Session: SAT 414-428-Thyroid Neoplasia & Case Reports
Poster Board SAT-423
Background: Differentiated thyroid cancer is the commonest cancer affecting thyroid gland. Medullary thyroid carcinoma (MTC) constitutes 2-8% of all thyroid cancers. Simultaneous occurrence of mixed medullary and follicular thyroid carcinoma (mixed MTC-FTC) is a rare finding that poses challenges in diagnosis, treatment, follow up and future prediction of prognosis.
Clinical case: A 28 -year-old Emirati lady who presented with a neck swelling that increased in size over 2 months period. She was clinically and biochemically euthyroid. 99m Tc04 Thyroid scan showed a cold nodule in the right lobe of thyroid. Ultrasound thyroid confirmed the presence of hypoechoic well defined lesion. Fine needle aspiration biopsy (FNAB) revealed a medullary thyroid cancer. Following total thyroidectomy and lymph node dissection the histopathology showed a solitary tumour with mixed features, predominantly medullary with areas of follicular architecture, confirmed by immunohistochemical staining as mixed MTC-FTC. Work up for MEN II and RET-proto-oncogen was negative. 99m Tc (04) Thyroid scan postoperatively showed an increased uptake in the remnant thyroid tissue. She was treated with adjuvant radioactive iodine therapy. Her initial calcitonin level post operatively was 13.4pg/ml (NR < 5.0), CEA 36ng/ml (NR <3.8), and thyroglobulin was 0.7ng/ml (NR <1). On follow up visits, the thyroglobulin as well as calcitonin and CEA levels were suppressed. Follow up 99m Tc 04 thyroid scan and I131 scan were normal.
Conclusion: This case presents a challenge in management. We treated her surgically as well as radioactive iodine. Follow up with calcitonin and thyroglobulin did not show any evidence of recurrence. We recommend including mixed tumors in thyroid cancer management guidelines.
MTC: Medullary Thyroid Cancer
FTC: Follicular Thyroid Cancer
RAI: Radioactive Iodine
ATG: Anti-thyroglobulin Antibodies.
FMTC: Familial medullary thyroid cancer
MEN: Multiple Endocrine Neoplasias
Nothing to Disclose: AB, FFA, MA, FR, SD
*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm
See more of: Abstracts - Orals, Featured Poster Presentations, and Posters