title: Synchronous occurrence of medullary and papillary carcinoma of the thyroid in a patient with cutaneous melanoma: determination of BRAFV600E in peripheral blood and tissues. Report of a case and review of the literature.
abstract: The purpose of this study is to describe a case of concurrent medullary and papillary thyroid carcinoma (MTC and PTC) and cutaneous melanoma and to analyze BRAF(V600E) mutation in plasma and tissues. We report the clinical history and the laboratory, imaging, and histopathological findings of a 47-year-old man affected by multinodular goiter. BRAF(V600E)-mutated DNA was quantified in plasma samples and in cancer sections by quantitative real-time polymerase chain reaction (qPCR). At ultrasound examination, the dominant right nodule of the thyroid was weakly hyperechoic and hypervascularized, while the left one was hypoechoic without internal vascularization. Regional lymphadenomegalia was not detected. Basal plasma calcitonin was elevated, and the patient underwent total thyroidectomy and resection of central cervical lymph nodes. Histopathological examination identified two distinct foci of MTC and PTC and micrometastasis of well-differentiated carcinoma in one of the six resected lymph nodes. RET proto-oncogene germline mutations were not detected. Cutaneous melanoma of the thorax was subsequently diagnosed. BRAF(V600E) tissue DNA was detected in PTC and melanoma but not in MTC. The cell-free plasma percentage of BRAF(V600E) DNA was detected in pre-thyroidectomy peripheral blood and was drastically reduced after cancer treatments. This study confirms the occurrence of synchronous MTC and PTC and is the first evidence of the co-existence of melanoma and distinct thyroid cancers of different origin. BRAF(V600E) allele was detected in PTC and melanoma but not in MTC tissues. BRAF(V600E) molecular quantification in pre- and post-treatment blood supports our previous data, suggesting its possible role in diagnosis and follow-up of BRAF-positive tumors.
authors.affiliation: Endocrinology Unit, Careggi Hospital and University of Florence, Florence, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Fibbi
authors.forename: Pamela
authors.initials: P
authors.lastname: Pinzani
authors.forename: Francesca
authors.initials: F
authors.lastname: Salvianti
authors.forename: Matteo
authors.initials: M
authors.lastname: Rossi
authors.forename: Luisa
authors.initials: L
authors.lastname: Petrone
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: De Feo
authors.forename: Roberto
authors.initials: R
authors.lastname: Panconesi
authors.forename: Vania
authors.initials: V
authors.lastname: Vezzosi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Bianchi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Simontacchi
authors.forename: Monica
authors.initials: M
authors.lastname: Mangoni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pertici
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.forename: Cinzia
authors.initials: C
authors.lastname: Pupilli
mesh_terms: D000483:Alleles; D018276:Carcinoma, Medullary / Q000235:genetics / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000235:genetics / Q000473:pathology*; D004252:DNA Mutational Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009378:Neoplasms, Multiple Primary / Q000235:genetics / Q000473:pathology*; D000090063:Proto-Oncogene Mas; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D013961:Thyroid Gland / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000235:genetics / Q000473:pathology*
chemical_list: C000715470:MAS1 protein, human; D000090063:Proto-Oncogene Mas; D048493:Proto-Oncogene Proteins B-raf