Mixed Medullary Papillary Thyroid Carcinoma in Hyperfunctioning Hot Nodule: A Case Report and Review of the Literature

Authors

  • B. Raggiunti Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • A. Franchi Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • V. Congedo Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • S. Filipponi Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • G. Fiore Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • G. Raggiunti Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • D. Tina Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • A. Mongia Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • A. Rufo Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • F.A. Ruggieri Endocrinology Unit, “S. Liberatore” Hospital of Atri - ASL Teramo, Italy
  • D. Di Michele Department of Internal Medicine, “G. Mazzini” Hospital of Teramo, ASL Teramo, Abruzzo, Italy

DOI:

https://doi.org/10.6000/1927-7229.2014.03.03.7

Keywords:

Mixed medullary papillary carcinoma, calcitonin, hyperfunctioning thyroid nodule, thyroid ultrasound, fine needle aspiration, thyroidectomy.

Abstract

 Mixed medullary papillary carcinoma (MMPC) is a rare variant of papillary thyroid carcinoma, according to the WHO classification and it presents as a single lesion histologically composed of two distinct and intermingled neoplastic cell patterns. The histogenesis is still debatable. The lymph node metastases are usually present at the time of the diagnosis and distal metastases may appear late during follow-up. At least 13 similar lesions have been reported in the literature. We describe the case of a 61-year-old woman with a mixed medullary papillary carcinoma found in a hyperfunctioning thyroid nodule and negative pre-surgical serum calcitonin. After surgery, the patient started suppressive L-thyroxine therapy and underwent radioiodine ablation. The follow-up for both papillary and medullary components has shown no signs of persistence or recurrence of disease five years after surgery. However, the rarity of the MMPCs makes the management and the prognosis of these tumors still unclear.

References

Sizemore GW. Medullary carcinoma of the thyroid gland. Seminars in Oncology 1987; 14: 306-314.

Hedinger C, Williams ED, Sobin LH. The WHO classification of thyroid tumors: a commentary to second edition. Cancer 1989; 63: 908-911. http://dx.doi.org/10.1002/1097-0142(19890301)63:5<908::AID-CNCR2820630520>3.0.CO;2-I

Eszlinger M, Krohn K, Hauptmann S, Dralle H, Giordano TJ, Paschke R. Perspectives for improved and more accurate classification of thyroid epithelial tumors. J Clin Endocrinol Metab 2008; 93 (9): 3286-3294. http://dx.doi.org/10.1210/jc.2008-0201

Lamberg BA, Reissel P, Stenman S, Ekblom A, Makinen J, Franssila K. Concurrent medullary and papillary thyroid carcinoma in the same thyroid lobe and in siblings. Acta Medica Scandinavica 1981; 209: 421-424. http://dx.doi.org/10.1111/j.0954-6820.1981.tb11620.x

Ishida T, Kawai T, Iino Y, Shinozaki K, Oowada S, Izuo M. Concurrent medullary carcinoma adjacent to papillary carcinoma of the thyroid - a clinicopathological and electron microscopic study. Gan No Rinsho 1985; 31: 1814-1820.

Gero MJ, Lipper S, Chernys AE, Silver L. Medullary and papillary carcinomas occurring as a collision tumor: report of a case. Clinics in Nuclear Medicine1989; 14: 171-174. http://dx.doi.org/10.1097/00003072-198903000-00006

Gonzalez-Campora R, Lopez-Garrido J, Martin-Lacave I,Miralles-Sanchez EJ, Villar JL. Concurrence of a symptomatic encapsulated follicular carcinoma, an occult papillary carcinoma and a medullary carcinoma in the same patient. Histopathology 1992; 21: 380-382. http://dx.doi.org/10.1111/j.1365-2559.1992.tb00412.x

Darwish A, Satir AA, Hameed T, Malik S, Aqel N. Simultaneous medullary carcinoma, occult papillary carcinoma and lymphocytic thyroiditis. Malaysian Journal of Pathology 1995; 17: 103-107.

Kobayashi K, Teramoto S, Maeta H, Ishiguro S, Mori T, Horie Y. Simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid. Journal of Surgical Oncology 1995; 59: 276-279. http://dx.doi.org/10.1002/jso.2930590416

Meinhard K, Michailov I. Simultaneous occurrence of medullary and papillary carcinoma in the same thyroid lobe. Zentralblatt fu¨r Pathologie 1995; 140: 459-464.

