TY - JOUR
T1 - Mediastinal Mass as First Clinical Manifestation of Medullary Thyroid Microcarcinoma in a Patient With Hashimoto’s Thyroiditis
AU - Garcia-Ruiz, Victor Raul
AU - Suarez-Rojas, Jacsel
AU - Alvarez-Gamero, Julio Cesar
AU - Somocurcio-Peralta, Jose Rene
AU - Paz-Ibarra, Jose Luis
N1 - Publisher Copyright:
© The authors.
PY - 2022/12
Y1 - 2022/12
N2 - Medullary thyroid cancer is a rare neuroendocrine tumor with ag-gressive behavior and an uncertain prognosis. Calcitonin is the associated tumor marker; however, neuroendocrine tumors of the lung or intestine can also present high values. We report the case of a 53-year-old patient presenting with dry cough for 3 years. Comput-ed tomography (CT) showed a 58-mm expansive lesion in the right anterior mediastinum and cervical ultrasound informed a 9-mm hypoechoic nodule with a lobulated edge and thick calcifications. Cytology reported Hashimoto’s thyroiditis. He underwent emergent surgery for respiratory failure. The pathological study informed G2 neuroendocrine carcinoma, immunohistochemistry showed: cytokeratin (+), vimentin (+), alpha-actin (-), synaptophysin (+), chromogranin (+), Ki-67: 10%. He progressed with bone metastasis visualized in scintigraphy and mediastinal tumor remnants, adenop-athy, and pulmonary nodules on CT scan, prompting chemotherapy. Due to elevated and increasing calcitonin, an ultrasound study with needle washout for calcitonin resulted in 1,724 pg/mL, and cytology of the nodule reported medullary carcinoma. He was finally diagnosed with medullary thyroid microcarcinoma with metastasis to the mediastinum. Coexistence with Hashimoto’s thyroiditis could alter the initial fine-needle aspiration results. We conclude that in the case of calcitonin-secreting neuroendocrine tumors or medullary thyroid cancer, calcitonin fine needle aspirate washout may be help-ful in elucidating a diagnosis. Due to its severity, medullary thyroid cancer should always be approached and managed aggressively, even microcarcinomas.
AB - Medullary thyroid cancer is a rare neuroendocrine tumor with ag-gressive behavior and an uncertain prognosis. Calcitonin is the associated tumor marker; however, neuroendocrine tumors of the lung or intestine can also present high values. We report the case of a 53-year-old patient presenting with dry cough for 3 years. Comput-ed tomography (CT) showed a 58-mm expansive lesion in the right anterior mediastinum and cervical ultrasound informed a 9-mm hypoechoic nodule with a lobulated edge and thick calcifications. Cytology reported Hashimoto’s thyroiditis. He underwent emergent surgery for respiratory failure. The pathological study informed G2 neuroendocrine carcinoma, immunohistochemistry showed: cytokeratin (+), vimentin (+), alpha-actin (-), synaptophysin (+), chromogranin (+), Ki-67: 10%. He progressed with bone metastasis visualized in scintigraphy and mediastinal tumor remnants, adenop-athy, and pulmonary nodules on CT scan, prompting chemotherapy. Due to elevated and increasing calcitonin, an ultrasound study with needle washout for calcitonin resulted in 1,724 pg/mL, and cytology of the nodule reported medullary carcinoma. He was finally diagnosed with medullary thyroid microcarcinoma with metastasis to the mediastinum. Coexistence with Hashimoto’s thyroiditis could alter the initial fine-needle aspiration results. We conclude that in the case of calcitonin-secreting neuroendocrine tumors or medullary thyroid cancer, calcitonin fine needle aspirate washout may be help-ful in elucidating a diagnosis. Due to its severity, medullary thyroid cancer should always be approached and managed aggressively, even microcarcinomas.
KW - Calcitonin
KW - Hashimoto’s disease
KW - Medullary carcinoma
KW - Neoplasm metastasis
KW - Thyroid neoplasms
UR - http://www.scopus.com/inward/record.url?scp=85146129170&partnerID=8YFLogxK
U2 - 10.14740/jem841
DO - 10.14740/jem841
M3 - Artículo
AN - SCOPUS:85146129170
SN - 1923-2861
VL - 12
SP - 198
EP - 201
JO - Journal of Endocrinology and Metabolism
JF - Journal of Endocrinology and Metabolism
IS - 6
ER -