Papillary thyroid carcinoma may be associated with medullary thyroid carcinoma (MTC) in patients with multiple endocrine neoplasia type 2a who have a mutation in the RET protooncogene, according to a new study presented at the 25th European Congress of Endocrinology (ECE).
Read more about the etiology of MTC
“Nevertheless, this activity remains modest and occurs in specific circumstances explaining the rare occurrence of [papillary thyroid carcinoma] in this context,” the authors of the study wrote. “This observation underlines the importance of calcitonin determination before surgery in case of thyroid nodules to avoid inappropriate therapeutic management.”
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The findings presented here are based on the case study of a 38-year-old male patient with a history of papillary thyroid carcinoma.
The patient had undergone total thyroidectomy to treat his multinodular goiter, which was classified as TIRADS 4.
Anatomical and pathological examination revealed that he had a lobar MTC measuring 20 mm and an isthmic papillary thyroid carcinoma measuring 5 mm.
His calcitonin levels were not measured before the operation. After surgery, they were negative, and the patient was treated with levothyroxine suppression therapy.
Genetic analysis revealed that the patient had a mutation in exon 10 of the RET gene. He also had a pheochromocytoma, a usually noncancerous tumor that develops in an adrenal gland and is a component of multiple endocrine neoplasia type 2a.
The patient was referred for surgery, and a genetic study of his family was requested.
MTC is a rare type of neuroendocrine tumor of the thyroid gland arising from the parafollicular cells. Once they become malignant, these cells secrete high levels of calcitonin, which is widely used as a biomarker for the identification of the disease.
Papillary thyroid carcinoma is a different type of thyroid carcinoma and the most frequent thyroid neoplasm. It shows evidence of follicular cell differentiation and has a set of distinctive nuclear features.
Reference
Ali BM, Cheikh M, Mohamed M, Rifai K, Hinde I, Gharbi M. Association of papillary and medullary thyroid carcinoma in multiple endocrine neoplasia type 2a. Poster presented at: 25th European Congress of Endocrinology (ECE); May 13-16, 2023; Istanbul, Turkey.
