|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 [email protected] for a second opinion before you submit to have surgery.
|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.
Tilted Fry Pan Effect pushes nucleus to the extreme edge of the pan.
On Dif Quik calcitonin granules are seen in these spindle cells.
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.
Conclusion: 1. Serum calcitonin case finding for suspicious cytology with eccentric nuclei or spindle cells.
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