title: Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature.
abstract: BACKGROUND
  Mixed medullary-follicular thyroid carcinoma denotes a rare and heterogeneous group of tumors displaying morphological and immunophenotypical features of both origins within the same lesion.
  
  
  METHODS
  We report a case of a 41-year-old woman with a lump in the right side of the neck, increasing in pain and size over several weeks. Serum levels of calcitonine (1140 ng/L) and carcinoembryonic antigen (288 microg/L) were very high. Fine-needle aspiration cytology suggested a diagnosis of medullary thyroid carcinoma. Total thyroidectomy, along with bilateral functional neck and mediastinal lymph-node dissection, were performed.
  
  
  RESULTS
  The histopathological examination yielded a diagnosis of medullary carcinoma in the right thyroid lobe, closely intermingled with a nonencapsulated classical papillary carcinoma. One ipsilateral lymph node showed micrometastasis of the medullary counterpart.
  
  
  CONCLUSIONS
  When compared with other cases reported in literature, this particular presentation should be recognized, if required, morphologic and functional criteria are used. The treatment is mostly surgical, driven by the medullary component. The presence of micrometastasis in 1 ipsilateral cervical lymph-node underlines the importance of cervicomediastinal lymph-node dissection and careful searching for metastatic disease.
authors.affiliation: Institute of Pathology, CHUV Hospital, University of Lausanne, Lausanne CH-1015, Switzerland. farzana.mahomed@nhls.ac.za
authors.forename: Charlette
authors.initials: C
authors.lastname: Nangue
authors.forename: Luc
authors.initials: L
authors.lastname: Bron
authors.forename: Luc
authors.initials: L
authors.lastname: Portmann
authors.forename: Marco
authors.initials: M
authors.lastname: Volante
authors.forename: Hans-Beat
authors.initials: HB
authors.lastname: Ris
authors.forename: Philippe
authors.initials: P
authors.lastname: Monnier
authors.forename: Snezana
authors.initials: S
authors.lastname: Andrejevic-Blant
mesh_terms: D000328:Adult; D018276:Carcinoma, Medullary / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D018198:Mixed Tumor, Malignant / Q000473:pathology* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy