medullary thyroid
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2022 ◽  
Author(s):  
Inés Califano ◽  
Fabian Pitoia ◽  
Roxana Chirico ◽  
Alejandra de Salazar ◽  
Maria Bastianello

Abstract Purpose 18F-DOPA Positron Emission Tomography/Computed Tomography (18F-DOPA PET/CT) is a sensitive functional imaging method (65-75%) for detecting disease localization in medullary thyroid cancer (MTC). We aimed: i) to assess the clinical usefulness of 18F-DOPA PET/CT in patients with MTC and elevated calcitonin (Ctn) and CEA levels and, ii) to evaluate changes in disease management secondary to the findings encountered with this methodology. Methods thirty-six patients with MTC and Ctn levels ≥150 pg/ml were prospectively included. Neck ultrasound, chest contrast-enhanced CT, liver magnetic resonance imaging/ abdominal 3-phase contrast-enhanced CT and bone scintigraphy were carried out up to 6 months before the 18F DOPA PET/CT. Results 77.7% were female and 27% had hereditary MTC. Median Ctn level was 1450 pg/ml [150-56620], median CEA level 413 ng/ml [2.9-7436]. Median Ctn DT was 37.5 months [5.7-240]; median CEA DT was 31.8 [4.9-180]. 18F-DOPA PET/CT was positive in 33 patients (91.6%); in 18 (56%) uptake was observed in lymph nodes in the neck or mediastinum, in 7 cases (22%) distant metastases were diagnosed, and in 8 additional patients (24%) both locoregional and distant sites of disease were found. Ctn and CEA levels were higher in patients with ≥ 3 foci of distant metastases. In 14 patients (38.8%), findings on 18F-DOPA PET/CT led to changes in management; surgery for locoregional lymph nodes was the most frequent procedure in 8 patients (22%). Conclusion 18F-DOPA PET/CT was useful for the detection of recurrent disease in MTC and provided helpful information for patient management.


2022 ◽  
pp. 1-12
Author(s):  
Sule Canberk ◽  
Eleni Thodou ◽  
Massimo Bongiovanni

“Small-cell malignancies of thyroid” is an unsolved dilemma. This term represents an umbrella terminology in thyroid, encompassing for a small group of tumors in which some of them are well-recognized tumors like medullary thyroid carcinoma, poorly differentiated thyroid carcinoma, and primary thyroid lymphomas and teratoma, whereas the remaining are less known as primary neuroendocrine carcinoma of thyroid, primary extraskeletal Ewing family tumors, and adamantinoma-like Ewing sarcoma. When the issue comes to evaluate a cytological sample predominantly composed of small-cell morphology, metastatic small-cell carcinomas to thyroid also should be excluded. In this review, our group focused on the main cytomorphological and clinical clues of each entity that help to set up a correct differential diagnosis. The literature discussions were also included for the entities that are not yet recognized by the mother publication WHO. A key point of the issue’s simple algorithm based on FNAC with small-cell morphology of thyroid was suggested by the authors.


Cureus ◽  
2022 ◽  
Author(s):  
Reza Pishdad ◽  
Mona Vahidi Rad ◽  
Lissette Cespedes

2022 ◽  
Author(s):  
Stéphane Bardet ◽  
Renaud Ciappuccini ◽  
Livia Lamartina ◽  
Sophie Leboulleux

Introduction: Serum calcitonin (CT) and carcinoembryonic antigen (CEA) are valuable tumour markers in patients with medullary thyroid carcinoma (MTC). Both markers most often evolve in parallel after treatment. Selpercatinib (LOXO-292) is a highly selective RET kinase inhibitor indicated in advanced RET-mutant MTC patients. Case presentation: We report two observations of RET-mutant progressive metastatic and symptomatic MTC patients who were treated with selpercatinib. Patient 1, a 61-year-old man, presented dyspnoea and diarrhoea at selpercatinib initiation with large neck lymph nodes and lung metastases. Patient 2, a 76-year-old man, had acute discomfort with flush and diarrhoea, with small but diffuse bone and liver disease. Both patients had an objective response with rapid clinical improvement and RECIST 1.1 response (-90%) in patient 1. A rapid dramatic decrease in CT level was observed in both patients (-99% in both patients) while CEA levels gradually and sustainably increased after selpercatinib initiation (+207% at cycle 15 in patient 1 and + 835% at cycle 14 in patient 2). In both patients, FDG PET/CT did not show any abnormal uptake that could explain the CEA increase. Colonoscopy and oesogastric fibroscopy showed colonic polyposis with mild oesophagitis and gastritis in patient 1 and were normal in patient 2. Conclusion: These observations show an unusual and lasting increase in serum CEA in two MTC patients who exhibited an objective tumour response to selpercatinib. The mechanism behind this unexpected rise in CEA level remains unknown. The frequency of this evolving profile will be determined in further phase III studies.


2021 ◽  
Vol 10 (2) ◽  
pp. 13-18
Author(s):  
Hiroko Kawamura ◽  
Hiroki Yamane ◽  
Rui Mizuno ◽  
Kotomi Sawa ◽  
Sawako Mitani ◽  
...  

Author(s):  
Oleh Duda ◽  
◽  
Nina Boyko ◽  
Roman Slipetsky ◽  
◽  
...  

Introduction. Medullary thyroid cancer (MTC) belongs to a class of rare neuroendocrine aggressive tumors and arises from parafollicular cells (C-cells). An important modern problem is the development of ways to predict the recurrence of this disease. The aim of the study is to determine the role of immunohistochemical tumor markers of medullary thyroid cancer in predicting recurrence or death. Materials and methods. The analysis of the prospective study included 22 patients with MTC, 5 of whom have developed a recurrence and 4 have died at the end of the 10-year (120 months) follow-up period. Immunohistochemical examinations were performed using monoclonal antibodies of tumor markers calcitonin, chromogranin A, vimentin and Ki-67. Results. The discrepancy between the data of histological and immunohistochemical examinations in MTC is 12.0%, which indicates the hyperdiagnosis of this nosology and argues the importance of performing immunohistochemical examinations to verify the diagnosis. Patients who had a recurrence of MTC had significantly (p <0.05) lower levels of calcitonin expression (5.00 [5.00; 5.00] points) compared with patients who did not relapse, where this figure was 6.00 [6.00; 7.00] points. In patients with MTC, an increase in calcitonin expression was significantly associated with an increase in chromogranin A expression (r = + 0.49, p = 0.02); a similar relationship was found for the proportions of immunopositive cells of these tumor markers: r = + 0.68, p = 0.001. At the same time, it was found that the increase in the level of calcitonin expression was apparently combined with the decrease in the level of Ki-67 expression (r = -0.52, p = 0.02). It was also found that the increase in the level of vimentin expression is combined with an increase in the expression (r = + 0.64, p = 0.001) and the proportion of immunopositive cells of chromogranin A (r = + 0.45, p = 0.038). Conclusions. Low levels of calcitonin expression are prognostically unfavorable markers for the recurrence of MTC. Specific tumor markers are important in the treatment process and for the dynamic monitoring of patients with MTC.


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