A 31-year-old woman was diagnosed with concomitant medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC), a rare synchronous occurrence seen in less than 1% of all thyroid cancer cases.

“Synchronous tumors refer to cases where two or more tumors are diagnosed within 6 months of the primary tumor, most of them are of metastatic origin. Roughly 92 cases had been reported worldwide until 2011, and 7 more cases have been reported since then,” said the team who reported the case in the International Journal of Otorhinolaryngology and Head and Neck Surgery.

The woman complained of a 4-month history of swelling in the anterior part of the neck. She had no relevant personal or family history of cancer. Ultrasound-guided fine-needle aspiration biopsy pointed to a concomitant diagnosis of MTC and PTC.


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“We should be careful when establishing the primary [diagnosis] to avoid suboptimal treatment,” the authors advised.

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The patient also presented with bilateral adenopathies, with right-sided, but not left-sided, nodules, showing signs of malignancy. Her levels of calcitonin and calcium were 11166 pg/mL and 7.7 mg/dL, respectively.

She underwent total thyroidectomy with bilateral radical neck dissection (II-V), central dissection, and mediastinal dissection, which included the thymus.

Histopathological analyses confirmed MTC affecting the left thyroid lobe (stage T3bN1bM0) and multifocal, nonencapsulated PTC affecting the right thyroid lobe (stage T1N1bM0). Several positive nodules were identified during right, left, and central radical neck dissection. The thymus showed signs of infiltration.

The clinical team performed mass sequencing analysis of 322 cancer-associated genes but results were negative.

The patient was referred to iodine-131 therapy, but she refused. Due to her consistently elevated levels of calcitonin, the clinical team performed positron emission tomography/computed tomography scans (68Ga-DOTATOC, 18FDG, and 18F-DOPA), which indicated additional neoplastic activity in the lungs and liver. Ultimately, the patient decided on an alternative medicine approach.

Reference

Varela-Cano O, Luna-Peteuil Z, Luna-Ortiz K. A synchronous medullary and papillary thyroid carcinoma. Int J Otorhinolaryngol Head Neck Surg. 2022;8(3):273. doi:10.18203/issn.2454-5929.ijohns20220483