1
|
Yang CM. A Case Study of Multiple Endocrine Neoplasia Type 2A. Cureus 2022; 14:e27504. [PMID: 36060328 PMCID: PMC9424833 DOI: 10.7759/cureus.27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 12/01/2022] Open
Abstract
Multiple endocrine neoplasia type 2 is an autosomal dominant neoplastic syndrome with subtypes multiple endocrine neoplasia type 2A, multiple endocrine neoplasia type 2B, and familial medullary thyroid carcinoma. Medullary thyroid carcinoma universally coincides with multiple endocrine neoplasia type 2. Multiple endocrine neoplasia type 2A is a rare disease and the affected patients are generally asymptomatic. The morbidity and mortality are mainly due to medullary thyroid carcinoma and often proper clinical workup is warranted for expedited surgical intervention. Total thyroidectomy along with neck dissection may be required for disease control. This report will cover a patient who presented with medullary thyroid carcinoma and was worked up to have multiple endocrine neoplasia type 2A. She underwent total thyroidectomy with central neck dissection.
Collapse
|
2
|
Parra-Robert M, Orois A, Augé JM, Halperin I, Filella X, Molina R. Utility of proGRP as a tumor marker in the medullary thyroid carcinoma. ACTA ACUST UNITED AC 2017; 55:441-446. [DOI: 10.1515/cclm-2016-0572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/19/2016] [Indexed: 01/28/2023]
Abstract
AbstractBackground:Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor caused by a malignant transformation in the parafollicular C-cells of the thyroid, where calcitonin (CT) is released. Nowadays the main tumor markers (TM) used in the diagnosis and follow-up of MTC patients are CT and carcinoembryonic antigen (CEA). Nonetheless, progastrin releasing peptide (proGRP) has been recently proposed as a TM useful in the MTC. Our aims were to investigate the release of proGRP in thyroid tumors, its role in the assessment of advanced MTC and its utility in the differential diagnosis between MTC and non-MTC thyroid tumors.Methods:Serum samples from 22 patients with MTC and 16 with non-MTC were collected. Patients were classified into advanced cancer or no evidence of disease (NED). ProGRP was performed by Architect (Abbot Diagnostics), CT by Liaison (Diasorin) and CEA by Cobas E601(Roche Diagnostics).Results:ProGRP median concentration in advanced MTC was significantly higher (1398.4 pg/mL) when compared with non-MTC, either in advanced disease (24.9 pg/mL) or NED (14.6 pg/mL). In non-MTC patients, proGRP median concentration was below its cutoff level (50 pg/mL). Similar to CT, proGRP was able to detect 88.9% of MTC patients, but with a slightly lower specificity of 76.9%. Using proGRP together with CT the sensitivity increased to 100%.Conclusions:The low prevalence of this malignancy strongly recommends further collaborative studies, mainly focused on monitoring proGRP during tyrosine kinase inhibitors treatment for early detection of resistance and assessing its usefulness to avoid the observed false positive fluctuations that occur with CT and CEA.
Collapse
|
3
|
Rowe CW, Bendinelli C, McGrath S. Charting a course through the CEAs: diagnosis and management of medullary thyroid cancer. Clin Endocrinol (Oxf) 2016; 85:340-3. [PMID: 27230389 DOI: 10.1111/cen.13114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/15/2016] [Accepted: 05/22/2016] [Indexed: 01/10/2023]
Abstract
Medullary thyroid cancer (MTC) is an uncommon thyroid cancer that requires a high index of suspicion to facilitate diagnosis of early-stage disease amenable to surgical cure. The challenges of diagnosis, as well as management in the setting of persistent disease, are explored in the context of a case presenting with the incidental finding of elevated carcinoembryonic antigen (CEA) and an (18) F-fluorodeoxyglucose positron emission tomography ((18) F-FDG-PET)-positive thyroid incidentaloma detected following treatment of colorectal cancer. Strategies to individualize prognosis, and emerging PET-based imaging modalities, particularly the potential role of (18) F-DOPA-PET in staging, are reviewed.
Collapse
Affiliation(s)
- Christopher W Rowe
- Department of Endocrinology, John Hunter Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Cino Bendinelli
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Department of Surgery, John Hunter Hospital, Newcastle, Australia
| | - Shaun McGrath
- Department of Endocrinology, John Hunter Hospital, Newcastle, Australia
| |
Collapse
|
4
|
Chigurupati MV, Madiraju V, Chigurupati N, Shinkar PG, Dhagam S, Prabhakar Rao VVS. Great cervical venous tumoral thrombosis of melanotic medullary carcinoma thyroid: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography enabled diagnosis and radiotherapy planning. Indian J Nucl Med 2016; 31:45-8. [PMID: 26917895 PMCID: PMC4746842 DOI: 10.4103/0972-3919.172361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The authors report an extremely rare occurrence of a massive tumor thrombus involving right internal and external jugular veins extending into superior vena cava from a still rarer melanotic medullary carcinoma thyroid in the postoperative follow-up. The case was managed by hypofractionated intensity modulated radiotherapy technique with gratifying results.
