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Corsello A, Ramunno V, Locantore P, Pacini G, Rossi ED, Torino F, Pontecorvi A, De Crea C, Paragliola RM, Raffaelli M, Corsello SM. Medullary Thyroid Cancer with Ectopic Cushing's Syndrome: A Case Report and Systematic Review of Detailed Cases from the Literature. Thyroid 2022; 32:1281-1298. [PMID: 35833793 DOI: 10.1089/thy.2021.0696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Medullary thyroid cancer (MTC) is a neuroendocrine tumor arising from parafollicular C-cells of the thyroid gland that, in rare cases, can cause a paraneoplastic ectopic Cushing's syndrome (ECS). The development of Cushing's syndrome (CS) in MTC patients is generally associated with advanced disease and poor prognosis. Summary: We described a case of severe CS due to MTC in a young male. We performed a systematic review to identify cases of ECS due to MTC. We searched PubMed, Scopus, and Web of Science for publications between database inception and February 2022 and we collected the patient characteristics, disease presentation, employed treatment strategies, and disease outcomes. In addition to our patient, we identified 96 cases of ECS due to MTC reported in literature. Mean age at diagnosis was 44.4 years (range 10-84), and there was a male predominance (male:female [M:F] = 1.8:1). Most patients (51%) presented with metastatic disease at diagnosis and showed severe hypercortisolism. Seventeen patients developed distant metastasis and hypercortisolism during follow-up. Interestingly, in 48% of patients, the diagnosis of CS followed the diagnosis of MTC with a median time of 48 months but, among patients in whom the diagnosis was concomitant (38%), symptoms due to hypercortisolism were frequently the reason for seeking medical advice. Pathology results showed evidence of adrenocorticotropic hormone (ACTH) or corticotropin releasing hormone (CRH) positive cells in 76% of patients in whom they were tested. The management of hypercortisolism was challenging in most patients with 48% requiring, eventually, definitive treatment with bilateral adrenalectomy (BLA). Recently, some limited evidence has emerged regarding tyrosine kinase inhibitors (TKIs) treatment for hypercortisolism in patients with ECS due to MTC. Despite limited information on survival, prognosis was generally poor and the main causes of death were either complications of CS or disease progression. Conclusions: Despite its rarity, MTC should be considered in the differential diagnosis of ECS. Management of hypercortisolism is a key factor to improve the patient's symptoms but it is often challenging and BLA is frequently required. Further studies are needed for investigating the role of TKIs in patients with MTC with ECS.
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Affiliation(s)
- Andrea Corsello
- Division of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vittoria Ramunno
- Division of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Locantore
- Division of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Pacini
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Torino
- Medical Oncology, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmela De Crea
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rosa Maria Paragliola
- Division of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Maria Corsello
- Division of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medicine, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
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Kashi Z, Emadian O, Movahedirad M. A rare case of Cushing's disease concurrent with papillary thyroid carcinoma. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:618-621. [PMID: 34820072 PMCID: PMC8590404 DOI: 10.22088/cjim.12.4.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/02/2021] [Accepted: 03/02/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although a nodular thyroid disease is higher in patients with pituitary adenoma, concurrent thyroid cancer with pituitary tumor is uncommon. CASE PRESENTATION We report a young woman with discovered papillary thyroid carcinoma after 1-year transsphenoidal surgery for Cushing's disease. Thyroidectomy was done and patient is well after three years follow-up. CONCLUSION We suggest the patient with functional pituitary adenoma be evaluated for thyroid tumor.
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Affiliation(s)
- Zahra Kashi
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Omid Emadian
- Department of Pathology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marzieh Movahedirad
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran,Correspondence: Marzieh Movahedirad, Diabetes Research Center, Imam Khomeini hospital, Razi Street, Sari, 4816633131, Iran. E-mail: , Tel: 0098 1133378789, Fax: 0098 1133378789
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Affiliation(s)
- A Munro Neville
- Chester Beatty Research Institute, Institute of Cancer Research: Royal Cancer Hospital, Fulham Road, London SW3
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5
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Affiliation(s)
- Sylvia L Asa
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Abstract
The cytomorphologic features in fine-needle aspiration (FNA) biopsies from 91 histologiacally verified medullary carcinomas of the thyroid (MCT) were investigated. FNA was able to diagnose neoplasms with indications of surgical removal in 98.9% of cases and moreover, was accurate in specific tumor typing in 89% of cases. The most important cytologic criteria of MCT with FNA are: dispersed cell-pattern of polygonal or triangular cells, azurophilic cytoplasmic granules, and extremely eccentrically placed nuclei with coarse granular chromatin and amyloid. These and other cytologic features of MCT are discussed in detail. Fourteen cases of thyroid tumors originally diagnosed as MCT by cytology are illustrated to discuss the differential diagnosis of MCT and its potential pitfalls. If MCT is cytologically presumed but amyloid and azurophilic cytoplasmic granules are not demonstrated, the use of immunostaining is necessary for a correct tumor typing. The application of immunocytochemistry in MCT is discussed.
