HATRICK-Synchronous Triple Primary Tumors of Thyroid

Multiple primary cancer (MPC) has an incidence of 1.8% and is defined as having two or more cancers in a single patient. Synchronous tumors are defined as ≥ 2 primary tumors occurring within 6 months of diagnosis of the first primary tumor. We present a case of a 27-year-old female patient who presented with a painless, gradually progressive right-sided neck swelling for the last 1 year with no systemic complaints. Examination revealed a 4 × 3-cm, firm, smooth surfaced swelling on right lobe of thyroid. USG neck showed a hypoechoic solid nodule on the right lobe and the left lobe was normal. FNAC showed features of adenomatous colloid nodule, Bethesda II. Right hemithyroidectomy specimen revealed evidence of triple tumors-not otherwise-specified (NOS) tumor, papillary carcinoma thyroid, and medullary carcinoma thyroid, which was confirmed with positivity on IHC with synaptophysin, CEA, and chromogranin. Concurrent appearance of NOS, PTC, and medullary carcinoma thyroid in the very same patient is extremely rare and has not been previously reported in the English literature.