Collapse
Affiliation(s)
| | - Vidya Madiraju
- Department of Radiation Oncology, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - Namrata Chigurupati
- Department of Radiation Oncology, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - Pawan Gulabrao Shinkar
- Department of Radio Diagnosis, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - Snehalatha Dhagam
- Department of Pathology, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - Vatturi Venkata Satya Prabhakar Rao
- Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India
| |
Collapse
|
5
|
Yeganeh MZ, Sheikholeslami S, Hedayati M. RET Proto Oncogene Mutation Detection and Medullary Thyroid Carcinoma Prevention. Asian Pac J Cancer Prev 2015; 16:2107-17. [DOI: 10.7314/apjcp.2015.16.6.2107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
6
|
Maia AL, Siqueira DR, Kulcsar MAV, Tincani AJ, Mazeto GMFS, Maciel LMZ. Diagnóstico, tratamento e seguimento do carcinoma medular de tireoide: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia. ACTA ACUST UNITED AC 2014; 58:667-700. [DOI: 10.1590/0004-2730000003427] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/12/2014] [Indexed: 12/20/2022]
Abstract
Introdução O carcinoma medular de tireoide (CMT) origina-se das células parafoliculares da tireoide e corresponde a 3-4% das neoplasias malignas da glândula. Aproximadamente 25% dos casos de CMT são hereditários e decorrentes de mutações ativadoras no proto-oncogene RET (REarranged during Transfection). O CMT é uma neoplasia de curso indolente, com taxas de sobrevida dependentes do estádio tumoral ao diagnóstico. Este artigo descreve diretrizes baseadas em evidências clínicas para o diagnóstico, tratamento e seguimento do CMT. Objetivo O presente consenso, elaborado por especialistas brasileiros e patrocinado pelo Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia, visa abordar o diagnóstico, tratamento e seguimento dos pacientes com CMT, de acordo com as evidências mais recentes da literatura. Materiais e métodos: Após estruturação das questões clínicas, foi realizada busca das evidências disponíveis na literatura, inicialmente na base de dados do MedLine-PubMed e posteriormente nas bases Embase e SciELO – Lilacs. A força das evidências, avaliada pelo sistema de classificação de Oxford, foi estabelecida a partir do desenho de estudo utilizado, considerando-se a melhor evidência disponível para cada questão. Resultados Foram definidas 11 questões sobre o diagnóstico, 8 sobre o tratamento cirúrgico e 13 questões abordando o seguimento do CMT, totalizando 32 recomendações. Como um todo, o artigo aborda o diagnóstico clínico e molecular, o tratamento cirúrgico inicial, o manejo pós-operatório e as opções terapêuticas para a doença metastática. Conclusões O diagnóstico de CMT deve ser suspeitado na presença de nódulo tireoidiano e história familiar de CMT e/ou associação com feocromocitoma, hiperparatireoidismo e/ou fenótipo sindrômico característico, como ganglioneuromatose e habitus marfanoides. A punção aspirativa por agulha fina do nódulo, a dosagem de calcitonina sérica e o exame anatomopatológico podem contribuir na confirmação do diagnóstico. A cirurgia é o único tratamento que oferece a possibilidade de cura. As opções de tratamento da doença metastática ainda são limitadas e restritas ao controle da doença. Uma avaliação pós-cirúrgica criteriosa para a identificação de doença residual ou recorrente é fundamental para definir o seguimento e a conduta terapêutica subsequente.
Collapse
|
7
|
Bentzien F, Zuzow M, Heald N, Gibson A, Shi Y, Goon L, Yu P, Engst S, Zhang W, Huang D, Zhao L, Vysotskaia V, Chu F, Bautista R, Cancilla B, Lamb P, Joly AH, Yakes FM. In vitro and in vivo activity of cabozantinib (XL184), an inhibitor of RET, MET, and VEGFR2, in a model of medullary thyroid cancer. Thyroid 2013; 23:1569-77. [PMID: 23705946 PMCID: PMC3868259 DOI: 10.1089/thy.2013.0137] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND A limited number of approved therapeutic options are available to metastatic medullary thyroid cancer (MTC) patients, and the response to conventional chemotherapy and/or radiotherapy strategies is inadequate. Sporadic and inherited mutations in the tyrosine kinase RET result in oncogenic activation that is associated with the pathogenesis of MTC. Cabozantinib is a potent inhibitor of MET, RET, and vascular endothelial factor receptor 2 (VEGFR2), as well as other tyrosine kinases that have been implicated in tumor development and progression. The object of this study was to determine the in vitro biochemical and cellular inhibitory profile of cabozantinib against RET, and in vivo antitumor efficacy using a xenograft model of MTC. METHODS Cabozantinib was evaluated in biochemical and cell-based assays that determined the potency of the compound against wild type and activating mutant forms of RET. Additionally, the pharmacodynamic modulation of RET and MET and in vivo antitumor activity of cabozantinib was examined in a MTC tumor model following subchronic oral administration. RESULTS In biochemical assays, cabozantinib inhibited multiple forms of oncogenic RET kinase activity, including M918T and Y791F mutants. Additionally, it inhibited proliferation of TT tumor cells that harbor a C634W activating mutation of RET that is most often associated with MEN2A and familial MTC. In these same cells grown as xenograft tumors in nude mice, oral administration of cabozantinib resulted in dose-dependent tumor growth inhibition that correlated with a reduction in circulating plasma calcitonin levels. Moreover, immunohistochemical analyses of tumors revealed that cabozantinib reduced levels of phosphorylated MET and RET, and decreased tumor cellularity, proliferation, and vascularization. CONCLUSIONS Cabozantinib is a potent inhibitor of RET and prevalent mutationally activated forms of RET known to be associated with MTC, and effectively inhibits the growth of a MTC tumor cell model in vitro and in vivo.
Collapse
|
8
|
Figlioli G, Landi S, Romei C, Elisei R, Gemignani F. Medullary thyroid carcinoma (MTC) and RET proto-oncogene: Mutation spectrum in the familial cases and a meta-analysis of studies on the sporadic form. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2013; 752:36-44. [DOI: 10.1016/j.mrrev.2012.09.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 09/28/2012] [Accepted: 09/29/2012] [Indexed: 12/16/2022]
|
9
|
|
10
|
Chen H, Sippel RS, O'Dorisio MS, Vinik AI, Lloyd RV, Pacak K. The North American Neuroendocrine Tumor Society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas 2010; 39:775-83. [PMID: 20664475 PMCID: PMC3419007 DOI: 10.1097/mpa.0b013e3181ebb4f0] [Citation(s) in RCA: 362] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pheochromocytomas, intra-adrenal paraganglioma, and extra-adrenal sympathetic and parasympathetic paragangliomas are neuroendocrine tumors derived from adrenal chromaffin cells or similar cells in extra-adrenal sympathetic and parasympathetic paraganglia, respectively. Serious morbidity and mortality rates associated with these tumors are related to the potent effects of catecholamines on various organs, especially those of the cardiovascular system. Before any surgical procedure is done, preoperative blockade is necessary to protect the patient against significant release of catecholamines due to anesthesia and surgical manipulation of the tumor. Treatment options vary with the extent of the disease, with laparoscopic surgery being the preferred treatment for removal of primary tumors. Medullary thyroid cancer (MTC) is a malignancy of the thyroid C cells or parafollicular cells. Thyroid C cells elaborate a number of peptides and hormones, such as calcitonin, carcinoembryonic antigen, and chromogranin A. Some or all of these markers are elevated in patients with MTC and can be used to confirm the diagnosis as well as to follow patients longitudinally for recurrence. Medullary thyroid cancer consists of a spectrum of diseases that ranges from extremely indolent tumors that are stable for many years to aggressive types associated with a high mortality rate. Genetic testing for RET mutations has allowed identification of familial cases and prophylactic thyroidectomy for cure. The only curative treatment is complete surgical resection.
