OBJECTIVE: This study was designed to evaluate the ultrasonographic (US) findings of medullary thyroid carcinoma (MTC) as compared to findings for papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: The study included 21 cases of MTC that were surgically diagnosed between 2002 and 2007 and 114 cases of PTC that were diagnosed in 2007. Two radiologists reached a consensus in the evaluation of the US findings. The US findings were classified as recommended by the Thyroid Study Group of the Korean Society of Neuroradiology and Head and Neck Radiology (KSNHNR) and each nodule was identified as suspicious malignant, indeterminate or probably benign. The findings of medullary and papillary carcinomas were compared with use of the chi-squared test. RESULTS: The common US findings for MTCs were solid internal content (91%), an ovoid to round shape (57%), marked hypoechogenicity (52%) and calcifications (52%). Among the 21 cases of MTC nodules, 17 (81%) were classified as suspicious malignant nodules. The mean size (longest diameter) of MTC nodules was 19 +/- 13.9 mm and the mean size (longest diameter) of PTC nodules was 11 +/- 7.4 mm; this difference was statistically significant (p < 0.05). An ovoid to round shape was more prevalent for MTC lesions than for PTC lesions (p < 0.05). CONCLUSION: The US criteria for suspicious malignant nodules as recommended by the Thyroid Study Group of the KSNHNR correspond to most MTC cases. The US findings for MTC are not greatly different from PTC except for the prevalence of an ovoid to round shape.
Adult ; Aged ; Calcitonin/blood ; Carcinoma, Medullary/*ultrasonography ; Carcinoma, Papillary/*ultrasonography ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Thyroid Neoplasms/*ultrasonography

Cases of simultaneously occurring medullary thyroid carcinoma (MTC) and lymphoma are extremely rare. An 84-year-old woman visited the hospital due to dyspnea, resulting from rapidly aggravated enlarged neck mass. Ultrasonography revealed two lesions in the thyroid and they were diagnosed as concurrent medullary thyroid carcinoma and diffuse large B cell lymphoma after total thyroidectomy. A few cases simultaneously diagnosed with MTC and systemic lymphoma have been reported. However, the coexistence of MTC and primary thyroid lymphoma is extremely rare.
Aged, 80 and over ; Carcinoma, Medullary ; Dyspnea ; Female ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Neck ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Ultrasonography

No abstract available.
Aged ; Carcinoma, Medullary/*diagnosis/surgery/ultrasonography ; Epstein-Barr Virus Infections/diagnosis ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Male ; Stomach Neoplasms/*diagnosis/surgery/ultrasonography

Patients with breast lesion suggestive of malignancy underwent Tc-99m MIBI scan in order to assess the value of this technique in the detection of breast carcinoma and axillary lymph node metastasis. One hundred five patients with breast lesion underwent 99m-MIBI scan before biopsy. 20mCi of Tc-99m MIBI was given intravenously in contralateral arm of the breast lesion and planar prone lateral and supine anterior views for 10 minutes each were taken. Pathological diagnoses were carcinoma in 77 breasts of 76 patients and benign in 29 patients. Pathologic types were DCIS in 4, IDC in 62, mucinous carcinoma in 3, medullary carcinoma in 2 and others in 6. The pathologic tumor status was DCIS in 4, T1 in 27 ,T2 in 30, T3 in 6, T4 in 4 and Tx is 6 cases. All patients with multiple lesions were positive. The sensitivity of Tc-99m-MIBI scan was 95%(73/77) and specificity was 69%(20/29). Sensitivity of mammography and ultrasonography were 85% and 82%. Axillary metastasis study showed 68% sensitivity and 92% specificity. The Tc-99m MIBI scan is a highly effective method in the diagnosis of breast cancer.
Adenocarcinoma, Mucinous ; Arm ; Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Medullary ; Diagnosis* ; Humans ; Lymph Nodes ; Mammography ; Neoplasm Metastasis ; Sensitivity and Specificity ; Ultrasonography

