CASE REPORT
Coexistence of Papillary and Medullary Thyroid Carcinoma: A Rare Entity
Papiller ve Medüller Tiroid Kanseri Birlikteliği: Nadir Bir Olgu Sunumu
Received Date : 26 Oct 2019
Accepted Date : 25 Apr 2020
Available Online : 08 May 2020
Emel BAYRAK, Rüştü SERTER*
Lösev Losante Child and Adult Hospital, Department of Internal Medicine, Ankara, TURKEY
*Acıbadem MAA University Faculty of Medicine, Division of Endocrinology & Metabolism, İstanbul, TURKEY
Doi: 10.25179/tjem.2019-72499 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:168-172
ABSTRACT
The coexistence of different types of thyroid carcinomas is
rather unusual. It has been considered coincidental and linked
to the growing incidence of papillary thyroid carcinoma
(PTC). This paper presents a case of multifocal PTC and coexistent
medullary thyroid carcinoma (MTC) distinct from
each other, along with PTC lymph node metastasis. The 44-
year-old female patient underwent subtotal thyroidectomy
with a pre-operative diagnosis of multinodular goiter. Histological
reports revealed PTC in the right lobe and PTC beside
a tumoral area morphologically suspicious for MTC in the
left thyroid lobe. Immunohistochemistry confirmed the diagnosis
of MTC. Post-operative ultrasound and subsequent
fine needle aspiration biopsy revealed lymph node metastases
of PTC in the right anterior cervical area. Complementary
thyroidectomy, central neck dissection, and right
modified neck dissection were carried out with subsequent
I-131 ablation therapy. In conclusion, the biological behaviors
and prognoses of MTC and PTC are different. Therefore,
the entity demands a different clinical approach in treatment
and follow-up.
Keywords: Papillary thyroid carcinoma; medullary thyroid carcinoma
ÖZET
Farklı tipteki tiroid karsinomlarının birlikteliği oldukça nadirdir.
Bu durum tesadüfi olarak kabul edilmekte olup, giderek
artan papiller tiroid kanseri [papillary thyroid carcinoma
(PTC)] insidansı ile ilişkilendirilmektedir. Bu yazıda, birbirinden
normal tiroid dokusu ile net olarak ayrılmış medüller tiroid
kanseri [medullary thyroid carcinoma (MTC)] yanı sıra multifokal
PTC ve PTC lenf metastazı tespit ettiğimiz olgumuzu sunuyoruz.
Kliniğimize başvuran 44 yaşındaki kadın hasta,
multinodüler guatr tanısı ile subtotal tiroidektomi operasyonu
geçirmiş. Histolojik incelemede sağ tiroid lobunda PTC, sol tiroid
lobunda ise PTC’nin yanı sıra MTC için morfolojik olarak
şüpheli tümör bölgesi rapor edilmiş. MTC şüphesi immünohistokimyasal
olarak pozitif kalsitonin ekspresyonu ile doğrulandı.
Postoperatif ultrasonografi ve takiben ince iğne aspirasyon
biyopsisi ile sağ ön servikal lenf nodunda PTC metastazı
tespit edildi. Hastaya tamamlayıcı tiroidektomi, santral boyun
diseksiyonu ve sağ modifiye boyun diseksiyonu sonrası I-131
ablasyon tedavisi uygulandı. Sonuç olarak, bu iki kanserin biyolojik
özellikleri ve prognozlarının farklı olması bu tip olgularda
tedavi ve takipte farklı klinik yaklaşım gerektirir.
Anahtar Kelimeler: Papiller tiroid kanseri; medüller tiroid kanseri
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