Collapse
Affiliation(s)
- Herbert Chen
- Department of Surgery, University of Wisconsin, Madison, WI 53792-7375, USA.
| | | | | | | | | | | |
Collapse
|
11
|
Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009; 19:565-612. [PMID: 19469690 DOI: 10.1089/thy.2008.0403] [Citation(s) in RCA: 759] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians. METHODS Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. RESULTS Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and handling of devascularized parathyroid glands), initial evaluation and treatment of postoperative patients (including the role of completion thyroidectomy), management of persistent or recurrent MTC (including the role of tumor marker doubling times, and treatment of patients with distant metastases and hormonally active metastases), long-term follow-up and management (including the frequency of follow-up and imaging), and directions for future research. CONCLUSIONS One hundred twenty-two evidence-based recommendations were created to assist in the clinical care of MTC patients and to share what we believe is current, rational, and optimal medical practice.
Collapse
|
12
|
Allen SM, Bodenner D, Suen JY, Richter GT. Diagnostic and surgical dilemmas in hereditary medullary thyroid carcinoma. Laryngoscope 2009; 119:1303-11. [DOI: 10.1002/lary.20299] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
13
|
Puñales MKC, da Rocha AP, Meotti C, Gross JL, Maia AL. Clinical and oncological features of children and young adults with multiple endocrine neoplasia type 2A. Thyroid 2008; 18:1261-8. [PMID: 18991485 DOI: 10.1089/thy.2007.0414] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND RET genotype analysis allows identification of asymptomatic carriers at risk of developing medullary thyroid carcinoma (MTC). However, there is still controversy regarding the ideal timing and extent of prophylactic thyroidectomy due to the wide spectrum of clinical presentation. Surveillance of a large number of young patients is crucial to advance our understanding of the natural course of the disease. This study aimed to describe the clinical presentation, oncological features, and treatment outcome of children and young adults harboring RET mutations followed at our institution from 1997 to 2007. METHODS Forty-one individuals aged < or =25 years from 17 independent multiple endocrine neoplasia type 2A kindred were studied. Twenty-one individuals presented with thyroid nodules at diagnosis, and 20 were disease free at physical examination. RESULTS Preoperative basal calcitonin levels were elevated in 85.7% of patients with clinical disease and in 54.5% of asymptomatic carriers. Thyroid ultrasonography (US) showed one or more nodules in 69.0% of the patients. A positive correlation between age at surgery and tumor-node-metastasis (TNM) stages was observed (p < 0.001). None of the patients under 15 years of age presented lymph node or distant metastasis. After a follow-up of 4.4 +/- 1.4 years all asymptomatic patients were disease free based on physical examination, cervical US, and undetectable serum calcitonin levels. In the group of patients with clinical disease, 47.6% have persistent disease (follow-up of 12.0 +/- 5.9 years). Indeed, palpable thyroid nodule at diagnosis was significantly associated with persistent disease (p < 0.001, odds ratio [OR] 1.9, 95% confidence interval [CI 95%] 1.27-2.87). Of note, none of the patients who presented lymph node metastasis at diagnosis were cured by surgical intervention (p < 0.001, OR 5.0, CI 95% 1.45-17.0). CONCLUSION Our data show a time-dependent MTC progression. The presence of a palpable thyroid nodule and lymph node metastasis at diagnosis was associated with persistent or recurrent disease after surgical procedure.
Collapse
Affiliation(s)
- Márcia K C Puñales
- Endocrine Division, Thyroid Section, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil
| | | | | | | | | |
Collapse
|
14
|
Skip metastases in medullary thyroid carcinoma: a single-center experience. Surg Today 2008; 38:499-504. [PMID: 18516528 DOI: 10.1007/s00595-007-3664-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 05/02/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Total thyroidectomy (TT) with level VI and VII central neck dissection is the initial treatment for medullary thyroid carcinoma (MTC) without identifiable neck metastasis. Level II to V lateral neck dissection is performed if neck metastasis is present or suspected. We conducted this study to identify the frequency and clinical determinants of skip neck metastasis in MTC. METHODS We reviewed the medical records of 32 patients who underwent TT and bilateral neck dissection for MTC. The clinical features were correlated with pN status in the central versus lateral compartments of the neck. RESULTS Neck lymph node metastasis (pN+) was found in 20 patients (62.5%) and skip metastases were found in 7 (35%) patients. The sensitivity of the pN status of the central compartment of the neck to predict the pN status of the lateral compartment of the neck was 53.8% and specificity was 63.2%. We found pN+ in 90% of the patients with lymph nodes >15 mm in diameter versus 50% in those with lymph nodes <15 mm in diameter. CONCLUSIONS There is skip metastasis in MTC. It is unsafe to use the lymph node status of the central compartment of the neck to define the pN status of the lateral neck. A lymph node greater than 15 mm in diameter is related to pN status.
Collapse
|
15
|
Weigel RJ. Thyroid. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Long-term clinical and biochemical follow-up in medullary thyroid carcinoma: a single institution's experience over 20 years. Ann Surg 2007; 246:815-21. [PMID: 17968174 DOI: 10.1097/sla.0b013e31813e66b9] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Many patients with medullary thyroid carcinomas (MTC) have reoperative surgery in different hospitals, which makes their follow-up difficult. To comprehend these complex courses and to find relevant prognostic factors we report a 20-year single center experience of 289 patients with MTC or precursor C-cell-hyperplasias. PATIENTS AND METHODS Between April 1986 and May 2006, 289 consecutive patients with MTC or MEN2 gene carriers were treated at the Department of Surgery at the University Hospital Düsseldorf. Tumor stages were documented according to the classification of the International Union against Cancer 5th edition, 1997 (Schott. Endocr Relat Cancer. 2006;13:779-795). A system to easily comprehend operative procedures is suggested. RESULTS There were 159 female and 130 male patients (f/m ratio 1.22). Mean age at time of diagnosis was 32 years (4-77) in the familial cases and 53 years (23-84) years in the sporadic cases. Sixty-six patients (23%) had multifocal disease. Twelve MEN2-patients had only C-cell-hyperplasia (pT0). Tumor stage was pT1 in 86 patients, pT2 in 106 patients, pT3 in 25 patients, pT4 in 52 patients and unclear in 8 patients. In the 289 patients 648 operations were performed. One hundred seventy patients had more than 1 operation (59%). Ninety-nine patients (34%) are calcitonin-negative and 91 patients (31%) live with elevated calcitonin. Median follow-up time of the surviving 211 patients was 8.9 years (range, 0.3-30.7 years). The 5- and 10-year survival of all tumor patients was 86% and 68%, respectively. CONCLUSION The chance to achieve biochemical cure in MTC is clearly dependent on the primary tumor size. The chance for long-term biochemical cure in a pT4-tumor is almost nil even after multiple and extended reoperations, whereas a pT1 tumor can be cured in up to 67% of the patients. Long-term survival, however, can be achieved even in pT4 tumor patients in almost 50%.
