Medullary thyroid cancer, papillary thyroid microcarcinoma and Graves' disease: an unusual clinical coexistence.
We describe the unusual case of a Caucasian woman who had a diagnosis of medullary thyroid cancer and papillary microcarcinoma 5 years after a diagnosis of Graves' disease. The patient came to our observation for recurrence of hyperthyroidism. An ultrasound scan revealed diffuse thyroid enlargement with a nodule, recently increased in size. The serum CT and carcinoembrional antigen were elevated, and the fine-needle aspiration cytology with immunocytochemical analysis for CT was suggestive for medullary thyroid carcinoma. The nodular lesion showed intense 111In-pentetreotide uptake, whereas total body scintigraphy with the same tracer and with Thallium-201, 99mTc (V) dimercaptosuccinic acid was negative for lymph node and distant metastasis. The histological examination of thyroidectomy specimens confirmed the diagnosis of medullary thyroid cancer, showing a lymphocytic intratumoral infiltration. The histological analysis of the controlateral lobe showed an occult papillary microcarcinoma. Medullary thyroid carcinoma and papillary microcarcinoma showed intense staining with policlonal anti-RET antibodies, although genetic analysis was negative for RET mutations most frequently involved in familial and sporadic medullary thyroid carcinomas. Possible implications about the coexistence of the 3 thyroid diseases are discussed.
Mazziotti
G
G
Endocrinology Institute, Second University of Naples, Italy.
Rotondi
M
M
Manganella
G
G
Franco
R
R
Capone PFRS
Colantuoni
V
V
Amato
G
G
Carella
C
C
D000328:Adult; D018276:Carcinoma, Medullary / Q000150:complications*; D002291:Carcinoma, Papillary / Q000150:complications*; D005260:Female; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D009378:Neoplasms, Multiple Primary / Q000150:complications; D013964:Thyroid Neoplasms / Q000150:complications*