Medullary Thyroid Carcinoma Pathologic Regional Lymph Nodes TNM Finding v8

Abstract Background: To investigate the factors that affect postoperative recurrence in medullary thyroid carcinoma (MTC) patients, including preoperative ultrasonic characteristics and other factors. Method: A retrospective analysis of seventy four MTC patients who underwent the first thyroid surgery from 2009 to 2018 and who had complete follow-up data was conducted. According to the follow-up results, these patients were divided into the recurrence group (17 cases) and non-recurrence group (57 cases). The preoperative ultrasound characteristics, preoperative and postoperative calcitonin levels, and general informations of the two groups were recorded, respectively. Univariate and multivariate analyses were performed. Results: Single factor Kaplan-Meier (K-M) analysis showed that: ① Preoperative ultrasonic characteristics including tumor size > 40.0 mm, capsular invasion, and metastatic cervical lymph nodes, as well as preoperative calcitonin level > 565.8 pg/ml, and postoperative calcitonin (within one week) level > 45.0 pg/ml were positively correlated with the risk of postoperative recurrence of MTC (P <0.05); ② There was no evidence to show that gender and age had a statistically significant effect on postoperative recurrence of MTC (P> 0.05). Multivariate Cox regression analysis showed that metastatic lymph nodes shown by ultrasound (HR=5.368, 95%CI 1.063-27.104, P=0.042) was an independent risk factor for postoperative recurrence of MTC. Conclusions: MTC patients with metastatic lymph nodes shown by ultrasound are prone to postoperative recurrence of MTC. In addition, MTC patients with a tumor > 40.0 mm, capsular invasion, preoperative calcitonin level > 565.8 pg/ml, and postoperative calcitonin level > 45.0 pg/ml are more likely to have postoperative recurrence.

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

Tumori Journal ◽

10.1177/0300891619829571 ◽

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.

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Parathyroid Glands Hyperplasias Mimicking Medullary Thyroid Carcinoma Metastatic Lymph Nodes on 18F-DOPA PET/CT

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000002633 ◽

2019 ◽

Vol 44 (8) ◽

pp. e497-e498

Author(s):

Marie Terroir ◽

Serena Grimaldi ◽

Dana Hartl ◽

Sophie Leboulleux ◽

Désirée Deandreis

Keyword(s):

Thyroid Carcinoma ◽

Lymph Nodes ◽

Medullary Thyroid Carcinoma ◽

Parathyroid Glands ◽

Medullary Thyroid ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Pet Ct

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Correlation between preoperative ultrasonic features of medullary thyroid carcinoma and postoperative recurrence

BMC Cancer ◽

10.1186/s12885-021-07953-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiaodan Zhu ◽

Dong Xu

Keyword(s):

Thyroid Carcinoma ◽

Lymph Nodes ◽

Medullary Thyroid Carcinoma ◽

Postoperative Recurrence ◽

Capsular Invasion ◽

Calcitonin Level ◽

Medullary Thyroid ◽

Metastatic Lymph Nodes ◽

Recurrence Group

Abstract Background To investigate the factors that affect postoperative recurrence in medullary thyroid carcinoma (MTC) patients, including preoperative ultrasonic characteristics and other factors. Method A retrospective analysis of 7 MTC patients who underwent the first thyroid surgery from 2009 to 2018 and who had complete follow-up data was conducted. According to the follow-up results, these patients were divided into the recurrence group (17 cases) and non-recurrence group (57 cases). The preoperative ultrasound characteristics, preoperative and postoperative calcitonin levels, and general informations of the two groups were recorded, respectively. Univariate and multivariate analyses were performed. Results Single factor Kaplan-Meier (K-M) analysis showed that: ① Preoperative ultrasonic characteristics including tumor size > 40.0 mm, capsular invasion, and metastatic cervical lymph nodes, as well as preoperative calcitonin level > 565.8 pg/ml, and postoperative calcitonin (within one week) level > 45.0 pg/ml were positively correlated with the risk of postoperative recurrence of MTC (P < 0.05); ② There was no evidence to show that sex and age had a statistically significant effect on postoperative recurrence of MTC (P > 0.05). Multivariate Cox regression analysis showed that metastatic lymph nodes shown by ultrasound (HR = 5.368, 95%CI 1.063–27.104, P = 0.042) was an independent risk factor for postoperative recurrence of MTC. Conclusions MTC patients with metastatic lymph nodes shown by ultrasound are prone to postoperative recurrence of MTC. In addition, MTC patients with a tumor > 40.0 mm, capsular invasion, preoperative calcitonin level > 565.8 pg/ml, and postoperative calcitonin level > 45.0 pg/ml are more likely to have postoperative recurrence.

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Medullary Thyroid Carcinoma: An Update on Imaging

Journal of Thyroid Research ◽

10.1155/2019/1893047 ◽

2019 ◽

Vol 2019 ◽

pp. 1-17 ◽

Cited By ~ 4

Author(s):

Sergiy V. Kushchayev ◽

Yevgeniya S. Kushchayeva ◽

Sri Harsha Tella ◽

Tetiana Glushko ◽

Karel Pacak ◽

...

Keyword(s):

Positron Emission Tomography ◽

Magnetic Resonance ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Medullary Thyroid Carcinoma ◽

Emission Tomography ◽

Imaging Modalities ◽

Whole Body ◽

Medullary Thyroid ◽

Positron Emission

Medullary thyroid carcinoma (MTC), arising from the parafollicular C cells of the thyroid, accounts for 1–2% of thyroid cancers. MTC is frequently aggressive and metastasizes to cervical and mediastinal lymph nodes, lungs, liver, and bones. Although a number of new imaging modalities for directing the management of oncologic patients evolved over the last two decades, the clinical application of these novel techniques is limited in MTC. In this article, we review the biology and molecular aspects of MTC as an important background for the use of current imaging modalities and approaches for this tumor. We discuss the modern and currently available imaging techniques—advanced magnetic resonance imaging (MRI)-based techniques such as whole-body MRI, dynamic contrast-enhanced (DCE) technique, diffusion-weighted imaging (DWI), positron emission tomography/computed tomography (PET/CT) with 18F-FDOPA and 18F-FDG, and integrated positron emission tomography/magnetic resonance (PET/MR) hybrid imaging—for primary as well as metastatic MTC tumor, including its metastatic spread to lymph nodes and the most common sites of distant metastases: lungs, liver, and bones.

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