True Mixed Medullary Papillary Carcinoma of the Thyroid: a Case Report with Low Blood Calcitonin Levels
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True Mixed Medullary Papillary Carcinoma of the Thyroid: a Case Report with Low Blood Calcitonin Levels Pablo Zoroquiain & Javiera Torres & Ignacio Goñi & Lizzet Fernández & Antonieta Solar
Published online: 26 June 2012 # Springer Science+Business Media, LLC 2012
Case History
Materials and Methods
A 24-year-old woman with no personal or family history of thyroid malignancy presented with an asymptomatic solid nodule on the right lobe. A thyroid ultrasonography revealed a 2-cm, irregular, solid and vascularized nodule, on the right lobe. An ultrasound-guided fine needle aspiration (FNA) was then performed, and the cytological findings were consistent with medullary carcinoma. A preoperatory evaluation neck ultrasound was negative for malignant lymph nodes, and calcium and calcitonin blood levels were normal. The patient then was admitted for a total thyroidectomy without lymph node dissection procedure. After 2 years of follow-up, the patient is asymptomatic, normocalcemic and with a neck ultrasound without remarkable findings.
Preparation of Cytological Samples
P. Zoroquiain : J. Torres : L. Fernández : A. Solar Department of Pathology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile I. Goñi Department of Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile P. Zoroquiain (*) Departamento de Anatomía Patológica, Pontificia Universidad Católica de Chile, Lira 85 4to Piso, Santiago 8330074, Chile e-mail: [email protected]
An ultrasound-guided FNA was performed using a 21-gauge needle. The aspirated material was fixed in 10 % buffered formalin, centrifugated for 10 min at 3,000 rpm and then prepared in a paraffin-embedded cell block. Five-micrometrethick histological slides were stained with haematoxylin–eosin. Immunohistochemistry For diagnostic confirmation, immunohistochemical analysis was performed on the cytological and surgically resected specimen. The surgical specimen was fixed in 10 % buffered formalin, processed routinely and embedded in paraffin blocks. Immunohistochemistry with antibodies against chromogranin A (Cro A) was performed in the cell block. For the surgical specimen, a carcino-embrionary antigen (CEA), thyroglobulin, calcitonin, Cro A, synaptophysin and HMBE-1 were performed (Table 1).
Results The FNA revealed fragments of tumour compound of cohesive medium-large cells with round, large, slightly pleomorphic, with finely dispersed chromatin nuclei and scanty eosinophilic cytoplasm, arranged in clusters and sheets (Fig. 1a, b). Immunohistochemical studies using Cro A were positive in the neoplastic cells (Fig. 1, inset). The diagnosis made was “morphological and immunohistochemical findings consistent with medullary carcinoma”. A total
Endocr Pathol (2012) 23:168–171
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Table 1 Description of the antibodies Antigen
Clone
Dilution
Brand
Chromogranin A CEA Calcitonin Synaptophysin HBME-1 Thyroglobulin
DAK-A3 CEA88 Calcitonin Sy38 HBME-1 DAK-Tg6
1:100 1:50 1:200 1:20 1:20 1:150
Dako Biogenex Dako Dako Dako Dako
CE
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