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Affiliation(s)
- K Papaparaskeva
- Department of Cytopathology, Institute of Pathology, University of G]ottingen, G]ottingen, Germany
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Ohta M, Tokuda Y, Suzuki Y, Kuge S, Okumura A, Kubota M, Tajima T, Osamura RY, Mitomi T. A case of multiple endocrine neoplasia type 2B. Jpn J Clin Oncol 1997; 27:268-73. [PMID: 9379517 DOI: 10.1093/jjco/27.4.268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A sporadic case of multiple endocrine neoplasia type 2B in a twenty-six year old man who manifested medullary thyroid carcinoma, multiple mucosal neuromas of the tongue and a marfanoid habitus is reported. At the time of diagnosis, he also had multiple liver and lung metastases. Genetic analysis of his lymphocytes revealed a point mutation in exon 16 of the RET proto-oncogene. Since multiple endocrine neoplasia type 2B has a relatively poor prognosis because of the occasional aggressive behavior of medullary thyroid carcinoma, the necessity of the genetic diagnosis of multiple endocrine neoplasia in the early stage is suggested.
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Affiliation(s)
- M Ohta
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Patnaik AK, Lieberman PH. Gross, histologic, cytochemical, and immunocytochemical study of medullary thyroid carcinoma in sixteen dogs. Vet Pathol 1991; 28:223-33. [PMID: 1907046 DOI: 10.1177/030098589102800306] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The gross, histomorphologic, cytochemical, and immunocytochemical findings in 16 dogs with medullary thyroid carcinoma were evaluated. Grossly, the neoplasms were encapsulated, firm, lobulated, and grey-white to tan. The typical histologic pattern was groups or sheets of round to polygonal cells with fibrovascular stroma, which was thickened and hyalinized in places. Variants of clear cell (two dogs), giant cell (one dog), and oxyphil cell (one dog) types were also seen. In all 16 dogs, Grimelius-stained sections of the neoplasms revealed intracytoplasmic silver granules; ten tumors contained amyloid and four contained mucin. Immunohistochemically, the neoplasms reacted to AE1/AE3 (n = 13), S-100 protein (n = 5), neuron specific enolase (n = 14), synaptophysin (n = 11), calcitonin (n = 16), somatostatin (n = 4), gastrin (n = 7), and serotonin (n = 6). Only one neoplasm was positive for vimentin. None of the neoplasms reacted to antibodies for neurofilaments, thyroglobulin, insulin, glucagon, or adrenocorticotrophic hormone. Eleven neoplasms contained multiple (two to four) peptides, in various combinations. It was concluded that in dogs, gross and histologic features can be used to distinguish medullary thyroid carcinoma from other thyroid malignancies. Cytochemical and immunocytochemical studies with neuron specific enolase, synaptophysin, and calcitonin can be used to establish the diagnosis of medullary thyroid carcinoma in dogs.
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Affiliation(s)
- A K Patnaik
- Department of Pathology, Animal Medical Center, New York, NY
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Lairmore TC, Wells SA. Medullary carcinoma of the thyroid: current diagnosis and management. SEMINARS IN SURGICAL ONCOLOGY 1991; 7:92-9. [PMID: 2034946 DOI: 10.1002/ssu.2980070209] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Medullary thyroid carcinoma (MTC) accounts for 5-10% of thyroid malignancies and occurs in either a sporadic or a familial form. The familial form is inherited in an autosomal dominant pattern, and expressed clinically as multiple endocrine neoplasia (MEN), types IIa and IIb, or as familial MTC alone. This neoplasm is derived from the parafollicular or C-cells, and has the ability to secrete a variety of polypeptide hormones including calcitonin, which serves as a tumor marker for the presence of MTC. The development of a calcitonin radioimmunoassay and the screening of patients at risk for the familial forms of MTC allows the diagnosis of the neoplasm in an occult stage when total thyroidectomy results in virtually 100% cure. We will present our experience with the diagnosis, treatment, and postoperative follow-up of our patients with this interesting neoplasm.
