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Synchronous papillary-medullary thyroid microcarcinoma: a case report.
Ramapaada Reddy Medam1, Gabriela Castro1, Rami Alhassan2
1Department of Surgery, College of Medicine, University of Central Florida, Orlando, FL, USA.
AME Case Reports
|August 5, 2022
Summary
Synchronous papillary-medullary thyroid carcinoma is rare, often missed by initial biopsies. This case highlights the importance of considering this diagnosis in patients with multinodular goiters, even with initially benign-appearing results.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Papillary thyroid carcinoma (PTC) accounts for 85-90% of thyroid cancers, while medullary thyroid carcinoma (MTC) represents less than 5%.
- Synchronous PTC and MTC is exceptionally rare, with fewer than 40 cases documented.
- Multinodular thyroid goiters can present with symptomatic compression, necessitating further investigation.
Observation:
- A 65-year-old man with a symptomatic multinodular thyroid goiter underwent evaluation.
- Initial fine needle aspiration (FNA) biopsy results were indeterminate (AUS, Bethesda III), with molecular testing (ThyGeNEXT®, ThyraMIR®) suggesting a benign outcome.
- Despite initial nonoperative management, worsening compressive symptoms led to total thyroidectomy.
Findings:
- Surgical pathology revealed incidental, multifocal micropapillary thyroid carcinoma (0.1-0.5 cm) and a 0.3 cm medullary thyroid carcinoma in the left lobe.
- The findings were incidental, discovered on a background of nodular hyperplasia.
- The final diagnosis was synchronous papillary-medullary thyroid carcinoma.
Implications:
- This rare case underscores the importance of considering synchronous papillary-medullary thyroid carcinoma in patients with symptomatic multinodular thyroid goiters.
- Reporting such rare cases enhances awareness and aids in understanding and managing these unusual thyroid carcinomas.
- Further research and case reporting are crucial for improving diagnostic and therapeutic strategies for synchronous thyroid cancers.