Pastolero GC, Coire CI, Asa SL. Concurrent medullary and papillary carcinomas of thyroid with lymph node metastases. A collision phenomenon. American Journal of Surgical Pathology 1996; 20: 245-250. http://dx.doi.org/10.1097/00000478-199602000-00014

Tseleni-Balafouta S, Grigorakis SI, Alevizaki M, Karaiskos C, Davaris P, Koutras DA. Simultaneous occurrence of a medullary and a papillary thyroid carcinoma in the same patient. General Diagnostic Pathology 1997; 142: 371-374.

Mazziotti G, Rotondi M, Manganella G, Franco R, Capone PFRS, Colantuoni V, Amato G, Carell,C. Medullary thyroid cancer, papillary thyroid microcarcinoma and Graves’ disease: an unusual clinical coexistence. Journal of Endocrinological Investigation 2001; 24: 892-896. http://dx.doi.org/10.1007/BF03343948

Seki T, Kameyama K, Hayashi H, Nagahama M, Masudo K, Fukunari N, Tanaka K, Sugino K, Ito K, Takami H. Composite metastatic carcinoma in lymph nodes of patients with concurrent medullary and papillary thyroid carcinoma: a report of two cases. Endocrine Pathology 2004; 15: 83-88. http://dx.doi.org/10.1385/EP:15:1:83

Meshikhes AW, Tingura M, Al-Saeed JY. Concurrent papillary and medullary thyroid carcinomas with mixed metastases to lymph nodes. Saudi Medical Journal 2004; 25 (3): 373-375.

Rossi S, Fugazzola L, De Pasquale L, Braidotti P, Cirello V, Beck-Peccoz P, Bosari S and Bastagli A. Medullary and papillary carcinoma of the thyroid gland occurring as a collision tumour: report of three cases with molecular analysis and review of the literature Endocrine-Related Cancer 2005; 12: 281-289. http://dx.doi.org/10.1677/erc.1.00901

Adnan Z, Arad E, Dana J, Shendler Y, Baron E. Simultaneous occurrence of medullary and papillary thyroid microcarcinomas: a case series and review of the literature. Journal of Medical Case Reports, 2013 21; 7:26.

Papotti M, Negro F, Carney JA, BussolatiG, LloydRV. Mixed medullary-follicular carcinoma of the thyroid. A morphological, immunohistochemical and in situ hybridization analysis of 11 cases. Virchows Archiv 1997; 430: 397-405. http://dx.doi.org/10.1007/s004280050049

Dionigi G, Castano P, Bertolini V, Boni L, Rovera F, Tanda ML, Capella C, Bartalena L and Dionigi R. Simultaneous medullary and papillary thyroid cancer: two case reports Journal of Medical Case Reports 2007; 1: 133. http://dx.doi.org/10.1186/1752-1947-1-133

Albores-Saavedra J, Gorraez de la Mora T, de la Torre-Rendon F, Gould E. Mixed medullary-papillary carcinoma of the thyroid: a previously unrecognized variant of thyroid carcinoma. Hum Pathol 1990; 21 (11): 1151-5. http://dx.doi.org/10.1016/0046-8177(90)90152-U

Lax SF, Beham A, Kronberger SD, Langsteger W, Denk H. Coexistence of papillary and medullary carcinoma of the thyroid gland-mixed or collision tumour? Clinicopathological analysis of three cases. Virchows Arch 1994; 424: 441-447. http://dx.doi.org/10.1007/BF00190568

Apel RL, Alpert LC, Rizzo A, LiVolsi VA, Asa SL. A metastasizing composite carcinoma of the thyroid with distinct medullary and papillary components. Archives of Pathology, Laboratory Medicine 1994; 118: 1143-1147.

Macák J, Vaverková H, Dushová M, Perglerová I. Medullary and mixed medullary-papillary carcinoma of the thyroid gland. Pathologica1997; 89 (3): 317-322.

Shiroko T, Yokoo N, Okamoto K, Kitakado Y, Azuma H, Fukui T, Tanaka C. Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case Surgery Today 2001; 31 (4): 317-321. http://dx.doi.org/10.1007/s005950170151

Nangue C, Bron L, Portmann L, Volante M, Ris HB, Monnier P, Andrejevic-Blant S. Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature Head Neck 2009; 31 (7): 968-974. http://dx.doi.org/10.1002/hed.20984

Hasney CP, Amedee RG. Mixed medullary-papillary carcinoma of the thyroid: a case report. Laryngoscope 2010; 120 Suppl 4: S153. http://dx.doi.org/10.1002/lary.21617

