Simultaneous occurrence of medullary and papillary thyroid microcarcinomas: a case series and review of the literature

Abstract

IntroductionPapillary thyroid microcarcinoma has been demonstrated to present in association with medullary thyroid carcinoma, however, medullary thyroid carcinoma and papillary thyroid carcinoma represent rare entities. In recent years this rarity has been increasingly observed. The pathogenesis is still controversial. Genetic analysis of RET proto-oncogenes in cases of simultaneous papillary thyroid carcinoma and medullary thyroid carcinoma has so far provided conflicting results; although it seems that germline mutations play a potential role in the development of both histological types.Case presentationsThis paper describes four rare cases of simultaneous medullary thyroid carcinoma and papillary thyroid microcarcinoma with unique features:Case one was a 43-year-old Jewish woman, born in Israel, daughter of a Latvian immigrant mother and a father born in Israel. Case two was a 44-year-old Arab woman born in Israel. Case three was a 45-year-old Jewish woman, born in Israel, daughter of Moroccan immigrant parents and is unique for the presence of lymph node metastatic medullary thyroid carcinoma, and one lymph node with metastatic papillary carcinoma found in the same side. Case four was a 77-year-old Jewish woman, born in Iraq. These cases are unique in their composition of thyroid carcinoma, consisting of histologic features of medullary thyroid carcinoma, papillary thyroid microcarcinoma, and follicular thyroid adenoma. The four cases represent different ethnicity groups that live in north Israel, and case four is notable for the advanced age of the patient (77 years).ConclusionThese four cases add more data supporting the coincidental coexistence of papillary thyroid microcarcinoma and medullary thyroid carcinoma; our results may suggest that the simultaneous occurrence of medullary thyroid carcinoma and papillary thyroid microcarcinoma is generally a simple reflection of this coincidence. Endocrinologists and pathologists should be aware of this entity. The pathologist can play a pivotal role in identifying papillary thyroid microcarcinoma in concurrent existence with medullary thyroid carcinoma.

Optical biopsy of head and neck cancer using hyperspectral imaging and convolutional neural networks

“…However, the co-occurrence of both MTC and PTC is rare, although cases have been documented. [38][39][40] We hypothesized that HSI has further potential than binary cancer detection, as we explored in this work, and that different types of cancer can be identified from benign hyperplasia. Therefore, we performed a set of two binary classifications (MTC versus MNG and PTC versus MNG) to show both can be successfully identified from MNG.…”

Simultaneous Occurrence of Papillary Carcinoma and Medullary Carcinoma

“…The first is the ‘stem cell theory’ which describes a common stem cell that transform into both follicular and C-cell lineages. 4 Another is the ‘field effect theory’ which proposes that simultaneous transformation of both follicular and C cells is a result of common neoplastic stimuli. On the other hand, the ‘collision theory’ suggests that two independent tumours are located in the same thyroid by simple coincidence.…”

“…On the other hand, the ‘collision theory’ suggests that two independent tumours are located in the same thyroid by simple coincidence. 4 …”

“…On the other hand, the 'collision theory' suggests that two independent tumours are located in the same thyroid by simple coincidence. 4 Papillary carcinoma generally has a good prognosis since most patients are diagnosed during the early stage of the disease (stage I or II), with 5% having a lethal outcome. 5 Medullary thyroid carcinoma, on the other hand, may have an indolent clinical course or an aggressive variant with a high mortality rate.…”

Simultaneous occurrence of follicular and papillary thyroid carcinomas in same thyroid lobe: A case series of six patients from Qatar

“…About 71 cases of concurrent papillary thyroid cancer (PTC) and medullary thyroid cancer (MTC) have been reported [ 2 ], but cases of PTC and follicular thyroid cancer (FTC) presenting synchronously are much rarer [ [3] , [4] , [5] ] and signify the simultaneous occurrence of distinctly different entities. Well-differentiated thyroid carcinomas (e.g., PTC and FTC) are usually sporadic in most cases [ 6 ], and the coexistence of two independent and simultaneous follicular epithelial cell carcinomas, a papillary carcinoma and a follicular carcinoma, is extremely rare [ 7 ].…”