Endocrine Abstracts (2017) 49 EP1400 | DOI: 10.1530/endoabs.49.EP1400

A case report: co-occurence of medullary thyroid carcinoma and papillary thyroid carcinoma

Beliz Camur1, Mehmet Celik2, Buket Yilmaz Bulbul2, Semra Ayturk2, Ebru Tastekin3, Nuray Can3, Atakan Sezer4, Funda Ustun5 & Sibel Guldiken2

1Trakya University, Medical Faculty, Department of Internal Medicine, Edirne, Turkey; 2Trakya University, Medical Faculty, Department of Endocrinology and Metabolism, Edirne, Turkey; 3Trakya University, Medical Faculty, Department of Pathology, Edirne, Turkey; 4Trakya University, Medical Faculty, Department of Surgery, Edirne, Turkey; 5Trakya University, Medical Faculty, Department of Nuclear Medicine, Edirne, Turkey.

Introduction: Co-occurence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same patient is unusual. We report a case with this rare event.

Case: A 39 year old woman was presented with cough and shortness of breath. She had no prior history of radiation exposure, cigarette or alcohol consumption and no family history of thyroid cancer. On physical examination, a 3x5 cm thyroid nodule was palpated in the middle portion of thyroid gland, which could be noticed after neck extention. Laboratory examination revealed calcitonin 348 pg/ml(n:0-10), CEA 12,39 mg/L (n: < 3,8 mg/L), FT3: 3,6 pg/mL (n: 1,71-3,81), FT4: 1,41 ng/dl (n:0,7-1,48), TSH:0,53 mlU/ml (n:0,35-4,94). Thyroid ultrasonografy examination demonstrated a hypoechogen 3*3*5 cm sized nodule invading thyroid gland. I131 thyroid uptake scintigraphy was negative and autoantibodies were also found to be negative. Cytologic examination of fine needle aspiration biopsy was suspicious for follicular neoplasia. Therefore, she underwent total tyroidectomy. Pathologic examination of the specimen revealed both medullary and papillary thyroid carcinoma. 3.5 cm sized classic variant papillary tyroid carcinoma was reactive for thyroglobulin and tumor stage was reported as pT3pNxpMx; 5*3*3 cm sized medullary thyroid carcinoma was reactive for calcitonin. Investigation for multıple endocrine neoplasia (MEN) detected RET protooncogen mutation. She underwent 100 mCi radioactive I131 treatment. Since CEA and calcitonin levels were high during follow-up period, neck ultrasonography was performed, which revealed no pathologic lymphadenopathy. PET/CT examination detected metastasis in the upper lobe of the right lung, mediastinal lymph nodes and liver. The patient was given vandatanib chemotherapy by medical oncology department. In conclusion, co-occurence of medullary and papillary thyroid carcinoma in the same gland has rarely been reported. Occurence of medullary and papillary tyroid carcinoma are independent; however, common points of pathogenic events can not be ruled out in their carcinogenesis.

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