Though the first well-documented thyroidectomy was performed in 1595, Kocher at Bern, Switzerland can be called “Father of thyroid surgery” with his outstanding contributions to the understanding of thyroid disease through both clinical surgery and research. Leadership in the surgery and research of thyroid disease shifted largely to the United States in the 20th century beginning with the elegant studies and careful operative techniques of Halsted and his colleagues. Through this century, there were a lot of progress in surgical treatment of benign and malignant thyroid disease, based on hormonal radioimmunoassay, antithyroid agents, propranolol, FNA, ultrasonography, total thyroidectomy, neck dissection, radioiodine ablation, and molecular thyroidology. Modern technology for genetic analysis has induced detection of genetic alterations underlying hereditary forms of MEN and medullary carcinoma. Prospects toward 21th century also will be progress in the endoscopic thyroid surgery, molecular thyroidology and recontruction or transplantation of larynx, trachea and esophagus.
Antithyroid Agents ; Carcinoma, Medullary ; Esophagus ; Humans ; Larynx ; Leadership ; Male ; Neck Dissection ; Propranolol ; Radioimmunoassay ; Switzerland ; Thyroid Diseases ; Thyroid Gland* ; Thyroidectomy ; Trachea ; Ultrasonography ; United States

We report here on a rare case of concurrent papillary thyroid carcinoma and medullary thyroid carcinoma on each of the lobes of the thyroid gland. A 43-year-old female presented with a one-week history of throat discomfort. A neck ultrasonogram (US) was done, along with fine needle aspiration biopsy (FNAB) of the left thyroid nodule, and the results showed papillary cancer. This patient underwent total thyroidectomy and central compartment neck dissection. The pathologic diagnosis of the nodule at the left lobe of the thyroid was papillary thyroid carcinoma (PTC) and the right thyroid nodule was medullary thyroid carcinoma (MTC).
Adult ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Medullary* ; Diagnosis ; Female ; Humans ; Neck ; Neck Dissection ; Pharynx ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Ultrasonography

Neuroendocrine lesions of the thyroid are rare. The most common types are medullary thyroid carcinomas (MTCs) and C-cell hyperplasia. MTCs originate from thyroid parafollicular cells that secrete calcitonin which serves as a serum marker of MTCs. Here, the rare case of a calcitonin-negative neuroendocrine tumor (NET) derived from follicular lesions of the thyroid is described. A 34-year-old man presented at our hospital for the surgical management of an incidental thyroid nodule that was observed on an ultrasound sonography (USG) of the neck. Initially, USG-guided aspiration cytology was performed, and a MTC was suspected. The expressions of thyroglobulin and thyroid transcription factor-1, which are thyroid follicular cell markers, and synaptophysin and chromogranin A, which are neuroendocrine markers, was confirmed following surgical pathology. However, the staining of calcitonin, a marker of MTCs, was not observed. A nonmedullary NET of the thyroid is uncommon, and the distinction between calcitonin-negative NETs and MTCs of the thyroid may be important due to differences in their clinical courses and management.
Adult ; Calcitonin ; Carcinoma, Medullary ; Chromogranin A ; Humans ; Hyperplasia ; Neck ; Neuroendocrine Tumors* ; Pathology, Surgical ; Synaptophysin ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography ; Biomarkers

