Journal List > Korean J Endocr Surg > v.15(1) > 1060139

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

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.

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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.
kjes-15-15f1.tif
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.
kjes-15-15f2.tif
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).
kjes-15-15f3.tif
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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