Endocrine Abstracts

Introduction: Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are two different types of thyroid carcinoma with significant different clinical and histological findings. Synchronous occurrence of these two carcinomas is uncommon. The aim of the study is to determinate the clinical, histological and therapeutic aspects of the coexistence of medullary and papillary thyroid carcinomas.

Materials and Methods: We report two rare cases of simultaneous medullary thyroid carcinoma and papillary thyroid carcinoma collected in ENT department of Fattouma Bourguiba Hospital of Monastir over a period of 20 years.

Results: Case one was a 46-year-old woman, with no personal history of radiation exposure and family history of thyroid cancer, presented to our consultation for management of a left thyroid nodule discovered by ultrasound examination of her neck. The patient underwent a total thyroidectomy with node dissection. The histology disclosed a medullary carcinoma in left lobe and a micropapillary carcinoma in the right lobe. Three months postsurgery, the patient’s calcitonin levels were less than three ng/l and there was no distant metastasis. The second case was a 49-year-old man, with no apparent family history of endocrine disorders or any previous external radiation therapy, hospitalised in our ENT department for multinodular goiter with compression symptoms. A cervical computed tomography objectified a laryngo-tracheal invasion by an endoluminal tissue lump. Fine needle aspiration cytology from the thyroid nodule was performed showing a medullary carcinoma. A total thyroidectomy and total laryngectomy with node dissection were performed. The histology results showed a medullary carcinoma occupying the majority of the thyroid associated to a papillary carcinoma in the right lobe. Surgical treatment was followed by I-131 100 mCi therapy and external radiotherapy. The extension assessment revealed synchronous renal cell carcinoma associated to bone and lymph node metastases due to MTC.

Conclusion: PTC and MTC are two different types of thyroid carcinoma with significant different histology. Synchronous occurrence of these two carcinomas is uncommon and rare. The prognosis depends essentially on MTC.