Collapse
|
17
|
de Groot JWB, Links TP, Sluiter WJ, Wolffenbuttel BHR, Wiggers T, Plukker JTM. Locoregional control in patients with palpable medullary thyroid cancer: results of standardized compartment-oriented surgery. Head Neck 2007; 29:857-63. [PMID: 17427969 DOI: 10.1002/hed.20609] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Extent of neck dissection is controversial in patients with palpable medullary thyroid cancer (MTC). METHODS We evaluated 64 MTC patients (19 hereditary, 45 sporadic) with palpable thyroid nodules (group 1, n = 35) or palpable lymph node metastases (group 2, n = 29). Standard surgery included total thyroidectomy, central compartment dissection, and additional neck dissection on indication. RESULTS In group 1, 40% of the patients were cured. Thirty-one percent of all patients had central, 23% ipsilateral, 14% contralateral, and 14% mediastinal, metastases. Fifty-one percent developed locoregional recurrence. Locoregional recurrence (p = .043) and reoperations (p = .020) were noted more often after a less than standard initial procedure. In group 2, no patients were cured. All had central, 93% ipsilateral, 45% contralateral, and 52% mediastinal metastases. Thirty-eight percent developed locoregional recurrence. CONCLUSIONS Locoregional recurrence frequently occurs in palpable MTC, and tumor control may be improved by standard central, bilateral, and upper mediastinal neck dissection.
Collapse
Affiliation(s)
- Jan Willem B de Groot
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
Properly performed clinical trials provide a foundation for evidence-based medical practice. The surgeon plays a central role in the management of patients with malignant solid tumors, including thyroid cancer, because operative extirpation of the malignancy is the essential first step in effective therapy. This article discusses the role of the surgeon in the clinical research of thyroid cancer and also reviews the important clinical trials that have influenced the treatment of patients with thyroid cancer. Recent discoveries defining the genetic mutations underlying the various types of thyroid cancers have led to the development of targeted therapies. These chemical compounds, which are now being evaluated in clinical trials, hold great promise for the treatment of patients with locally advanced and distant metastatic disease. The surgical investigator also plays an important role in procuring tumor tissue from patients in clinical trials. The molecular analysis of these tissues is of critical importance in selecting specific therapies and predicting patient response and prognosis.
Collapse
Affiliation(s)
- Y Nancy You
- Department of Surgery, Mayo Clinic, Rochester, Minnesota 55902, USA
| | | |
Collapse
|
19
|
Labidi SI, Gravis G, Tarpin C, Brun V, Viens P. Medullary thyroid cancer treated by capecitabine. Anticancer Drugs 2007; 18:831-4. [PMID: 17581307 DOI: 10.1097/cad.0b013e3280adc8f3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medullary thyroid carcinoma with distant metastases is generally incurable, with 20% overall survival at 10 years. The treatment goal is palliative. Chemotherapy has a limited role, with low response rates and high toxicities with the different regimens. Here, we report the case of 64-year-old man with metastatic medullary thyroid carcinoma in progression after primary treatment with cisplatin-doxorubicin. The patient received capecitabine 2000 mg/m total per day x 14 days followed by 1-week rest. He received 41 cycles, and presented prolonged and objective tumor response (30 months), without any toxicity.
Collapse
Affiliation(s)
- Sana Intidhar Labidi
- Department of Medical Oncology, Institut Paoli Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille, France.
| | | | | | | | | |
Collapse
|
20
|
Abstract
Medullary thyroid carcinoma is a neuroendocrine tumor derived from the C cells of the thyroid gland and accounts for approximately 5% of all thyroid carcinomas. Approximately 30% of the cases are associated with an autosomal dominant syndrome called multiple endocrine neoplasia type 2, and the identification of these individuals is important because affected family members may benefit from an early diagnosis. The treatment of this disease is predominantly surgical, and the impact of radiotherapy and chemotherapy is limited. The identification of the associated molecular events has lead to the development of specific molecular targeted agents that may change the way this disease is treated in the near future.
Collapse
Affiliation(s)
- Ana O Hoff
- Centro de Oncologia, Hospital Sírio Libanês, Sao Paulo, Brazil.
| | | |
Collapse
|
21
|
Featherstone C, Colley A, Tucker K, Kirk J, Barton MB. Estimating the referral rate for cancer genetic assessment from a systematic review of the evidence. Br J Cancer 2007; 96:391-8. [PMID: 17242707 PMCID: PMC2360013 DOI: 10.1038/sj.bjc.6603432] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To estimate the optimal proportion of new patients diagnosed with cancer who require assessment and evaluation for familial cancer genetic risk, based on the best evidence available. We identified evidence of the patients who require assessment for familial genetic risk when diagnosed with cancer through extensive literature reviews and searches of guidelines. Epidemiological data on the distribution of cancer type, presence of a family history, age and other factors that influence referral for genetic assessment were identified. Decision trees were constructed to merge the evidence-based recommendations with the epidemiological data to calculate the optimal proportion of patients who should be referred. We identified 'high probability' and 'moderate probability' groups for having a genetic susceptibility. The proportion of patients diagnosed with cancer in Australia who have a high probability of having a genetic predisposition and who should be referred for genetic assessment is 1%. If the moderate probability group is also assessed this proportion increases to 6%. This model has identified the proportion of new patients diagnosed with cancer who should be referred for genetic assessment. This data is the first step in determining the resources required for provision of an adequate cancer genetic service.
Collapse
Affiliation(s)
- C Featherstone
- Department of Oncology, Beatson Oncology Centre, Glasgow, G11 6NT, Scotland.
| | | | | | | | | |
Collapse
|
22
|
Abstract
Medullary thyroid cancer (MTC) consists of a rare, undifferentiated tumor and often is described as having a chronic and indolent disease process. Approximately 5%-10% of all thyroid malignancies are MTC, and about 25% of patients diagnosed with the disease have a genetic form that was inherited through a mutation of the RET proto-oncogene. The mutation is expressed by an autosomal dominant allele and, if inherited, has almost a 100% chance of developing into a malignancy. Detection of the germline mutation identifies individuals at risk and enables prophylactic treatment for the prevention of MTC. As a result, patients and family members commonly undergo genetic testing during the diagnostic phase and experience certain psychosocial stressors. The purpose of this article is to provide an overview of MTC and its symptoms, treatment, prognosis, and genetics. The psychosocial effects of genetic testing on the quality of life of patients with MTC also will be described. By learning more about the pathophysiology and psychosocial stressors, nurses can facilitate proper counseling and increase the likelihood of positive outcomes for their patients.