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Affiliation(s)
- T C Lairmore
- Department of Surgery, Washington University Medical Center, St. Louis, MO 63110
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Schlaghecke R, Kreuzpaintner G, Bürrig KF, Juli E, Kley HK. Cushing's syndrome due to ACTH-production of an ovarian carcinoid. KLINISCHE WOCHENSCHRIFT 1989; 67:640-4. [PMID: 2549297 DOI: 10.1007/bf01718148] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The case of a 56-year old woman with severe Cushing's syndrome due to ovarian ACTH-production is described. Both clinical picture and biochemical pattern were consistent with the ectopic ACTH syndrome. ACTH was found by specific immunohistochemical staining in a carcinoid tumor of the patient's right ovary. In contrast, pituitary cells exhibited immunoreactive ACTH to only a minimum extent.
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Abstract
A young man presenting with Cushing's syndrome was found to have multiple endocrine neoplasia type 2b MEN 2b and adenomatous colonic polyposis with duodenal and gastric polyps. The entire syndrome of MEN 2b was present, including metastatic medullary carcinoma of the thyroid, a pheochromocytoma, and peripheral nerve abnormalities. The concurrence of these two inherited multiple neoplasia syndromes may reflect a common pathogenetic step in this patient.
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Holm R, Sobrinho-Simões M, Nesland JM, Gould VE, Johannessen JV. Medullary carcinoma of the thyroid gland: an immunocytochemical study. Ultrastruct Pathol 1985; 8:25-41. [PMID: 3901454 DOI: 10.3109/01913128509141506] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty-seven cases of medullary carcinoma of the thyroid gland (MCT) were studied by light microscopy, immunocytochemistry, and electron microscopy. Immunoreactivity for neuron-specific enolase (NSE) and calcitonin was present in all tumors. The numbers of peptides and serotonin demonstrated in each case varied from one to eight. Bombesin was present in 18 of the 27 cases, serotonin in 15, leu-enkephalin in 8, somatostatin in 8, gastrin in 3, substance P in 1, vasoactive intestinal peptide (VIP) in 1, and ACTH in 1. Insulin and glucagon were not encountered in any of the tumors. Immunoreactivity for thyroglobulin was seen in five primary tumors as well as in one lymph node metastasis. The finding of concurrent production of calcitonin and thyroglobulin within the same tumor is enough to question the dogma of the separate origin of follicular cells and C-cells. We were unable to attach any clinical importance to the production of multiple peptides and/or amines.
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Abstract
An unusual thyroid carcinoma is described, showing structural, histochemical and radioimmunologic features of both a follicular and a parafollicular cell carcinoma. Radioimmunoassay revealed high levels of thyroglobulin in the patient's serum and in extracts from metastatic tumor tissue. Immunoreactive thyroglobulin was demonstrated histochemically in tumor cells. On scanning, pulmonary metastases showed uptake of 131I. Somatostatin and neurotensin immunoreactivity was also revealed histochemically in the tumor and a large proportion of the neoplastic cells were argyrophil. Serum calcitonin level was normal and no immunoreactive calcitonin was found in tumor tissue by radioimmunoassay or histochemically. Light microscopy showed cribriform patterns suggestive of follicular carcinoma as well as solid areas reminiscent of medullary carcinoma. Electron microscopy revealed two types of tumor cells. One type had electron dense granules resembling secretory granules characteristic of polypeptide hormone and/or monoamine producing endocrine cells. The other type had no such granules but showed a prominent vesicular rough endoplasmic reticulum similar to that seen in neoplastic follicular cells. The results suggest two alternative possibilities regarding the histogenesis of the tumor. One would be a mixed neoplasm, resulting from a coincidental malignant change in both follicular and parafollicular thyroid cells. The other, more likely alternative would be that the tumor cells are derived from a common stem cell with the potentiality of differentiating into both follicular and parafollicular adult cells. The finding that both thyroglobulin and somatostatin or neurotensin immunoreactivity occurred together in some tumor cells supports the latter possibility and suggests that at least some follicular and parafollicular cells may have a common precursor origin.