Background: Thyroid nodule is a common disease of thymid gland. The incidence of malignant nodule is about 3%, so most of thyroid nodules are benign. Because most thyroid nodule morbidity is related to cancerous lesions, early detection of malignant nodule is important. However, some of these nodules are srnall sized or deep seated which were not detected by physieal exarnination but by ultrasonography incidentally. In these cases the diagnostic approach is difficult with conventional methods but it is easy with ultrasound-guided fine needle aspiration (FNA). However, the role of ultrasound-guided FNA on the thyroid nodules has been poorly evaluated, so we tried to assess the diagnostic value of high resolution ultrasound-guided FNA in the thyroid nodules. Methods: We examined the medical records retrospectively of all patients who were engaged in high resolution ultrasonography(ATL Ultramark-9, 10 MHz linear transducer) due to thyroid nodules and/or other thyroid abnormalities from September, 1995 to March, 1996. Ultrasound- guided FNA was performed in 137 patients with palpable or nonpalpable(small sized or deep seated) nodules which were detected by high resolution ultrasonography. Results: The mean age of the patients was 45 and most of them were middle aged. Male to female ratio was 1:8.1. Malignant nodules were frequent in patients over 30 yus of age. Of 137 patients 43 were involutional change, 45 hyperplasia, 12 Hashimotos thyroiditis, 12 follicular neoplasm, ll papillary carcinoma, 1 Hurthle cell tumor, 1 medullary carcinoma, and 12 inadequate specimen. In 22 cases thyroid nodules were not detected by physical examinatian but by ultrasonography and in 31 cases additional thyroid nodules were detected by ultrasonography. In the nature of thyroid nodules, 99 cases were solid, 16 cystic, 22 mixed. Malignant nodule were more frequent in the solid nodule, but thete was no significant difference between each group. The size of masses was categorized into four groups. Thirty-one cases measured less than 1cm, 63 between 1cm and 1.9cm, 29 between 2cm to 2.9cm, and 14 over 3cm. The malignant nodule was not palpable in 3 cases and the smallest was 0.7cm in diameter. Most of malignant lesions were between 1cm and 2.9cm, but the difference of incidence rate of rnalignant nodules between each group was not significant. The incidence rate of malignancy was 8.8% in solitary nodule and 8.7% in multiple nodules. Twenty-three cases including 12 malignancies diagnosed by FNA underwent operation. Of those 13 were papillary earcinoma, 1 follicular carcinoma, 1 medullary carcinoma. Upon the correlation of ultrasound-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 80.0%, the specificity 100% and overall diagnostic accuracy was 86.1%. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 91%. No complication except pain was noted during this study. Conclusion: High resolution ultrasound-guided FNA cytology in the thyroid nodules may be useful in the diagnosis of thyroid cancer especially in the nodules which were small sized or deep seated and also useful in early detection of recurrence of thyroid cancer.
Adenoma, Oxyphilic ; Biopsy, Fine-Needle ; Carcinoma, Medullary ; Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Hyperplasia ; Incidence ; Male ; Medical Records ; Middle Aged ; Recurrence ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroiditis ; Ultrasonography

The medullary carcinoma of the thyroid gland is relatively rare tumor, accounting about 1.2~10% of the all thyroid malignancies, which arises from the parafollicular C-cells in thyroid gland. Operation is the only means to cure the patients. Serial concentrations of serum CEA and calcitonin seem to play an important role in the diagnosis and clinical management and also in the therapeutic monitoring of patients with medullary thyroid cancer. In this case, patient with high serum CEA levels after the resection of rectal cancer underwent abdomen CT scan, colonofibroscopy, FDG-PET scan and chest X-ray, but this imaging methods couldn't detect recurrent evidence of rectal cancer. Neck ultrasonography was performed after 8 years from operation, and fine needle aspiration biopsy was performed for thyroid nodule. As diagnosed to suspicious medullary carcinoma, patient underwent total thyroidectomy and central compartment neck dissection. Patient diagnosed as medullary thyroid cancer without lymph node metastasis and capsular invasion pathologically. As well as this case, in patients with high serum CEA levels after definitive surgical resection of gastrointestinal cancer, if imaging study or FDG-PET scan detect no evidence of recurrence, evaluation of thyroid such as neck ultrasonography and serum calcitonin should be performed.
Abdomen ; Biopsy ; Biopsy, Fine-Needle ; Calcitonin ; Carcinoma, Medullary ; Diagnosis ; Gastrointestinal Neoplasms ; Humans ; Lymph Nodes ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence ; Thorax ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Tomography, X-Ray Computed ; Ultrasonography

Medullary thyroid carcinoma (MTC) is a relatively rare malignant thyroid disease that accounts for approximately 1% to 5% of all thyroid carcinomas. MTC occurs as a sporadic disease and as an inherited disease with the multiple endocrine neoplasia type 2A (MEN2A), MEN2B, and familial non-MEN medullary carcinoma (FMTC). MEN2A is characterized by MTC, pheochromocytoma, and parathyroid adenoma. The mutation of RET proto-oncogene plays an important role in MEN2A syndromes. Recently the authors diagnosed MEN2A patient and screened his family with thyroid ultrasonogram and RET proto-oncogene analysis. A genetic analysis of the peripheral leukocyte showed a codon 618 mutation (Cys618Arg) at exon 10 of the RET proto-oncogene in a family presenting third generations from age 7 to age 56 years. We report this case of MEN2A with a review of the related literatures.
Carcinoma, Medullary ; Codon ; Exons ; Family Characteristics ; Humans ; Leukocytes ; Multiple Endocrine Neoplasia Type 2a* ; Multiple Endocrine Neoplasia Type 2b ; Multiple Endocrine Neoplasia* ; Parathyroid Neoplasms ; Pheochromocytoma ; Proto-Oncogenes* ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Ultrasonography