HATRICK-Synchronous Triple Primary Tumors of Thyroid

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Multiple primary cancer (MPC) involves diagnosing two or more distinct cancers in one patient, with an incidence of 1.8%. Synchronous tumors are defined as two or more primary tumors diagnosed within six months.
• Thyroid nodules are common, but the concurrent presence of multiple distinct thyroid malignancies is rare.

Observation:

• A 27-year-old female presented with a year-long, painless, progressive right-sided neck swelling.
• Initial ultrasound revealed a hypoechoic solid nodule on the right thyroid lobe, with the left lobe appearing normal.
• Fine-needle aspiration cytology (FNAC) suggested an adenomatous colloid nodule (Bethesda II).

Findings:

• Histopathological examination of the right hemithyroidectomy specimen unexpectedly revealed three distinct tumors: a not-otherwise-specified (NOS) tumor, papillary carcinoma thyroid (PTC), and medullary carcinoma thyroid.
• Immunohistochemistry (IHC) confirmed the presence of medullary carcinoma thyroid through positive staining for synaptophysin, CEA, and chromogranin.

Implications:

• This case represents an extremely rare instance of concurrent triple thyroid tumors (NOS, PTC, and medullary carcinoma) in a single patient.
• The simultaneous occurrence highlights the complexity of thyroid cancer diagnosis and the potential for multiple primary malignancies.
• Further investigation into the genetic and etiological factors contributing to such rare multifocal thyroid neoplasms may be warranted.