[Diagnosis and treatment of the precancer state in hereditary medullary thyroid carcinoma].
We attempted to elucidate the diagnosis and treatment in 11 patients with hereditary medullary thyroid carcinoma which were inherited as autosomal dominant traits. The oncogens are thought to be supported by the two-mutational event theory; the C cell hyperplasia, the first step, is the expression of the genetic mutation, which requires a subsequent somatic mutation to transform the initially mutated cell into a cancer cell. The C-cell hyperplasia was thought to be precancer state. The definitive diagnosis was established by measurement of calcitonin and CEA levels in sera. In patients with normal levels of calcitonin and CEA, the provocative test (Ca-gluconate plus pentagastrin) was useful such as in pt. no. 11,K.N.). The principle of surgery is total thyroidectomy because of multicentric occurrence in both lobes. Two patients (pt nos. 10, 11) with normal postoperative levels of provocative test underwent total thyroidectomy.
Takami
H
H
1st Dept. of Surgery, Teikyo University School of Medicine, Tokyo.
Shikata
J
J
Kakudo
K
K
Yashiro
T
T
Ito
K
K
D000328:Adult; D000368:Aged; D002116:Calcitonin / Q000097:blood; D002125:Calcium Gluconate; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002277:Carcinoma / Q000235:genetics*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010418:Pentagastrin; D011230:Precancerous Conditions / Q000175:diagnosis / Q000235:genetics* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000235:genetics*
D002272:Carcinoembryonic Antigen; D002116:Calcitonin; D010418:Pentagastrin; D002125:Calcium Gluconate