An extremely rare synchronous occurrence of medullary thyroid carcinoma (MTC), papillary thyroid microcarcinoma (PTMC), and Hashimoto thyroiditis was recently identified in Iraq.

“Synchronous existence of these two neoplasms can occur in two forms: distinct MTC and PTC [papillary thyroid carcinoma] isolated by normal thyroid tissue, or mixed medullary and follicular-derived thyroid carcinoma, in which single or multiple lesions show morphology and immunoreactivity for both MTC and follicular-derived carcinoma,” explained the authors of the case report published in the International Journal of Surgery Case Reports.

The patient, a middle-aged male (53 years), presented with a growing right-sided neck mass. He had no family history of thyroid cancer or other relevant pathologies. On physical examination, clinicians identified a mobile lesion localized at the right side of the neck, accompanied by skin redness.


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Ultrasound confirmed the presence of a well-defined nodule (12 mm x 7.8 mm) with microcalcification and increased peri- and intra-nodular vascularity associated with cervical lymphadenopathy. Biopsies were positive for chromogranin, synaptophysin, calcitonin, carcinoembryonic antigen (CEA), cytokeratin AE1/AE3, and lymphocyte common antigen CD45, which suggested MTC.

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The patient had high levels of calcitonin (>2000 pg/mL) and CEA (251.6 ng/ml), despite normal thyroid function. He underwent total thyroidectomy with right central neck, right lateral neck, and right mediastinal lymph node
dissections. The histopathological examination of the specimens confirmed multifocal MTC along with the incidental findings of unifocal PTMC and Hashimoto thyroiditis.

The co-occurrence of PTC with Hashimoto thyroiditis has been observed in a number of cases (average concurrence rate of 23%). “Although the mechanism behind this correlation is not fully understood, some experimental investigations have shown that the occurrence of [Hashimoto thyroiditis] and PTC at the same time reflects an immunological link,” the authors explained.

However, the synchronous occurrence of the 3 conditions is extremely rare. The patient recovered from the surgery and was discharged home in good condition. He was scheduled to receive radioactive iodine due to the PTMC.

Reference

Abdullah AM, Ali RM, Salih KM, Mohammed KK, Kakamad FH, Salih AM. Synchronous occurrence of papillary thyroid microcarcinoma, medullary thyroid carcinoma and Hashimoto thyroiditis in a single thyroid: a case report with literature review. Int J Surg Case Rep. Published online March 1, 2022. doi:10.1016/j.ijscr.2022.106888