Lung metastases as the first manifestations of occult medullary microcarcinoma

Czech version

Authors: J. Mačák ¹; J. Dvořáčková ¹; J. Mačáková ²; P. Vlček ³
Authors‘ workplace: Ústav patologie Lékařské fakulty OU a FN Ostrava, přednostka prim. MU Dr. Jana Dvořáčková, Ph. D., MIAC ¹; Katedra fyziologie a patofyziologie Lékařské fakulty OU Ostrava, přednosta doc. RNDr. Pavol Švorc, CSc. ²; Klinika nukleární medicíny a endokrinologie 2. lékařské fakulty UK a FN Motol Praha, přednosta prof. MU Dr. Petr Vlček, CSc. ³
Published in: Vnitř Lék 2013; 59(4): 317-320
Category: Case Reports

Overview

The article is concerned with medullary microcarcinoma of the thyroid. Similarly to medullary macrocarcinoma, this may metastasize to distant sites. Reported is a case of a 54‑year- old male who had suffered from chest tightness and dry irritating cough. Chest X‑ray showed small nodules with poorly- defined borders of unknown etiology. Lung biopsy was performed, which detected amyloid- rich neuroendocrine carcinoma. Examination of the thyroid was recommended to confirm or rule out suspected medullary carcinoma. The biopsy examination also suggested G1 and G2 primary neuroendocrine carcinoma of the lung or diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Numerous examinations using imaging methods (CT, MRI, PET– CT) were carried out with no positive results in the thyroid. Despite that, thyroidectomy was performed. Subsequent biopsy examination revealed medullary microcarcinoma sized 0.6 cm. Apart from lung metastases, tumor lesions were found in cervical lymph nodes. This case is an example of a close cooperation between a pathologist and a clinician – endocrinologist. Based on serum calcitonin levels, this may aid in differential diagnosis.

Key words:
medullary microcarcinoma – lung metastases – cervical lymph nodes metastases – immunohistological examination

Sources

1. Kazaure HS, Roman AS, Sosa JA. Medullary thyroid microcarcinoma. Cancer 2012; 118: 620– 627.

2. Baloch ZW, LiVolsi VA. Microcarcinoma of the thyroid. Adv Anat Pathol 2006; 13: 69– 75.

3. Rosai J. Rosai and Ackerman’s surgical pathology, tenth edition. MOSBY ELSEVIER 2011.

4. Čáp J, Ryška A. Aspirační cytologie. Hradec Králové: Nucleus HK 2003.

5. Leslie KO, Wick MR. Practical pulmonary pathology. A diagnostic approch. Philadelphia: ELSEVIER SAUNDERS 2011.

6. Travis WD, Brambilla E, Müller– Hermelink KH et al. Tumors of the lung, pleura, thymus and heart. Pathology & genetics. Lyon: IARC Press 2004.

7. Abe Y, Utsunomiva H, Tsutsumi Y. Atypical carcinoid tumor of the lung with amyloid stroma. Acta Pathol Jpn 1992; 42: 286– 292.

8. Štěrba J. Metastasizing bronchial carcinoid with amyloid in the stroma. Zentralbl Allg Pathol 1968; 111: 555– 561.

9. el- Gatit A, al- Kaisi N, Moftah S et al. Atypical bronchial carcinoid tumor with amyloid deposition. Eur J Surg Oncol 1994; 20: 586– 587.

10. Gordon HW, Miller R, Mittman C. Medullary carcinoma of the lung with amyloid stroma: a counterpart of medullary carcinoma of the thyroid. Human Pathol 1973; 4: 431– 436.

11. Conway A, Wiernik A, Lam ARC et al. Occult primary medullary thyroid carcinoma presenting with pituitary and parotid metastases: case report and review of the literature. Endocrin Pathol 2012; 23: 115– 122.

12. Nonaka D, Tang Y, Chiriboga L et al. Diagnostic utility of the thyroid transcription factor Pax8 and TTF- 1 (FOX E1) in thyroid epitelial neoplasms. Mod Pathol 2008; 21: 192– 200.

13. Vlček P. Endokrinologicko‑nukleárně medicinské aspekty v léčbě nádorů štítné žlázy. Vnitř Lék 2007; 53: 807– 811.

14. Vlček P, Michalová K, Táborská K et al. Radionuklidové zobrazovací metody používané v endokrinologii. Vnitř Lék 2006; 52: 969– 972.

15. Marcy PY, Thariat J, Peyrottes I et al. Fulminant lethal spread of occult papillary microcarcinoma of the thyroid. Thyroid 2010; 20: 445– 448.

16. Roman S, Lin R, Sosa JA. Prognosis of medullary thyroid carcinoma. Cancer 2006; 107: 2134– 2142.

17. Aurora N, Turbendian HK, Kato MA et al. Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroid 2009; 19: 473– 477.

18. Kaserer K, Scheuba CH, Neuhold N et al. Sporadic versus familial medullary thyroid carcinoma. A histopathologic study of 50 consecutive patients. Am J Surg Pathol 2001; 25: 1245– 1251.