Collapse
|
23
|
Abstract
The goal in managing patients who have MTC is to detect and surgically remove disease at an early stage. Tumor marker-based biochemical screening and DNA-based genetic screening have created the opportunity for effective prophylactic surgery in patients at risk for hereditary MTC. Complete surgical resection is critical for cure because cervical reoperation for persistent or recurrent disease benefits only select patients. With the advent of therapies that target the RET-activated pathways, new hope may be emerging for patients who have locally advanced or metastatic disease.
Collapse
Affiliation(s)
- Y Nancy You
- Department of Surgery, Mayo Clinic, Gonda 12, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | | |
Collapse
|
24
|
Abstract
O termo neoplasia endócrina múltipla tipo 2 (NEM 2) foi sugerido em 1968, por Steiner e cols., para diferenciar a síndrome clínica caracterizada pela presença de carcinoma medular de tireóide (CMT), feocromocitoma e hiperparatireoidismo, então denominada síndrome de Sipple, da síndrome de Wermer ou NEM tipo 1, que acomete as glândulas paratireóides, pâncreas e hipófise. Sizemore e cols. (1974) complementaram a diferenciação através da classificação da NEM 2 em 2 subgupos: pacientes com CMT, feocromocitoma, hiperparatireoidismo e aparência normal (NEM 2A) e pacientes sem acometimento das paratireóides e fenótipo caracterizado por ganglioneuromatose intestinal e hábitos marfanóides (NEM 2B). CMT é usualmente o primeiro tumor a ser diagnosticado. O diagnóstico do CMT determina que seja avaliada a extensão da doença e rastreamento do feocromocitoma e hiperparatireoidismo. O diagnóstico de CMT esporádico ou hereditário é realizado através da análise molecular do proto-oncogene RET. Neste artigo são discutidos os aspectos fisiopatológicos, as anormalidades genéticas e os aspectos clínicos da NEM 2. A abordagem diagnóstica e terapêutica nos indivíduos afetados, carreadores assintomáticos e familiares em risco também são discutidos. Os avanços relacionados ao rastreamento genético e intervenção precoce permitiram uma melhoria no prognóstico a longo prazo. No entanto, ainda não dispomos de tratamento eficaz para doença metastática.
Collapse
Affiliation(s)
- Ana Luiza Maia
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS.
| | | | | |
Collapse
|
25
|
Abstract
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells. Spread of MTC commonly occurs to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine, and are not sensitive to hormonal manipulation. Because of these features, the treatment of metastatic or recurrent MTC is different from the treatment of differentiated thyroid cancer. Surgery is the only effective therapy at present that can result in cure, or reduction in tumor burden, or effective palliation. Systematic surgical removal of at-risk or involved lymph node basins should be done in patients with palpable primary tumors and recurrence. A "berry-picking" approach is discouraged. Although data are limited, standard chemotherapy and radiation therapy have not been effective in the treatment of MTC. Newer targeted drug therapies are being examined in therapeutic clinical trials.
Collapse
Affiliation(s)
- Frank Jay Quayle
- Washington University School of Medicine, Box 8109, 660 South Euclid St. Louis, MO 63110, USA
| | | |
Collapse
|
26
|
Puñales MK, Rocha AP, Gross JL, Maia AL. Carcinoma medular de tireóide: aspectos moleculares, clínico-oncológicos e terapêuticos. ACTA ACUST UNITED AC 2004; 48:137-46. [PMID: 15611826 DOI: 10.1590/s0004-27302004000100015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
O carcinoma medular de tireóide (CMT) pode ocorrer na forma esporádica ou familiar. O CMT hereditário é parte das síndromes de neoplasia endócrina múltipla (NEM) 2A e 2B, carcinoma medular de tireóide familiar (CMTF) ou outras formas. Mutações de linhagem germinativa do proto-oncogene RET causam a forma hereditária da neoplasia e os testes genéticos atualmente disponíveis formam a base para o manejo adequado da hereditariedade do tumor, visto que o diagnóstico precoce melhora significativamente o prognóstico no indivíduo afetado e nos carreadores. Nos últimos anos, vários estudos têm demonstrado uma correlação entre mutações codon-específica do RET e os diferentes fenótipos da NEM 2A, que pode, em parte, ser explicada por diferenças na intensidade da indução da dimerização do receptor. No presente artigo, revisamos os avanços nos mecanismos moleculares, diagnóstico e tratamento, bem como relatamos a nossa experiência no manejo dessa forma rara de neoplasia tireoidiana.
Collapse
Affiliation(s)
- Marcia K Puñales
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS
| | | | | | | |
Collapse
|
27
|
Hamy A, Raffaitin P, Floch I, Paineau J, Mirallie E, Visset J. [The importance of lymph node dissection in medullary thyroid macrocarcinomas]. ACTA ACUST UNITED AC 2003; 128:447-51. [PMID: 14559193 DOI: 10.1016/s0003-3944(03)00179-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Medullary thyroid carcinoma (MTC) is often regarded as good medium-term forecast. The 5- and 10-years survival rates are, respectively, appraised at 78-85% and 70-78%. These rates take no care, however, of the fact that 50-56% of the patients keep a pathological calcitonine (CT) level giving evidence of an evolutive disease. The treatment is based on the total thyroidectomy and cervical lymphadectomy. This treatment remains often incomplete and the results of reintervention are disappointing. AIM OF THE STUDY About 48 patients, we wanted to demonstrate the importance of a complete lymph node dissection performed in the neck as soon as possible. PATIENTS AND METHODS Between 1979 and 2000, 48 patients were treated for macroMTC (size >1 cm). The duration of follow-up was of 1-29 years (mean 9.3 years). The complete (central and lateral) neck dissection was initially made only in 22 cases. The selected criterion to assess the result was the normalization of the basal CT level. RESULTS The rate of node involvement was 66.6% if the complete lymphadectomies (n = 22), the secondary neck dissections (n = 15), the incomplete (n = 10) and not made lymphadectomies (n = 2) were gathered. In case of primary or secondary complete lymphadectomies, the rate of node involvement was 81%. The 22 primary complete lymphadectomies performed in 13 patients (59%) allowed to normalize the basal CT level and among 17 (77.2%) to decrease this rate over 90%. All the incomplete neck dissection failed in case of positive nodes. CONCLUSION The frequency of node involvement in macroMTC is about 80%. It does not have a preferential territory and the bilaterality is frequent (28-49%): that justifies a bilateral complete neck dissection. Initial surgical treatment seems essential in regard to the rate of normalization of basal CT level, which is, when a first complete lymphadectomy is done and in case of iterative surgery, respectively 59 and 26.6%. A complete lymphadectomy is still too rarely carried out: 22 times (45.8%) in our own experience and from 14 to 42% in the literature.
