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Endocrine Pathology Online

Pathology of Medullary Carcinoma of the Thyroid:

Undifferentiated, neuroendocrine tumor arising from the Parafollicular cells or C-cells of the Thyroid gland.

 

 Dr Sampurna Roy MD   

 

                                                                                                                      

 

Medullary thyroid carcinoma is an undifferentiated, neuroendocrine tumor which arises from the parafollicular cells or C-cells of the thyroid gland.

The particular characteristic of this tumor is the production of calcitonin 1 as well as ACTH, histaminase, corticotrophin, vasoactive intestinal peptide, serotonin, and carcinoembriogenic antigen (CEA).

Medullary thyroid carcinoma can be either sporadic (6570%) or familial as part of the multiple endocrine neoplasia type 2 (MEN2) syndrome. 

In most patients with a newly diagnosed MTC, a locoregional metastasis has already taken place, and a distant metastasis is present in 1520% of patients.

The most common sites of metastasis presentation are the lungs, liver, and bones, and metastasis rarely occurs in the brain, skin, and breast.

Munoz Bendix C, Santacroce A, Gierga K, et al. Recurrent spinal metastasis of a sporadic medullary carcinoma of the thyroid after radiation therapy: a case report and review of the literature. Clinical Case Reports. 2016;4(1):9-18. doi:10.1002/ccr3.409.

Medullary carcinoma can appear in many different growth patterns.

The most common variant comprises small packets of short spindle cells with a readily recognizable "neuroendocrine" appearance.

It some rare cases papillary structures are present.  Although papillae are present, these tumours are clearly not papillary carcinoma because the characteristic nuclear changes are absent.

The confirmation of medullary carcinoma rests on argyrophil stains, immunohistochemistry for calcitonin, calcitonin gene product, other neuroendocrine markers.

 

Further reading

Diagnosis of medullary thyroid carcinoma by calcitonin measurement in fine-needle aspiration biopsy specimens.

Molecular characterization of the desmoplastic tumor stroma in medullary thyroid carcinoma.

Current approaches to medullary thyroid carcinoma, sporadic and familial.

Natural history, diagnosis, treatment and outcome of medullary thyroid cancer: 37 years experience on 157 patients.

Pseudoangiosarcomatous features in medullary thyroid carcinoma spindle-cell variant. Report of a case studied by FNA and immunohistochemistry.

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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