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OJHAS Vol. 9, Issue 3:
(Jul - Sep, 2010) |
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| Sporadic Medullary Microcarcinoma in a Young Patient - A Rare Case |
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Vijayshankar S Assistant Professor, Department of Pathology,
Amita K, Assistant Professor Department of Pathology,
Abhishek M, Assistant Professor, Department
of Pathology,
Manjunath D, Assistant Professor, Department
of ENT,
Adichunchanagiri Institute of Medical Sciences, BG Nagara, Bellur cross, Mandya district, Karnataka, India. |
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Address For Correspondence |
Assistant Professor,
Department
of Pathology,
Adichunchanagiri Institute of Medical Sciences,
BG Nagara, Bellur cross,
Mandya district, Karnataka, India.
E-mail:
dramitay@rediffmail.com |
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Vijayshankar S, Amita K,
Abhishek M, Manjunath D. Sporadic Medullary Microcarcinoma in a Young Patient - A Rare Case. Online J Health Allied Scs.
2010;9(3):20 |
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Submitted: Aug 7, 2010;
Accepted:
Sep 10, 2010; Published: Oct 15, 2010 |
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| Abstract: |
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Sporadic medullary
microcarcinoma of thyroid is a rare disease detected usually in 0.15%
of all thyroid malignancy. We report a case of sporadic medullary microcarcinoma
(MMC) of thyroid in a 24 year old male presenting as solitary thyroid
nodule. There was no family history of medullary carcinoma of thyroid.
Although medullary carcinoma in a familial setting have been reported,
sporadic MMC is rare especially in a young patient.
Key Words: Medullary microcarcinoma; Sporadic; Solitary thyroid nodule
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Sporadic medullary
microcarcinoma of thyroid is a rare disease detected usually in 0.15%
of all thyroid malignancy. Usually these cases have been diagnosed in
thyroidectomies performed for other benign thyroid diseases. Medullary
microcarcinomas are common in familial settings. Case reports of sporadic
MMC is rare especially in a young patient.
A 23 years
old male
presented with a right sided solitary thyroid nodule (STN) measuring
2 x 2 cm. On examination, no lymphadenopathy was noted. Ultrasound (USG)
neck revealed a solitary hypoechoic lesion measuring one cm in greatest
dimension with fine specks of calcification.
FNAC was performed.
Smears showed round to polygonal cells in clusters showing overcrowding,
overlapping and fine stippled chromatin. Possibility of medullary carcinoma
was considered after which serum calcitonin was done which was found
to be elevated.
Total thyroidectomy was done. Gross examination revealed a well circumscribed,
solid grey white nodule one cm in greatest dimension in mid portion
of lateral lobe (Figure 1).
Histopathological
examination showed a well encapsulated tumor with cells arranged in
papillary pattern with amyloid and calcification (Figure 2). Cells showed
moderate amount of amphophilic cytoplasm and stippled nuclear chromatin.
Full thickness capsular and vascular invasion was demonstrated (Figure
3). Surrounding thyroid tissue showed non nodular C cell hyperplasia.
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Figure 1: A well circumscribed,
solid grey white lesion in the mid portion of lateral lobe
of thyroid |
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Figure 2: Photomicrograph
showing solid and papillary pattern along with amyloid deposition and
calcification. (Haematoxylin and Eosin, X 400) |
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Figure 3: Photomicrograph showing
capsular invasion. (Haematoxylin and Eosin, X 400) |
Family
history of thyroid disease, pheochromocytoma, sudden death, hypercalcemia
or history of neck surgery was absent.
A final diagnosis
of sporadic MMC of thyroid – papillary variant with capsular and vascular
invasion was made.
A central compartment
neck dissection was performed. There was no evidence of lymph node metastasis.
Patient is doing well eight months postoperatively.
Incidence
of MMC of thyroid is 0.20% in patients treated surgically for benign
thyroid disease. S-MMC usually occurs in older age group, mean age being
fourth to fifth decade.1 Sporadic MMC in younger age group
is rare.
Most
of the cases are diagnosed usually in thyroidectomies performed for
other reasons or at autopsy. Very few cases are symptomatic, present
as STN and have unfavourable outcome.2 Other common symptoms being diarrhoea
and cervical lymphadenopathy. As a result the diagnosis is usually
delayed. However ultrasound and FNAC has immensely contributed to the
preoperative diagnosis of MMC.3
At histopathology,
the presence of amyloid indicates unfavourable outcome as is capsular
and vascular invasion.2
Studies
have suggested that most of the MMC behave in benign fashion. However,
presence of capsular and lymph angio invasion indicates bad prognosis
and needs prophylactic central compartment neck dissection.
MMC is
an uncommon challenging malignancy. The present case report underscores
the utility of USG and FNAC in the diagnosis and planning management
in these cases. We report this case because of its rarity in young patients
and to illustrate the necessity of total thyroidectomy with modified
neck dissection in such cases.
- Chan JKC. Tumors of the
thyroid and parathyroid glands. In: Fletcher CDM. (ed). Diagnostic Histopathology
of Tumors. 3rd ed. Churchill Livingstone. London, England. 2007. PP 997–1097
- Guyetant S, Dupre F, Bigorgne
JC et al. Medullary thyroid microcarcinoma: A clinicopathologic retrospective
study of 38 patients with no prior familial disease. Hum Pathol. 1999;30:957–963
- Yang GCH, Livolsi VA, Baloch
ZW. Thyroid Microcarcinoma: Fine Needle Aspiration
Diagnosis and Histologic Follow up. International Journal of Surgical
Pathology. 2002;10:133-139
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