Collapse
Affiliation(s)
- A Hamy
- Clinique chirurgicale I, hôpital G.- et R.-Laënnec, 44093 Nantes, France.
| | | | | | | | | | | |
Collapse
|
28
|
Pellegriti G, Leboulleux S, Baudin E, Bellon N, Scollo C, Travagli JP, Schlumberger M. Long-term outcome of medullary thyroid carcinoma in patients with normal postoperative medical imaging. Br J Cancer 2003; 88:1537-42. [PMID: 12771918 PMCID: PMC2377113 DOI: 10.1038/sj.bjc.6600930] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Imaging-detected relapses are observed in a significant proportion of patients with medullary thyroid carcinoma (MTC) with normal postoperative imaging studies. The aim of this study was to search for prognostic factors of imaging-detected relapse. This retrospective study was performed in 63 consecutive MTC patients with normal postoperative medical imaging. After surgery, the basal calcitonin (CT) level was undetectable in 35 patients and elevated in 28. During follow-up, 18 patients developed a clinical or imaging-detected relapse (29%) in the neck and/or at distant sites: 15 had an elevated postoperative basal CT level and three had an undetectable postoperative basal CT level. At multivariate analysis, the significant parameters predictive of imaging-detected relapse were the postoperative plasma CT level and the tumour extension (pT). The 3- and 5-year relapse-free survival rates were 94 and 90% in patients with an undetectable postoperative basal CT level, and 78 and 61% in patients with a detectable basal CT level (P<0.05). The 3- and 5-year relapse-free survival rates were 92 and 85% in the pT1-3 patients, and 57 and 46% in the pT4 patients (P<0.01). These results show that postoperative CT level and tumour extension are critical prognostic factors for the identification of patients at a high risk of relapse.
Collapse
Affiliation(s)
- G Pellegriti
- Service de Médecine Nucléaire et de Cancérologie Endocrieme, Institut Gustave Roussy, Villejuif, France
| | - S Leboulleux
- Service de Médecine Nucléaire et de Cancérologie Endocrieme, Institut Gustave Roussy, Villejuif, France
| | - E Baudin
- Service de Médecine Nucléaire et de Cancérologie Endocrieme, Institut Gustave Roussy, Villejuif, France
| | - N Bellon
- Département de Biostatistique et de Santé Publique, Institut Gustave Roussy, Villejuif, France
| | - C Scollo
- Service de Médecine Nucléaire et de Cancérologie Endocrieme, Institut Gustave Roussy, Villejuif, France
| | - J P Travagli
- Service de Chirurgie Générale, Institut Gustave Roussy, Villejuif, France
| | - M Schlumberger
- Service de Médecine Nucléaire et de Cancérologie Endocrieme, Institut Gustave Roussy, Villejuif, France
- Service de Médecine Nucléaire, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France. E-mail:
| |
Collapse
|
29
|
Abstract
Thyroid carcinomas are fairly uncommon and include disease types that range from indolent localised papillary carcinomas to the fulminant and lethal anaplastic disease. Several attempts to formulate a consensus about treatment of thyroid carcinoma have resulted in published guidelines for diagnosis and initial disease management. Multimodality treatments are widely recommended, although there is little evidence from prospective trials to support this approach. Surgical resection to achieve local disease control remains the cornerstone of primary treatment for most thyroid cancers, and is often followed by adjuvant radioiodine treatment for papillary and follicular types of disease. Thyroid hormone replacement therapy is used not only to rectify postsurgical hypothyroidism, but also because there is evidence to suggest that high doses that suppress thyroid stimulating hormone prevent disease recurrence in patients with papillary or follicular carcinomas. Treatment for progressive metastatic disease is often of limited benefit, and there is a pressing need for novel approaches in treatment of patients at high risk of disease-related death. In families with inherited thyroid cancer syndromes, early diagnosis and intervention based on genetic testing might prevent poor disease outcomes. Care should be carefully coordinated by members of an experienced multidisciplinary team, and patients should be provided with education about diagnosis, prognosis, and treatment options to allow them to make informed contributions to decisions about their care.
Collapse
Affiliation(s)
- Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Texas, Houston 77030, USA.
| |
Collapse
|
30
|
Görges R, Eising EG, Fotescu D, Renzing-Köhler K, Frilling A, Schmid KW, Bockisch A, Dirsch O. Diagnostic value of high-resolution B-mode and power-mode sonography in the follow-up of thyroid cancer. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2003; 16:191-206. [PMID: 12573788 DOI: 10.1016/s0929-8266(02)00073-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Ultrasonography is an established diagnostic modality in the follow-up of thyroid cancer. Color flow Doppler has been proposed by some authors as an additional tool for differentiating benign from malignant cervical lesions in various types of head and neck cancer. Over the last few years, a new generation of high-resolution ultrasound platforms with the "power-mode" feature has become available, that also enables the imaging of small vessel blood flow. The objective of our study was to find ways of optimizing the differentiation of benign and malignant cervical tumors in thyroid cancer follow-up by means of sonography. METHODS Hundred and twelve cervical lesions in 90 patients with thyroid cancer were evaluated by high-end ultrasonography (Sonoline Elegra, Siemens) using a small-part transducer (7.5 L 40, Siemens). B-mode sonography was performed at a frequency of 8 MHz. The Solbiati index (SI= ratio of largest to smallest diameter), configuration, echogenicity, intranodular structures, and margins were assessed. Perinodular and intranodular blood flow was evaluated by color flow Doppler (PRF 1250 Hz for conventional color flow Doppler, 868 Hz for power-mode Doppler). Possible malignancy was validated by histology, cytology, scintigraphy, and follow-up. Thirty five lesions were benign (diameter 0.4-3.0 cm) and 77 were malignant (0.4-5.4 cm). The patients were randomized into a test group and a learning group to determine the diagnostic value of various ultrasound criteria by means of statistical analysis. In the learning group, decision rules based on the dichotomized criteria were developed using a logistic regression model. Sensitivity and specificity of these decision rules were then evaluated in the test group. RESULTS The presence of an echocomplex pattern or irregular hyperechoic small intranodular structures (criterion A) and the presence of an irregular diffuse intranodular blood flow (criterion B) are the best indicators of malignancy, whereas an SI >>2 is highly indicative of benign changes. Color flow Doppler is a useful addition to B-mode scanning for distinguishing benign and malignant neoplasms in the follow-up of thyroid cancer. Power-mode Doppler sonography significantly improves imaging of perinodular and intranodular blood flow when compared with conventional color flow Doppler. CONCLUSION We propose the following decision rules based on a combination of the criteria above: (A) and (B) fulfilled: malignant, if SI< or =4; (B) but not (A) fulfilled: malignant, if SI< or =3; (A) but not (B) fulfilled: malignant, if SI< or =2; neither (A) nor (B) fulfilled: malignant, if SI approximately equal to 1 (sensitivity: 90%; specificity: 82%; accuracy 88%).
