Abstract
Mixed medullary and follicular or papillary carcinoma of thyroid is an extremely rare tumor, characterized by coexistence of morphological and immunohistochemical features of both medullary carcinoma and follicular (or papillary) carcinoma. This case report describes for the first time in the indexed database a late recurrence of a medullary thyroid carcinoma initially diagnosed as follicular-papillary form, treated and monitored accordingly. After 14 years, a superior mediastinum tumor was discovered incidentally at a thorax computer tomography. The whole-body I-131 scan was negative and F-18 FDG-PET-CT showed glucose avidity of the tumor. The patient was operated on and the histology revealed medullary thyroid carcinoma. If there are no possibilities to have routinely extensive immunohistologic profiles, it is recommended to check the serum calcitonin, at least in any patient with confirmed thyroid carcinoma.
Highlights
Thyroid carcinoma is the most frequent endocrine cancer, accounting for about 5% of thyroid nodules [1] with a general incidence reported to be between 1.2 and 3.8 100.000 inhabitants [2, 3]
He was submitted to total thyroidectomy, with selective right lymphadenectomy for a follicular-papillary thyroid carcinoma with right cervical lymph nodes metastasis, T3N1 M0, stage III, according to the TNM of the moment [17]
The patient was followed up all the time in the same department, according to the procedure applied for differentiated thyroid carcinoma: clinical exam, thyroid and neck ultrasound, and either by thyroid hormone withholding or by 2 I.M. injections of recombinant thyroid-stimulating hormone (TSH) he was checked for the specific thyroid tumor markers: TSH > 40 mIU/L, the serum value of Tg < 0.1 ng/mL (N.V. < 0.1 ng/mL), and anti-Tg < 10 kIU/L (N.V. < 141 kIU/L)
Summary
Thyroid carcinoma is the most frequent endocrine cancer, accounting for about 5% of thyroid nodules [1] with a general incidence reported to be between 1.2 and 3.8 100.000 inhabitants [2, 3]. The differentiated thyroid cancers represent about 80% of all thyroid cancers [2], with a good prognosis [4, 5], while medullary, respectively, anaplastic forms, with considerable lower incidences [1, 6,7,8,9], have an aggressive evolution, frequently very severe and fast. Considered rare among human malignancies, the thyroid carcinoma has a very important increasing incidence in the last 10 years [3, 16], reported by studies from all over the world, with the fact that requires a new approach regarding the management of this pathology and special attention to the unusual or more aggressive forms
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