Unexpected Intra-Operative Discovery of Metastatic Medullary Thyroid Carcinoma: A Case Report
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Medullary thyroid cancer (MTC) is a rare carcinoma of calcitonin producing C cells of the thyroid which is often undiagnosed until after metastatic spread with clinical presentation. Surgical management with radiographic planning is necessary with excision of complete cervical lymph nodes to prevent recurrence. Here, we report a case of an exceedingly rare unplanned converted operation of an incidentally discovered metastatic MTC in a 28-year-old white female. Prior to the operation, ultrasound revealed an 8-mm nodule of mixed cystic and solid mural components, fine needle aspiration showing atypia of indeterminate etiology, Bethesda 3 with mildly suspicious appearance. Surgical exploration revealed a 10-cm right sided mass extending inferiorly from the clavicular head to the thyroid fat pad, encompassing the carotid sheath with the recurrent laryngeal nerve and extension on to the esophagus. Careful dissection with preservation of all vital structures and the recurrent laryngeal nerve was performed and is presented. Postoperative follow-up included serum calcitonin and carcinoembryonic antigen measurements, which returned to normal levels. This case underscores the importance of thorough preoperative evaluation, intraoperative vigilance, and shared decision-making when unexpected findings arise. It contributes uniquely to the literature by highlighting the challenges and decision-making processes involved in managing unexpected metastatic MTC discovered intraoperatively, emphasizing the need for preparedness for potential extensive surgery even when preoperative evaluations suggest low risk.
Abstract
Medullary thyroid cancer (MTC) is a rare carcinoma of calcitonin producing C cells of the thyroid which is often undiagnosed until after metastatic spread with clinical presentation. Surgical management with radiographic planning is necessary with excision of complete cervical lymph nodes to prevent recurrence. Here, we report a case of an exceedingly rare unplanned converted operation of an incidentally discovered metastatic MTC in a 28-year-old white female. Prior to the operation, ultrasound revealed an 8-mm nodule of mixed cystic and solid mural components, fine needle aspiration showing atypia of indeterminate etiology, Bethesda 3 with mildly suspicious appearance. Surgical exploration revealed a 10-cm right sided mass extending inferiorly from the clavicular head to the thyroid fat pad, encompassing the carotid sheath with the recurrent laryngeal nerve and extension on to the esophagus. Careful dissection with preservation of all vital structures and the recurrent laryngeal nerve was performed and is presented. Postoperative follow-up included serum calcitonin and carcinoembryonic antigen measurements, which returned to normal levels. This case underscores the importance of thorough preoperative evaluation, intraoperative vigilance, and shared decision-making when unexpected findings arise. It contributes uniquely to the literature by highlighting the challenges and decision-making processes involved in managing unexpected metastatic MTC discovered intraoperatively, emphasizing the need for preparedness for potential extensive surgery even when preoperative evaluations suggest low risk.
참고문헌 (22)
- Ahmed SR, "Clinical review : incidentally discovered medullary thyroid cancer : diagnostic strategies and treatment", J Clin Endocrinol Metab, 96, pp.1237~1245 (2011)
- Stamatakos M, "Medullary thyroid carcinoma : the third most common thyroid cancer reviewed", Oncol Lett, 2, pp.49~53 (2011)
- "Medullary thyroid cancer" (2024)[URL]
- Smit J, "Treatment of advanced medullary thyroid cancer", Thyroid Res, 6(Suppl 1), pp.S7~ (2013)
- "Medullary thyroid cancer overview: what to know about this rare form of thyroid cancer" (2018)[URL]
- Wells SA Jr, "Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma", Thyroid, 25, pp.567~610 (2015)
- Moley JF, "Patterns of nodal metastases in palpable medullary thyroid carcinoma : recommendations for extent of node dissection", Ann Surg, 229, pp.880~887 (1999)
- Wells SAJ Jr, "Predictive DNA testing and prophylactic thyroidectomy in patients at risk for multiple endocrine neoplasia type 2A", Ann Surg, 220, pp.237~247 (1994)
- American Thyroid Association Guidelines Task Force, "Medullary thyroid cancer : management guidelines of the American Thyroid Association", Thyroid, 19, pp.565~612 (2009)
- Correia-Deur JEM, "Sporadic medullary thyroid carcinoma : clinical data from a university hospital", Clinics(Sao Paulo), 64, pp.379~386 (2009)
- "Medullary" (2018)[URL]
- Beninato T, "Preoperative diagnosis predicts outcomes in patients with concurrent medullary and papillary thyroid carcinoma", World J Endocr Surg, 9, pp.94~99 (2017)
- Jo VY, "Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology", Am J Clin Pathol, 134, pp.450~456 (2010)
- Arrangoiz R, "Case report and literature review of medullary thyroid carcinoma", Am J Otolaryngol Head Neck Surg, 1, pp.1026~ (2018)
- Wirth LJ, "Efficacy of selpercatinib in RET-altered thyroid cancers", N Engl J Med, 383, pp.825~835 (2020)
- Chatal JF, "Survival improvement in patients with medullary thyroid carcinoma who undergo pretargeted anti-carcinoembryonic-antigen radioimmunotherapy : a collaborative study with the French Endocrine Tumor Group", J Clin Oncol, 24, pp.1705~1711 (2006)
- Borget I, "Editorial : Calcitonin determination in patients with nodular thyroid disease", J Clin Endocrinol Metab, 92, pp.425~427 (2007)
- Mirallié E, "Results of surgical treatment of sporadic medullary thyroid carcinoma following routine measurement of serum calcitonin", Eur J Surg Oncol, 30, pp.790~795 (2004)
- Jaiswal S, "Cytomorphological features of medullary thyroid carcinoma : an analysis based on 41 ultrasound-guided fine-needle aspiration specimens", World J Endocr Surg, 10, pp.108~118 (2018)
- Nosé V, "Familial thyroid cancer : a review", Mod Pathol, 24(Suppl 2), pp.S19~S33 (2011)
- Oakley GM, "Establishing a familial basis for papillary thyroid carcinoma using the Utah Population Database", JAMA Otolaryngol Head Neck Surg, 139, pp.1171~1174 (2013)
- Garg S, "Bilateral level I lymphadenopathy in differentiated thyroid carcinoma : a case report and review of literature", World J Endocr Surg, 12, pp.41~44 (2020)