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Medullary Thyroid Carcinoma Masquerading as Tuberculosis Reactivation: A Case of Diagnostic Concealment in an Occult
Ankit Girepunje1, Arvind Bhake, Anil Agrawal
1Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India.
Abstract:
Medullary thyroid carcinoma (MTC) with tumour-associated granulomas presents a significant diagnostic challenge in tuberculosis (TB)-endemic regions, particularly when thyroid nodules are non-palpable. We report a 75-year-old woman with treated pulmonary TB who presented with dyspnoea and pleural effusion, leading to initial clinical suspicion of TB reactivation. An incidental non-palpable thyroid nodule discovered on ultrasound was revealed to be MTC with epithelioid granulomas on fine-needle aspiration cytology. The absence of a palpable neck mass diverted clinical attention towards pulmonary TB, demonstrating how thyroid malignancy can remain concealed by TB manifestations. Elevated serum calcitonin (620 pg/mL) and Congo red-positive amyloid deposits confirmed MTC post-thyroidectomy. This case underscores the critical importance of systematic calcitonin testing in granulomatous thyroid lesions, even in non-palpable nodules, to prevent delayed cancer diagnosis in TB-prevalent healthcare settings.
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