Medullary Thyroid Cancer with Normal Serum Calcitonin and Tubercular Neck Nodes: A Rare and Challenging Presentation
J Anish Atchaya, Rabishankar Singh
Citation Information :
Atchaya JA, Singh R. Medullary Thyroid Cancer with Normal Serum Calcitonin and Tubercular Neck Nodes: A Rare and Challenging Presentation. World J Endoc Surg 2021; 13 (2):61-63.
We report a highly unusual case of medullary carcinoma thyroid with normal serum calcitonin and tuberculous lymphadenitis mimicking metastatic neck nodes. A 26-year-old married woman was diagnosed with sporadic medullary carcinoma of thyroid on fine needle aspiration cytology (FNAC). Preoperative ultrasonography (USG) and contrast-enhanced computed tomography (CECT) neck suggested a metastasis in level IIB neck nodes. Patient underwent total thyroidectomy with central neck dissection with right modified neck dissection type III. Final histopathological report revealed medullary carcinoma thyroid (MTC) with tubercular lymphadenitis, none of 47 nodes retrieved had metastasis. She remains disease free after 2 years following surgery.
Fialkowski EA, Moley JF. Current approaches to medullary thyroid carcinoma, sporadic and familial. J Surg Oncol 2006;94:737–747. DOI: 10.1002/jso.20690
Jeffrey F. Moley, MD, St. Louis, Missouri. Medullary thyroid carcinoma: management of lymph node metastases. J Natl Compr Canc Netw 2010;8(5):549–556.
Wells SA, Asa SL, Dralle H, et al. Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma The American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Thyroid 2015 Jun;25(6):567–610. DOI: 10.1089/thy.2014.0335
Wang TS, Ocal IT, Sosa JA, et al. Medullary thyroid carcinoma without marked elevation of calcitonin: a diagnostic and surveillance Dilemma. Thyroid. 2008;18(8):889–894. DOI: 10.1089/thy.2007.0413
Sand M, Gelos M, Sand D, et al. Serum calcitonin negative Medullary thyroid carcinoma. World J Surg Oncol 2006;4:97.
Brutsaert EF, Gersten AJ, Tassler AB, et al. Medullary thyroid cancer with undetectable serum calcitonin. J Clin Endocrinol Metab 2015;100(2):337-341. DOI :10.1210/jc.2014-3095
Bockhorn M, Frilling A, Rewerk S, et al. Lack of elevated serum carcinoembryonic antigen and calcitonin in medullary thyroid carcinoma. Thyroid 2004;14:468–470. DOI: 10.1089/105072504323150813
Moley JF, DeBenedetti MK. Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg 1999;229:880–887; discussion 887–888. DOI: 10.1097/00000658-199906000-00016
Machens A, Hinze R, Thomusch O, et al. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 2002;26:22–28. DOI: 10.1007/s00268-001-0176-3
Frank-Raue K, Machens A, Leidig-Bruckner G, et al. Prevalence and clinical spectrum of nonsecretory medullary thyroid carcinoma in a series of 839 patients with sporadic medullary thyroid carcinoma. Thyroid 2013;23:294–300. DOI: 10.1089/thy.2012.0236