Collapse
Affiliation(s)
- Rainer Görges
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Cohen MS, Hussain HB, Moley JF. Inhibition of medullary thyroid carcinoma cell proliferation and RET phosphorylation by tyrosine kinase inhibitors. Surgery 2002; 132:960-6; discussion 966-7. [PMID: 12490842 DOI: 10.1067/msy.2002.128562] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Most medullary thyroid carcinomas (MTCs) result from gain-of-function mutations in the RET proto-oncogene, which encodes a transmembrane tyrosine kinase receptor. Systemic therapies have not been effective in treating this disease. We evaluated the effects of 3 tyrosine kinase inhibitors (TKIs) on MTC cell growth and RET tyrosine kinase activity by using an in vitro model. METHODS An MTC cell line (TT cells, RETc634 mutant) cultured in RPMI medium was exposed to varying concentrations of STI571, genistein, or allyl-geldanamycin with controls (no TKI) for 3 to 48 hours. Cellular protein was analyzed by immunoprecipitated Western blot analysis probing with a monoclonal antiphosphotyrosine antibody. Cell proliferation was determined by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) and 5-bromo-2'-deoxyuridine (BrdU) assays. RESULTS RET phosphorylation was inhibited at 24 hours of exposure to 5 to 20 micromol/L STI571 and 48 hours of exposure to genistein (200 micromol/L) and allyl-geldanamycin (6 micromol/L). RET protein was detected in equal concentrations in all experimental conditions. MTT and BrdU assays demonstrated a dose-dependent decrease in TT cell proliferation with exposure to the 3 TKIs. CONCLUSIONS These TKIs selectively inhibit cell growth and RET tyrosine kinase activity of MTC cells in vitro in a dose manner. This study suggests the use of TKIs in human trials as a systemic therapy for MTC.
Collapse
Affiliation(s)
- Mark S Cohen
- Section of Endocrine and Oncologic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | | | | |
Collapse
|
32
|
Bitterman A, Bloch B, Ela B, Oleg L, Wolf T, Cohen O. A unique combination of pre- and intraoperative modalities for the diagnosis and localization of recurrent medullary thyroid carcinoma. Otolaryngol Head Neck Surg 2002; 126:188-90. [PMID: 11870351 DOI: 10.1067/mhn.2002.122005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Arie Bitterman
- Department of Surgery A, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
33
|
Tamagnini P, Bernante P, Piotto A, Toniato A, Pelizzo MR. [Reoperation of medullary thyroid carcinoma: long-term results]. ANNALES DE CHIRURGIE 2001; 126:762-7. [PMID: 11692761 DOI: 10.1016/s0003-3944(01)00609-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY AIM The impact of iterative surgery in medullary thyroid carcinoma is still debated. The study aim was to evaluate long-term results following reoperation for residual or recurrent medullary thyroid carcinoma. PATIENTS AND METHOD Among the 136 patients operated on in our centre for medullary thyroid carcinoma (MTC) between 1970 and 2000, 25 patients (10 men and 15 women) were reoperated on for locoregional residual or recurrent lesions. Their mean age was 46 years (range: 19-73 years). The MTC was sporadic in 21 patients and familial in 4: NEM 2A (n = 3), NEM 2B (n = 1). In 11 patients (44%) operated in another centre, the first procedure was a total thyroidectomy; in 2 patients (8%) a total thyroidectomy with central lymphadenectomy was performed, and in 12 patients (48%) a total thyroidectomy with central and jugulo-carotid lymphadenectomy. After the first operation, 6 patients (24%) were classified stage II, 15 (60%) stage III and 4 (16%) stage IV. Basal and post-stimulation calcitonin dosages were performed for all the patients before and after reoperation. RESULTS Thirty three reoperations were performed. In 24 cases, the recurrence was located in the laterocervical site; in 5 cases, the lymph node involvement was both central and laterocervical, in 2 cases, there was a mediastinal involvement and in 2 cases a spinal involvement. After reoperation, the calcitonin rate became normal in 4 patients (16%); in the other 21 (84%), the calcitonin rate was still high. With a mean 110 month--follow-up (range: 320-12 months), 4 patients (16%) were alive without disease, 2 (8%) died of their disease, 19 (76%) were alive with their disease, five of them with hypercalcitonemia without detectable metastasis. In addition to patients having metastasis at the time of reoperation, seven developed metastases secondarily (liver, bone, lung). CONCLUSION Biological cure of medullary thyroid carcinoma is rarely obtained with reoperation. Reoperations may reduce progression of the disease in selected patients. Complete removal of the lesions at the time of the first procedure must be the ideal treatment for medullary thyroid carcinoma.
Collapse
Affiliation(s)
- P Tamagnini
- Dipartimento di Scienze Mediche e Chirurgiche, Clinica Chirurgica Generale III, Università di Padova, Via Giustiniani 2, 35100 Padova, Italie
| | | | | | | | | |
Collapse
|
34
|
Koch CA, Sarlis NJ. The spectrum of thyroid diseases in childhood and its evolution during transition to adulthood: natural history, diagnosis, differential diagnosis and management. J Endocrinol Invest 2001; 24:659-75. [PMID: 11716153 DOI: 10.1007/bf03343911] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this contribution, we review current knowledge on the pathogenesis, diagnosis and differential diagnosis of thyroid disorders in childhood and adolescence, as well as present an update on therapy methods and management guidelines for these disorders. This overview is conceptually divided into two parts, one focusing on thyroid functional disorders, i.e. conditions leading to hyper- and hypothyroidism, and another one pertinent to structural abnormalities of the thyroid gland, i.e. nodular disorders and thyroid cancer. Currently, congenital hypothyroidism is diagnosed in a much more timely fashion rather than in the past, rendering hypothyroidism-related mental retardation and developmental deficits very rare in newborns and children and, hence, diminishing significantly its public health impact. At the same time, considerable advances have occurred in our understanding of the molecular basis of several genetic conditions affecting the thyroid gland in childhood, such as familial non-autoimmune hyperthyroidism, as well as of the pathways leading to thyroid neoplasia.
