title: Concurrent Medullary, Papillary, and Follicular Thyroid Carcinomas and Simultaneous Cushing's Syndrome.
abstract: BACKGROUND
  Papillary thyroid carcinoma is the most common thyroid cancer (85%). Follicular thyroid carcinoma is the second most common type of thyroid cancer, accounting for up to 10% of all thyroid cancers. Medullary thyroid carcinoma accounts for only 5-8% of thyroid cancers. Concurrent medullary, follicular, and papillary carcinomas of the thyroid gland are extremely rare and reported scarcely.
  
  
  METHODS
  A 72-year-old male presented with nonspecific neck pain. The workup revealed a nodular thyroid gland with a follicular lesion on fine-needle aspiration. Total thyroidectomy was performed and pathological examination identified a 25-mm follicular carcinoma, two papillary microcarcinomas, and two medullary microcarcinomas. The genetic workup was negative and no other family members were diagnosed with any endocrinopathy. Two months after surgery, the patient was diagnosed with Cushing's syndrome that was treated with laparoscopic left adrenalectomy. On 3-year follow-up, the patient is asymptomatic with no evidence of recurrent disease.
  
  
  CONCLUSIONS
  We present a rare case of a patient with follicular, papillary, and medullary thyroid carcinoma, and Cushing's syndrome. To date, no known genetic mutation or syndrome can account for this combination of neoplastic thyroid and adrenal pathologies, although future research may prove differently.
authors.affiliation: Department of SurgeryEndocrinology and Metabolism Service Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Haggi
authors.initials: H
authors.lastname: Mazeh
authors.affiliation: Department of SurgeryEndocrinology and Metabolism Service Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Orlev
authors.affiliation: Department of SurgeryEndocrinology and Metabolism Service Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Mizrahi
authors.affiliation: Endocrinology and Metabolism Service Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gross
authors.affiliation: Department of SurgeryEndocrinology and Metabolism Service Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Herbert R
authors.initials: HR
authors.lastname: Freund
keywords: Cushing's syndrome; Follicular carcinoma; Medullary carcinoma; Papillary carcinoma; Thyroid