applicability. Thyroid ultrasound remains the gold standard for the initial diagnostic planning, with limited application for CT, MRI, and PET imaging. <b><i>Conclusion:</i></b> With complete surgical resection the only definitive treatment, early MTC diagnosis has presented an elusive challenge, mainly due to its relative rarity and difficulty in finding an economic screening strategy. Careful family history combined with fine needle aspiration with serum Ctn analysis can improve diagnostic sensitivity and specificity to greater than 95%.

Oncocytic variant of medullary thyroid carcinoma; a rare tumor with numerous diagnostic mimics by fine needle aspiration

2017 ◽  
Vol 45 (12) ◽  
pp. 1148-1152 ◽  
Author(s):  
Sharon B. Sams ◽  
Kenneth D. Tompkins ◽  
Sarah Mayson ◽  
Christopher D. Raeburn ◽  
Sanjana Mehrotra
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Rare Tumor ◽  
Medullary Thyroid ◽  
Fine Needle ◽  
Oncocytic Variant

Diagnosis of pseudopapillary variant of medullary thyroid carcinoma by fine-needle aspiration cytology

2013 ◽  
Vol 42 (9) ◽  
pp. 823-826 ◽  
Author(s):  
Namiki Kawanishi ◽  
Yoshiaki Norimatsu ◽  
Hiroyuki Ohsaki ◽  
Tsutomu Yuminamochi ◽  
Ryohei Katoh ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Medullary Thyroid ◽  
Fine Needle ◽  
Needle Aspiration Cytology

scholarly journals Diagnostic Pitfall of Thyroid Fine-needle Aspiration Induced Fibrosis: Follicular Adenoma Mimicking Medullary Thyroid Carcinoma in Frozen Section

2020 ◽  
Author(s):  
Woo Sung Moon ◽  
Myoung Jae Kang ◽  
Hyun Jo Youn ◽  
Kyoung Min Kim
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Frozen Section ◽  
Follicular Adenoma ◽  
Needle Aspiration ◽  
Medullary Thyroid ◽  
Fine Needle ◽  
Histological Alterations ◽  
Diagnostic Pitfall

Abstract Background:Fine-needle aspiration (FNA) is a frequently utilized method for the diagnosis of thyroid nodules. Although the technique has clear advantages, the injury caused by the aspiration needle can induce various histological alterations. Herein, we report a case of follicular adenoma showing histological alterations possibly caused by FNA biopsy. Furthermore, the histological appearance of the lesion mimicked those of medullary thyroid carcinoma, particularly in the frozen section. Case presentation: Ultrasonography of a thyroid nodule in a 39-year-old man revealed a mass (2.2cm in diameter) in the right thyroid lobe. FNA was performed three times on the mass, and the results of the cytology were atypia of undetermined significance. Thereafter, the patient underwent right hemithyroidectomy. The histological findings of the operative frozen section analysis indicated medullary thyroid carcinoma. However, after evaluation and immunohistochemical staining of the permanent section, the mass was diagnosed as follicular adenoma with extensive fibrosis.Conclusion:The histological alterations observed in the follicular adenoma are believed to have been caused by injury during the repeated FNA procedures.

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