Collapse
Affiliation(s)
- C A Koch
- Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | | |
Collapse
|
35
|
Abstract
Familial thyroid cancer can arise from parafollicular cells (familial medullary thyroid cancer) or from follicular cells (familial nonmedullary thyroid cancer). Familial medullary thyroid cancer may occur in isolation or as part of multiple endocrine neoplasia (MEN) type II syndromes. Genetic testing for a RET mutation on chromosome 10 is used to identify new family members who are gene carriers. Total thyroidectomy should be used in gene carriers without clinical disease before age 6 in medullary thyroid cancer and MEN type IIA, and as soon as the diagnosis is made in MEN type IIB after the first year of life. Those with clinical disease should have at least a bilateral central neck dissection. Modified radical neck dissection is recommended for patients when the primary tumor is 1.5 cm. A normal postoperative serum calcitonin level suggests that the operation has been curative. Physicians need to be aware of ethical and lifestyle issues related to patients with familial disease and their family members. Familial nonmedullary thyroid cancer occurs as a discrete entity or as part of other family cancer syndromes such as Gardner syndrome, Cowden disease, and other rare syndromes. Familial nonmedullary thyroid cancer almost exclusively includes patients with papillary or Hurthle cell cancers. These families appear to have more benign thyroid conditions. The gene (or genes) for familial papillary thyroid cancer is yet to be identified, whereas that for some Hurthle cells (TCO) has been mapped to chromosome 19p13.2. Familial nonmedullary thyroid cancer is somewhat more aggressive than its sporadic counterpart, but is less aggressive than medullary thyroid cancer. Total thyroidectomy and central neck dissection followed by radioactive iodine ablation and thyroid hormone suppression appear to be the most effective therapy.
Collapse
Affiliation(s)
- O Alsanea
- Clinical Fellow-Endocrine Surgical Oncology, and Chief, Professor and Vice Chair, Department of Surgery, University of California, San Francisco/Mount Zion Medical Center, San Francisco, California, USA.
| | | |
Collapse
|
36
|
Weigel RJ. Thyroid. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
37
|
Abstract
Patients with clinically evident medullary thyroid cancer should have a total extracapsular thyroidectomy with bilateral central neck dissection and an ipsilateral prophylactic or therapeutic modified (functional) radical neck dissection when the primary tumor is greater than 1 cm and when the central neck nodes are positive. A prophylactic contralateral neck dissection should be done when the primary tumor is bilateral and when there is extensive lymphadenopathy on the side of the primary tumor. Patients who have gross, unresectable residual medullary thyroid cancer should receive postoperative external radiotherapy. Patients who are carriers of germ-line RET proto-oncogene point mutations or have an elevated (basal or stimulated) calcitonin levels on screening should have a prophylactic total thyroidectomy before age 6 years. In patients with an elevated basal or stimulated plasma calcitonin level and an intrathyroidal nodule on ultrasound, a total thyroidectomy and central neck lymph node dissection should be done. Patients with persistent or recurrent medullary thyroid cancer should have a complete thyroidectomy (if not done initially) and bilateral central and modified radical neck dissection, including upper mediastinal lymphadenectomy. Patients who are symptomatic from distant medullary thyroid cancer metastases (diarrhea, flushing, weight loss, or bone pain) should be treated with somatostatin analogs. Bone metastases should be resected if possible, and symptomatic lesions that are unresectable should be treated with external radiotherapy. Cytoreductive procedures such as radiofrequency ablation or cryoablation for liver metastases should be considered in symptomatic patients to reduce tumor burden. Localized pulmonary metastases should be resected. Chemotherapy or radioactive immunotherapy (iodine 131 labeled carcinoembryonic antigen monoclonal antibody) protocols should be considered in patients with nonoperative widely metastatic progressing medullary thyroid cancer.
Collapse
Affiliation(s)
- E Kebebew
- Department of Surgery, University of California, San Francisco, UCSF/Mt. Zion Medical Center, Box 0470, S343, San Francisco, CA 94143, USA
| | | |
Collapse
|
38
|
Engelbach M, Görges R, Forst T, Pfützner A, Dawood R, Heerdt S, Kunt T, Bockisch A, Beyer J. Improved diagnostic methods in the follow-up of medullary thyroid carcinoma by highly specific calcitonin measurements. J Clin Endocrinol Metab 2000; 85:1890-4. [PMID: 10843170 DOI: 10.1210/jcem.85.5.6601] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Calcitonin (CT) is an important tumor marker for medullary thyroid carcinoma (MTC). Recent CT assays chiefly recognize the monomeric form of CT (mCT). It was the objective of this study to examine the consequences of the higher specificity of the assay for interpretation of the postoperative CT values in MTC patients. The postoperative mCT concentration was measured in 214 patients with differentiated thyroid carcinoma (MTC excepted; non-MTC patients) to determine a reference range of mCT in totally thyroidectomized patients. Monomeric CT was also determined with a two-site chemiluminescence immunoassay (Nichols) in 94 healthy subjects and in 68 MTC patients. The mCT concentrations were below the detection limit in all examined completely thyroidectomized non-MTC patients. Basal and stimulated mCT values were also below the detection limit in 32 of the 68 MTC patients. The biochemical and imaging diagnosis of the latter patients did not give any indication of tumor recurrence. We conclude that completely thyroidectomized patients with non-MTC do not show any measurable mCT concentrations. In comparison with an unspecific CT-RIA, the more specific mCT determination by immunoluminometric assay permits a more precise differentiation between postoperative normal and pathological values and an earlier diagnosis of recurrent MTC.
Collapse
Affiliation(s)
- M Engelbach
- Department of Internal Medicine and Endocrinology, University Hospital of Mainz, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Medullary thyroid cancer (MTC) is a distinct C-cell tumor of the thyroid. We review the oncogenesis and management of both sporadic tumors and those tumors arising as part of specific inherited syndromes. The RET proto-oncogene plays a role in the development of inherited forms of MTC and has become important in the clinical management of patients and their families. The recognition of the high rate of regional nodal involvement has led to lymphadenectomy being strongly considered for patients undergoing thyroidectomy for MTC.
Collapse
Affiliation(s)
- G W Randolph
- Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
| | | |
Collapse
|