World Journal of Endocrine Surgery

Register      Login

VOLUME 9 , ISSUE 3 ( September-December, 2017 ) > List of Articles

ORIGINAL ARTICLE

Preoperative Diagnosis predicts Outcomes in Patients with Concurrent Medullary and Papillary Thyroid Carcinoma

Insoo Suh, Quan-Yang Duh, Toni Beninato, Orlo H Clark, Wen T Shen, Wouter P Kluijfhout, Frederick T Drake, Jessica E Gosnell

Citation Information : Suh I, Duh Q, Beninato T, Clark OH, Shen WT, Kluijfhout WP, Drake FT, Gosnell JE. Preoperative Diagnosis predicts Outcomes in Patients with Concurrent Medullary and Papillary Thyroid Carcinoma. World J Endoc Surg 2017; 9 (3):94-99.

DOI: 10.5005/jp-journals-10002-1219

License: CC BY 3.0

Published Online: 00-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim

This study examined patients with concurrent medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) with the primary objective of identifying factors that can determine the dominant subtype that will dictate recurrence.

Materials and methods

The cancer registry at our tertiary care referral center was reviewed to identify all patients from 1995 to 2015 who had been diagnosed with both MTC and PTC on initial total thyroidectomy. Patient demographic, pathology, and recurrence data were collected and reviewed.

Results

Nineteen patients met the inclusion criteria. Seventeen patients had separate foci of MTC and PTC, and two patients had mixed tumors of medullary and follicular or medullary and the follicular variant of PTC. Thirteen patients had a preoperative diagnosis of MTC, and all 13 had MTC as the higher stage tumor on final pathology. Of these, eight patients had recurrent disease, all of which recurred as MTC. In the six patients with concurrent MTC and PTC who did not have MTC as the preoperative diagnosis, the PTC was the higher stage tumor. Only one patient in this group recurred with PTC, none with MTC. No patients have had recurrent disease that was a different subtype from their preoperative diagnosis or the higher stage tumor.

Conclusion

The concurrent findings of MTC and PTC in the same patient may result in challenging patient counseling, management, and follow-up. In this series of 19 patients with concurrent PTC and MTC, the subtype of recurrence in all 9 patients with recurrent disease was determined by the preoperative diagnosis and higher stage tumor.

Clinical significance

The incidental discovery of a second subtype of differentiated thyroid cancer should not alter management of the primary tumor. Patients should be treated in accordance with the preoperative diagnosis and higher stage tumor.

How to cite this article

Beninato T, Kluijfhout WP, Drake FT, Shen WT, Suh I, Duh QY, Clark OH, Gosnell JE. Preoperative Diagnosis predicts Outcomes in Patients with Concurrent Medullary and Papillary Thyroid Carcinoma. World J Endoc Surg 2017;9(3):94-99.


  1. Concurrent medullary and papillary thyroid carcinoma in the same thyroid lobe and in siblings. Acta Med Scand 1981 Jan;209(5):421-424.
  2. A compound follicular-parafollicular cell carcinoma of the thyroid: a new tumor entity? Cancer 1983 Sep;52(6):1053-1061.
  3. Coexistence of papillary and medullary carcinoma of the thyroid gland-mixed or collision tumour? Clinicopathological analysis of three cases. Virchows Arch. 1994 May;424(4):441-447.
  4. Mixed medullary-follicular thyroid carcinoma. Molecular evidence for a dual origin of tumor components. Am J Pathol 1999 Nov;155(5):1499-1509.
  5. Multigenerational familial medullary thyroid cancer (FMTC): evidence for FMTC phenocopies and association with papillary thyroid cancer. Clin Endocrinol (Oxf) 2002 Jan;56(1):53-63.
  6. The oncogenic activity of RET point mutants for follicular thyroid cells may account for the occurrence of papillary thyroid carcinoma in patients affected by familial medullary thyroid carcinoma. Am J Pathol 2004 Aug;165(2):511-521.
  7. Case of concurrent MTC and PTC in a patient with a germline RET mutation. Endocr Pathol 2015 Sep;26(3):279-283.
  8. One hundred and seven family members with the rearranged during transfection V804M proto-oncogene mutation presenting with simultaneous medullary and papillary thyroid carcinomas, rare primary hyperparathyroidism, and no pheochromocytomas: is this a new syndrome—MEN 2C? Surgery 2009 Dec;146(6):998-1005.
  9. Medullary and papillary carcinomas occurring as a collision tumor: report of a case. Clin Nucl Med 1989;14(3):171-174.
  10. Simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid. J Surg Oncol 1995 Aug;59(4):276-279.
  11. Simultaneous occurrence of medullary and papillary carcinoma of the thyroid gland identified by fine needle aspiration. A case report. Acta Cytol 2002 Jul-Aug;46(4):762-766.
  12. Synchronous occurrence of a follicular, papillary and medullary thyroid carcinoma in a recurrent goiter. Endocr J 2005 Apr;52(2):281-285.
  13. Concurrent papillary and medullary thyroid carcinoma. Arch Pathol Lab Med 2005 Mar;129(2):264-265.
  14. Medullary and papillary carcinoma of the thyroid gland occurring as a collision tumour: report of three cases with molecular analysis and review of the literature. Endocr Relat Cancer 2005 Jun;12(2):281-289.
  15. Simultaneous medullary and papillary thyroid carcinoma with lymph node metastasis in the same patient: case report and review of the literature. Asian J Surg 2005 Jul;28(3):223-226.
  16. Association of medullary and differentiated thyroid carcinomas. Otolaryngol Head Neck Surg 2006 Sep;135(3):473-475.
  17. Simultaneous medullary and papillary thyroid cancer: two case reports. J Med Case Rep 2007 Nov;1:133.
  18. Synchronous occurrence of macroscopic papillary and medullary thyroid carcinomas. Hematol Oncol Stem Cell Ther 2008 Jul;1(3):193-196.
  19. Synchronous metastatic medullary and papillary thyroid carcinomas in a patient with germline RET mutation: case report, molecular analysis, and implications for pathogenesis. Endocr Pathol 2010 Jun;21(2):115-119.
  20. Simultaneous occurrence of medullary and differentiated thyroid carcinomas. Report of 4 cases and brief review of the literature. Hell J Nucl Med 2014 May-Jun;17(2):148-152.
  21. Synchronous occurrence of medullary and papillary carcinoma of the thyroid in a patient with cutaneous melanoma: determination of BRAFV600E in peripheral blood and tissues. Report of a case and review of the literature. Endocr Pathol 2014 Sep;25(3):324-331.
  22. Concurrent medullary and papillary carcinoma of thyroid. Kulak Burun Bogaz Ihtis Derg 2015 Jul;25(3):170-173.
  23. Concurrent medullary, papillary, and follicular thyroid carcinomas and simultaneous cushing's syndrome. Eur Thyroid J 2015 Mar;4(1):65-68.
  24. Medullary and papillary tumors are frequently associated in the same thyroid gland without evidence of reciprocal influence in their biologic behavior. Thyroid 2004 Nov;14(11): 946-952.
  25. Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental. Clin Endocrinol (Oxf) 2010 Feb;72(2):256-263.
  26. Simultaneous medullary and papillary thyroid cancer: a novel entity? Ann Surg Oncol 2012 Jan;19(1):37-44.
  27. Simultaneous medullary and differentiated thyroid cancer: a population-level analysis of an increasingly common entity. Ann Surg Oncol 2012 Aug;19(8):2635-2642.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.