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Abstract
The origin of medullary thyroid carcinoma and papillary thyroid carcinoma are embryogenically different, so these tumors have been thought to be independent of each other. We experienced a case of concurrent medullary and papillary thyroid carcinoma in one patient. The patient underwent total thyroidectomy and both two tumors were located at different lobes, respectively. Both tumors showed their own characteristic pathologic and immunohistochemical findings. The patient's elevated calcitonin level returned to the normal range after operation and there has been no evidence of recurrence. It is still controversial whether the concurrency is just coincidental or it arises from activation of a common tumorigenic pathway.
Figures and Tables
Fig. 1
Ultrasonographic finding showed 0.8 × 1.3 cm hypoechoic nodule in right lobe (A) and 2.9 × 2.1 cm hypoechoic nodule with lobulated margin in left lobe (B). Computed tomography scan showed 1.0 cm sized enhancing nodule in right lobe (C), and 2.0 × 2.4 cm hypodense enhancing mass was noted in left lobe (D).
Fig. 2
Fine needle aspiration cytology (FNAC) of left thyroid nodule showed moderate cellularity with papillary fronds and the nuclei show characteristic grooves and pseudo inclusions, diagnostic of papillary carcinoma (A: H&E, ×100 B: papinicolou ×400).
FNAC of right thyroid nodule showed moderately cellularity. The cells were loosely aggregated as individual cells with abundant amphophilic cytoplasm of irregular shape. Some cells showed plasmacytoid appearance. Medullary carcinoma could be diagnosed (C: H&E ×100, D: papinicolou ×100).
Fig. 3
Macroscopically the right lobe had two relatively well demarcated masses, the largest one showing homogeneous pale brown cut surface. The left lobe also had mass lesion, which showed papillary appearance and cystic changes.
Fig. 4
Pathologic finding of left thyroid nodule showed typical pattern of papillary carcinoma with characteristic nucleic features (A: H&E, ×100 B: H&E, ×200). The tumor cells showed positive reaction for galectin-3 (C: × 200). Right thyroid nodule was composed of monotonous tumor cells with neuroendocrine granules in the cytoplasm of ill defined border (D: H&E ×200). The tumor cell showed positive reaction to calcitonin (E: ×200) and chromogranin (F: ×200).
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