Researchers discovered the radiological features and mucin (MUC) immunohistochemical expression patterns of a recent case of amphicrine medullary thyroid carcinoma (MTC) and published their results in Endocrine Pathology.

Intra- and extracellular MUC production has been variably documented in benign and malignant thyroid tumors. While the expression and contribution of MUC1 have been significantly studied in papillary thyroid carcinoma, this study analyzes MUC expression in MTC.

This case report of a 28-year-old male patient with multiple endocrine neoplasia type 2B (MEN2B) syndrome considered a diagnosis of MTC with metastatic disease, adrenomedullary hyperplasia, and pheochromocytoma (adrenal paraganglioma). The patient underwent left and right adrenalectomy with total thyroidectomy and was on maintenance thyroxine and corticosteroid support. Treatment with multikinase inhibitors was planned in view of widespread metastatic disease.


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Based on the World Health Organization 2022 classification of MTCs, microscopic features of high-grade MTC were present and a diagnosis of multifocal amphicrine MTC with C cell hyperplasia was made. On radiological investigation, the irregular calcifications typically seen in MTC were surprisingly absent, while unusual large areas of hypodensities were noted on contrast-enhanced computed tomography.

To further evaluate the amphicrine nature of the tumor, the MUC expression profile was assessed, which revealed evidence of microlumina formation and unique, unreported expression patterns of MUC1, MUC5AC, and MUC6 in an amphicrine subtype of MTC.

Due to its rare occurrence, not much is known about the pathobiology of amphicrine MTCs. These tumors are frequently linked to MEN2B syndrome, and recognition of this rare subtype of MTC may be of clinical interest given their biological aggressiveness and poor prognosis.

Reference

Khandakar H, Agarwal S, Sharma MC, et al. Amphicrine medullary thyroid carcinoma – a case-based review expanding on its MUC expression profile. Endocr Pathol. Published online June 23, 2022. doi:10.1007/s12022-022-09725-1