QUESTION-Age 63, female,
Clinical diagnosis: nodular goiter. Right thyroid lobe enlarged retro-sternal plunged.
Macroscopic appearance: 5.5/4/2.5cm thyroid lobe. On sectioning to identify a 0.5cm diameter nodular formation, Cystic appearance, with slightly irregular walls, gray brown.
Histopathological diagnose: Nodular goiter with nodules poorly demarcated, consisting of unequal follicles, colloid relaxed, dilated cystic, with effusion coloidian the interstitium; issues associated papillary hyperplasia. Some nodules are degenerate hematic cyst containing overflowing. Interstitial fibrosis with areas hialinizare, fibroplasti proliferation and giant cell granulomatous inflammation in acicular crystals, common granulocyte in the inflammatory infiltrate; histiomacrofage pigmentation, hemorrhage and hemosiderin pigment deposition, transformation of epithelial cells feliculi Hurth.
In one section (2139/2012) to identify a small tumor nodule, consisting of relatively uniform round cells with round nuclei, finely granular nuclear chromatin and evident nucleolus, reduced tumor stroma with rare psamomatosi corpora.
Immunohistochemical expression of tumor cells shows strong and diffuse positive for calcitonin, positive immunoreactivity for carcinoembryonic antigen mild (CEA) and CK19 negative imunocolorare on tumor cells and normal thyroid follicles positive, residual tumor. Effectuate IHC stain, identify the presence of focal hyperplasia / diffuse neoplastic parafollicular cells (C cells) in normal thyroid tissue adjacent to tumor nodule.
Conclusion: Microcarcinom medullary thyroid LTD (possibly sporadic) with large and nests cellular architecture, with round and polygonal cells (pT1NxMx). The recommended dosage of serum calcitonin and diagnosis / detection of possible forms of familial medullary carcinoma ICD-O code: 8345/3.
Surgery was on 07.02.2012
Calcitonin ….. 13.7 pg / ml (<11.5) before surgery ….. 18.6 4.0 pmol / l (<3.36) made prior to surgery …… 5.4, (serum Imulite 2000, Method chemiliminiscenta CPD)
Lats (Antibodies antireceptori of HRT) .. <0.3 IU / l.. Negative: <= 1.75 IU / l
I mention that we are ready for the next surgery, here in Romania, is this also your opinion? Thank you in advance for your answer, Daniela STANCIOIU
RESPONSE–This is a case of fortuitous discovery of micro-medullary thyroid cancer with associated C cell hyperplasia. What I suggest is to test again serum CT (preferibly after calcium or pentagastrin stimulation) at greater distance from the time of thyroidectomy. If in that occasion CT is undetectable, you don’t need to undergo completion thyroidectomy. If, on the contrary, basal CT remains detectable or it is elevated after stimulation, completion thyroidectomy should be performed. I also recommend to undergo RET genetic screening to rule out the familial form of the disease, also in view of the C cell hyperplasia. In case that a RET mutation is found, completion thyroidectomy should be performed.
Sincerely, F. Pacini MD