Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy

Dong Hae Chung; Jae Yeon Seok; Yoo Seung Chung; Eun Mee Oh; Jung Won Ryu; Young Don Lee

doi:10.16956/kjes.2015.15.1.15

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Chung, Seok, Chung, Oh, Ryu, and Lee: Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy

Case Report

Korean J Endocrine Surg 2015;15(1):15-19.

Published online: 10 December 2015

DOI: https://doi.org/10.16956/kjes.2015.15.1.15

Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy

Dong Hae Chung, Jae Yeon Seok, Yoo Seung Chung¹, Eun Mee Oh¹, Jung Won Ryu¹, Young Don Lee¹

Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea

¹Department Surgery, Gachon University Gil Medical Center, Incheon, Korea

Correspondence: Yoo Seung Chung Department of Surgery, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea Tel: ＋82-32-460-3244 Fax: ＋82-32-460-3247 e-mail: dryooseung@gilhospital.com

Received 19 November 2014 Revised 12 December 2014 Accepted 29 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

On ultrasonography, medullary thyroid carcinoma (MTC) shows hypoechogenicity, an irregular margin, a predominantly solid composition, and microcalcifications, similar to those observed in papillary thyroid carcinoma (PTC). MTC presenting as a cystic lesion is rare, and endoscopic thyroidectomy can be performed for benign thyroid masses and early stage PTC, however it is inappropriate for MTC regardless of cystic change. The authors report a case of cystic MTC found after endoscopic thyroid lobectomy and provide a review of the literature on this topic.

Keywords: Medullary thyroid carcinoma, Thyroid cyst, Endoscopic thyroidectomy

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Fig. 1.

Transverse (A) and longitudinal (B) ultrasonographic views showing a 3.51×2.75×5.26 cm sized hypoechoic predominantly cystic lesion with incomplete septa occupying the entire left thyroid gland.

Fig. 2.

Left thyroid gland was easily separated from strap muscle during endoscopic thyroidectomy using BABA. On palpation, the left thyroid gland was soft and smooth after removal using an endoscopic plastic bag via a right areolar incision.

Fig. 3.

Photographs of medullary thyroid carcinoma showing prominent cystic change. (A) Low power view showing a large cystic space in the center and in the solid portion at the periphery of the tumor (H&E, ×10). (B) In the solid portion, cystic change with hemorrhage and aggregation of hemosiderin-laden macrophages was noted (H&E, ×100). (C) High power view showing solid sheets of uniform tumor cells. Note the prominent vasculature and focal amyloid deposition (arrow) (H&E ×400). (D) Tumor cells were positive for calcitonin (immunostain, ×400).

Table 1.

Clinicopathologic features of medullary thyroid carcinoma with prominent cystic change

No.	Author	Year	Age/Sex	MEN	Size (cm)	Aspiration cytology	Operation	LNM
1	Simcic(9)	1995	29/F	NA	6.0	No malignancy	ST→CT w LND	No
2 3	Simcic(9) Liberatore(10)	1995 1996	38/M 55/F	NA No	1.5 2.5	Non diagnostic Not done	TT w LND L→CT w LND	No
4	Fadda(11)	2000	77/F	No	3.5	MTC	TT w LND	No
5	Ozkara(12)	2002	43/F	No	6.0	Nodular colloidal goiter	NT	NA
6	Kim(13)	2012	50/M	NA	3.0	Suspicious for MTC	TT w LND	No
7	Present case	2014	32/F	No	5.0	Cystic change lesion	L→CT w LND	No

F = female; M = male; MEN = multiple endocrine neoplasia; NA = not available; MTC = medullary thyroid carcinoma; ST = subtotal thyroidectomy; CT = complete thyroidectomy; w = with; LND = lymph node dissection; TT = total thyroidectomy; L = lobectomy; NT = near total thyroidectomy; LNM = lymph node metastasis.

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