Simultaneous Occurrence of Papillary Intrafollicular and Microcarcinomas with Bilateral Medullary Microcarcinoma of the Thyroid in a Patient with Multiple Endocrine Neoplasia Type 2A: Report of a Case

Abstract

We report the case of a simultaneous occurrence of papillary intrafollicular and microcarcinomas with bilateral medullary microcarcinoma of the thyroid in a patient with multiple endocrine neoplasia type 2A. The concurrent presence of two thyroid carcinomas is rare. The simultaneous occurrence of two different tumors in the same thyroid each being multifocal and smaller than 1 cm in diameter has not been previously reported in the literature. Furthermore, we define the first case of intrafollicular papillary thyroid carcinoma (carcinoma in situ).

Inherited Follicular Epithelial-Derived Thyroid Carcinomas: From Molecular Biology to Histological Correlates

“…The well-defined familial syndromes that are closely linked to FNMTC include familial adenomatous polyposis (FAP) syndrome, PTEN-hamartoma tumor syndrome, DICER1 syndrome, Carney complex, and Werner syndrome; however, patients with MEN1 syndrome [118] Marfan syndrome [119] and familial paraganglioma syndromes caused by SDHx mutations [120] can also manifest with thyroid follicular epithelial-derived neoplasia. It is not clear if the association with papillary thyroid microcarcinomas in multiple endocrine neoplasia type 2A (MEN2A) patients is related to specific germline changes of the RET gene or is reflective of how carefully the thyroids of MEN2A patients are examined [121,122]. Recognition of these syndromes is important so that cancer screening and genetic counseling can be initiated.…”

Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental

“…MTC with concurrent PTC (MTC/PTC) was initially described by Lamberg et al. in 1981, 2 and 65 cases were recorded in the English literature as of 2007 2–36 …”

Synchronous occurrence of papillary thyroid microcarcinoma, medullary thyroid carcinoma and Hashimoto thyroiditis in a single thyroid: A case report with literature review

“…80% of thyroid cancers are PTCs. PTMC is defined by the World Health Organization (WHO) as a PTC with a diameter of 1 cm or less, and is a frequent accidental discovery in thyroid glands resected for other indications [10] . Radiation exposure, female sex, smoking, overweight, dietary iodine excess, alcohol, dietary nitrates, diabetes mellitus, and genetic factors have all been identified as risk factors for PTC [11] .…”