Zoroquiain P, Torres J, Goñi I, Fernández L. True mixed medullary papillary carcinoma of the thyroid: a case report with low blood calcitonin levels. Endocrine Pathology 2012; 23: 168-171. http://dx.doi.org/10.1007/s12022-012-9217-8

Kataria K, Yadav R, Sarkar C, Karak AK. Simultaneous medullary carcinoma, papillary carcinoma and granulomatous inflammation of the thyroid. Singapore Medical Journal 2013; 54 (7): e146-148. http://dx.doi.org/10.11622/smedj.2013115

Volante M, Papotti M, Roth J, Saremaslani P, Speel EJM, Lloyd RV, Carnei AJ, Heitz PhU, Bussolati G, Komminoth P. Mixed medullary-follicular thyroid carcinoma. Molecular evidence for a dual origin of tumor components. American Journal of Pathology 1999; 155:1499-1509. http://dx.doi.org/10.1016/S0002-9440(10)65465-X

Zhang P, Zuo H, Ozaki T, Nakagomi N, Kakudo K. Cancer stem cell hypothesis in thyroid cancer. Pathology International 2006; 56: 485-489. http://dx.doi.org/10.1111/j.1440-1827.2006.01995.x

Fugazzola L, Cerutti N, Mannavola D, Ghilardi G, Alberti L, Romoli R, Beck-Peccoz P. Multigenerational familial medullary thyroid cancer (FMTC): evidence for FMTC phenocopies and association with papillary thyroid cancer. Clinical Endocrinology 2002; 56: 53-63. http://dx.doi.org/10.1046/j.0300-0664.2001.01434.x

Brauckhoff M, Gimm O, Hinze R, Ukkat J, Brauckhoff K, Dralle H. Papillary thyroid carcinoma in patients with RET proto-oncogene germline mutation. Thyroid 2002; 12: 557-561. http://dx.doi.org/10.1089/105072502320288393

Papi G, Corrado S, Pomponi MG, Carapezzi C, Cesinaro A, LiVolsi V. Concurrent lymph node metastases of medullary and papillary thyroid carcinoma in a case with RET oncogene germline mutation. Endocrine Pathology 2003; 14: 269-276. http://dx.doi.org/10.1007/s12022-003-0020-4

Noel M, Delehaye MC, Segond N, Segond N, Lasmoles F, Caillou B, Gardet P, Fragu Ph, Moukhtar MS. Study of calcitonin and thyroglobulin gene expression in human mixed follicular and medullary thyroid carcinoma. Thyroid 1991; 1: 249-256. http://dx.doi.org/10.1089/thy.1991.1.249

Papotti M, Volante M, Komminoth P, Sobrinho-Simoes M, Bussolati G. Thyroid carcinomas with mixed follicular and C-cell differentiation patterns. Seminars in Diagnostic Pathology 2000; 17: 109-119.

Giacomelli L, Guerriero G, Falvo L, Altomare V, Chiesa C, Ferri S, Stio F. Simultaneous occurrence of medullary carcinoma and papillary microcarcinoma of thyroid in a patient with MEN 2A syndrome. report of a case. Tumori 2007; 93 (1): 109-111.

Kovacs CS, Mase RM, Kovacs K, Nguyen GK, Chik CL. Thyroid medullary carcinoma with thyroglobulin immunoreactivity in sporadic multiple endocrine neoplasia type 2-B. Cancer 1994; 74: 928-932. http://dx.doi.org/10.1002/1097-0142(19940801)74:3<928::AID-CNCR2820740321>3.0.CO;2-E

Mizukami Y, Nonomura A, Michigishi T, Noguchi M, Ishizaki T. Mixed medullary-follicular carcinoma of the thyroid gland: a clinicopathologic variant of medullary thyroid carcinoma. Modern Pathology 1996; 9: 631-635.

Piciu D, Piciu A, F-18 FDG-PET-CT in the Diagnostic of a Late Medullary Thyroid Carcinoma Recurrence in a Patient with Follicular-Papillary Thyroid Cancer, Case Reports in Endocrinology 2014; 2014: 741262.

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Published

2014-08-03

How to Cite

B. Raggiunti, A. Franchi, V. Congedo, S. Filipponi, G. Fiore, G. Raggiunti, D. Tina, A. Mongia, A. Rufo, F.A. Ruggieri, & D. Di Michele. (2014). Mixed Medullary Papillary Thyroid Carcinoma in Hyperfunctioning Hot Nodule: A Case Report and Review of the Literature. Journal of Analytical Oncology, 3(3),  167–172. https://doi.org/10.6000/1927-7229.2014.03.03.7

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