Thyroid Cancer 101: Are you being treated for the correct thyroid cancer? Read these 4 cases and then get a second opinion before the surgery.

Thyroid Cancer 101: Are you being treated for the correct thyroid cancer? Read these 4 cases and then get a second opinion before the surgery.

Thyroid Cancer 101: Are you being treated for the correct thyroid cancer? Read these 4 cases and then get a second opinion before the surgery.
Thyroid Cancer 101: Are you being treated for the correct thyroid cancer? Read these 4 cases and then get a second opinion before the surgery.

 Medullary Cancer MCT: Novel Insights Enabling Early Diagnosis For Clinicians / Pathologists

The importance of an out of network second opinion if there is Hurthle or follicular neoplasm mentioned in the cytology report or there is atypical spindle cells mentioned. They may be missing a medullary thyroid cancer. The first surgery is crucial for potential cure. 4 cases to think about before you have surgery.

Call me at 310-393-8860 or thyroid.manager@protonmail.com. for a second opinion before you submit to have surgery.

DR.G.

Keck/USC School of Medicine, Los Angeles, CA, United States.
Interventional Thyroidology, Santa Monica Thyroid Center, Santa Monica, CA, United States.
Introduction: Early diagnosis of MCT is critical but often challenging and overlooked. Cytology can mimic Hurthle cell/follicular neoplasms delaying recognition and treatment. We share our experience and insights with novel microscopic and molecular parameters for early definitive diagnosis.Methods: 4 MCT cases with failed early diagnosis and significant consequences were reviewed. Cytology and molecular marker features ( ThyGeNext mutational analysis and ThyraMIR microRNA profiling) were utilized for early diagnosis.

Results: Cytology features for parafollicular cell origin include spindle cells, extreme eccentric salt and pepper nuclei and lack of nucleoli.

Extreme excentric Salt and pepper nucleus and lack of nucleoli and spindle cells should put MCT in the DD.

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Tilted Fry Pan Effect pushes nucleus to the extreme edge of the pan.

sunny_side_up_egg-2-medullary-ca-cells

On Dif Quik calcitonin granules are seen in these spindle cells.

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Reliable molecular features for MCT included hyperexpression of NXK2.1. ( TTF-1) relative to PAX* messenger RNA, and strong hyperexpression of miRNA 375 relative to the other thyroid associated miRNAs.RET gene mutations can be readly detected for further support.. Ancillary tools to use include serum and needle washout calcitonin.
Case Summaries:
#1 Pathologist DX: Hurthle carcinoma.Treated for years with RAI/131 and multiple neck dissections.Patient died with metastatic MCT.#2 DX follicular thyroid carcinoma.Outside opinion= First Dif Quik slide classic MCT.#3 Dx was BTN for years. positive for MCT 4 years ago on first biopsy. Positve microRNA associated with MCT ( Interpace Diagnostics).#4 No moleculars markers were done on previous atypical cell results.
A delay of 4 years metastatic MCT lymph nodes at surgery.The first cytololy classic MCT fours earlier.

Conclusion: 1. Serum calcitonin case finding for suspicious cytology with eccentric nuclei or spindle cells.
2. Calcitonin needle washout from nodules to diagnose MCT.
3. Hyperexpression of MTC messenger and microRNA are reliable and definitive
4. Patients should consider second opinions on all diagnosis of Hurthle cell or follicular neoplasms to avoid the wrong treatment.
5. Failure to Dx MCT could result in a hypertensive crisis from a pheochromocytoma in a MEA syndrome.

 

 

 

 

 

 

Richard B. Guttler MD, FACE, ECNU       Director, Santa Monica Thyroid Center   American College of Endocrinology Certified Thyroid Physician Sonologist   Endocrine Certification in Neck Ultrasound “EC

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