Clinical and morphological characterization of C cell hyperplastic and neoplastic lesions of thyroid
F. Lugli, A. Fusco, A. Bianchi, D. Milardi, V. Cimino, S. Piacentini, M. Celico, P. Lanza, M. Raffaelli, C. Lombardi, G. Fadda, R. Bellantone, A. Pontecorvi, G. Rindi & L. De Marinis
Introduction: Medullary thyroid carcinoma (MTC) and C cell hyperplasia (CCH) have a variable clinical presentation and prognosis and few data are available on the correlation between immunohistochemical characterization (IIC) and clinical behavior.
Aim: We studied the clinical and morphological characterization of CCH and MTC and we evaluated IIC expression of PTTG-1, SSTR2A, VEGFR-1, VEGFR-2 and VEGFR-3 in 23 cases of CCH and/or MTC, correlating it with clinical features
Material and methods: 23 patients, affected by CCH and/or MTC, were included from 1990 to 2010. All patients underwent total thyroidectomy, pre and post operative serum calcitonin assay, staging, histological examination with immunohistochemical evaluation of PTTG, SSTR2A, VEGFR-1, VEGFR-2 and VEGFR-3 expression and 18 of them were tested for RET mutations.
Results: After surgery 3 cases presented only CCH and 10 cases had lymph node metastases (N+) and during follow-up 7 patients (all N+) were considered uncured. PTTG and VEGFR-1 were significantly overexpressed in lympho node metastatic and uncured patients. VEGFR-2 was not much expressed in all of patients, while VEGFR-3 and STTR2A were strongly expressed in about all of patients. Four cases were familiar (2 MEN2B, 1 MEN2A and 1 FMTC).
Conclusions: Our data suggest that PTTG-1 and VEGFR-1 seem related with a poor prognosis, while the expression of VEGFR-3 and SSTR2 in all patients confirms the key role of IIC evaluation for the therapeutic approach of these patients. Finally, a more complete IIC evaluation with new markers can be useful for diagnosis, prognosis and therapy of MTC.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.