Background: The most reliable biochemical markers in the follow-up of medullary thyroid carcinoma (MTC) are serum calcitonin (CAL) and carcinoembrional antigen (CEA).
Case: A 82 years male presented with rapidly growing neck tumour in April 2008. The patient underwent total thyroidectomy with lymph node dissection (June 2008). The pathology revealed MTC localized only in the left lobe (pT3NoMx), the immunohistology showed CAL-, synaptophysin, chromogranin- and p53 positivity. His CEA 1.7 ng/ml and CAL 2.19 pg/ml levels were normal (CEA 05, CAL 315). The peak CAL after calcium infusion test was 278 pg/ml (normal <244 pg/ml). January 2009: the postoperative octreoscan and CT showed no recurrent tumour or metastasis. February 2009: CAL (5.3 pg/ml) and CEA 1.7 ng/ml levels were normal. June 2009: acute myocardial infarct (with intraarterious stenting). August 2009: a recurrent tumour presented in the right upper side of the neck with multiple intrapulmonal metastases, but the CAL (7.48 pg/ml) and, CEA (1.7 ng/ml) (levels were normal again.). September 2009: severe anemia with occult gastrointestinal haemorrhage presented. Adenocarcinoma of the colon was diagnosed. October 2009: hemicolectomy and neck lymphnode metastases dissection were carried out. Adenocarcinoma of the prostate was also detected. December 2009: a recurrent tumour of the neck was found but despite of the positive metaiodobenzylguanidine (MIBG) scan, the MIBG treatment was unsuccessful. External irradiation of the neck was done, followed by capecitabine (Xeloda) therapy, only with partial and transient response. After almost 3 years of the diagnosis the patient is still in satisfactory condition.
Conclusions: The unusual case highlights the importance the detection of possible early metastases despite of normal CAL and CEA levels. Our case confirms that MTC sometimes does not secrete CT or CEA. The disease progression can be delayed with capecitabine and irradiation.
Supported by: OTKA grant K68660
30 Apr - 04 May 2011
European Society of Endocrinology