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Kameya T, Bessho T, Tsumuraya M, Yamaguchi K, Abe K, Shimosato Y, Yanaihara N. Production of gastrin releasing peptide by medullary carcinoma of the thyroid. An immunohistochemical study. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1983; 401:99-107. [PMID: 6412451 DOI: 10.1007/bf00644793] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Forty medullary carcinomas of the thyroid (MCT) with documented calcitonin (CT) production were studied immunohistochemically for the production of gastrin releasing peptide (GRP), a mammalian counterpart of amphibian bombesin. GRP-positive cells, revealed by an unlabelled peroxidase-antiperoxidase immunoenzyme histochemistry were found in 81% (34/40) of the MCTs. Variable numbers of tumor cells in positive MCTs were immunostained for GRP. In 3 cases with Sipple's syndrome, cells in scattered microscopic MCT nodules and hyperplastic intrafollicular C cells of the thyroid were frequently positive for GRP as well as for CT. Non-neoplastic C cells (or CT-positive cells) of the human thyroids were also positive for GRP. In the neoplastic and non-neoplastic C cell system, some cells were confirmed to be immunoreactive with both anti-GRP and anti-CT. All these findings indicate that GRP and CT are closely associated peptide hormones produced by the C cell system.
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Charpin C, Andrac L, Monier-Faugere MC, Hassoun J, Cannoni M, Vagneur JP, Toga M. Calcitonin, somatostatin and ACTH immunoreactive cells in a case of familial bilateral thyroid medullary carcinoma. Cancer 1982; 50:1806-14. [PMID: 6126268 DOI: 10.1002/1097-0142(19821101)50:9<1806::aid-cncr2820500926>3.0.co;2-i] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Bilateral medullary carcinoma of the thyroid (MCT) was discovered in a symptomless patient of a high-risk MCT family. Raised serum calcitonin responding abnormally to pentagastrin led to a thyroidectomy. Grossly, the thyroid showed one nodule in the upper third of each lobe. Light microscopy revealed typical MCT with amyloid deposits. Nontumoral thyroid tissue showed C cell parafollicular hyperplasia. Electron microscopy detected intracellular secretory granules (mean diameter, 150 nm) and typical amyloid fibrills. Immunochemistry revealed numerous calcitonin immunoreactive cells in the nodules, in normal para and intrafollicular C-cells and hyperplastic C-cells. Somatostatin and ACTH were detected in certain tumor cells, but not in normal and hyperplastic C-cells. MCT hormonal production potential is discussed.
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Kakudo K, Miyauchi A, Ogihara T, Takai S, Kitamura H, Kumahara Y, Kawaoi A. Medullary carcinoma of the thyroid with ectopic ACTH syndrome. ACTA PATHOLOGICA JAPONICA 1982; 32:793-800. [PMID: 7136694 DOI: 10.1111/j.1440-1827.1982.tb03193.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An autopsied patient with medullary carcinoma of the thyroid and ectopic ACTH syndrome is reported. A microadenoma of pancreatic islet coexisted in this case, which is assumed to be of D cell origin. Immunohistochemical study revealed decreased number of pituitary ACTH cells. Some of them showed Crooke's degeneration. Hormone assay study of tumor tissue and plasma disclosed abnormal ACTH, beta-MSH as well as calcitonin. Somatostatin and Substance P were also demonstrated in tissue. Histologically the tumor showed solid alveolar pattern with a minor part consisting of small cell variant and this histologic variation is discussed.
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Wolfe HJ, Delellis RA. Familial medullary thyroid carcinoma and C cell hyperplasia. CLINICS IN ENDOCRINOLOGY AND METABOLISM 1981; 10:351-65. [PMID: 7285384 DOI: 10.1016/s0300-595x(81)80027-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Grün R, Eberle F. Multiple endocrine neoplasia, type II (MEN II). ERGEBNISSE DER INNEREN MEDIZIN UND KINDERHEILKUNDE 1981; 46:151-201. [PMID: 6262071 DOI: 10.1007/978-3-642-67954-4_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Iwanaga T, Koyama H, Uchiyama S, Takahashi Y, Nakano S, Itoh T, Horai T, Wada A, Tateishi R. Production of several substances by medullary carcinoma of the thyroid. Cancer 1978; 41:1106-12. [PMID: 638953 DOI: 10.1002/1097-0142(197803)41:3<1106::aid-cncr2820410345>3.0.co;2-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Two patients with the typical morphology of medullary carcinoma of the thyroid are reported. Biochemical analysis of the tumor tissue demonstrated the presence of calcitonin, ACTH and MSH, although symptoms referable to these hormones were hardly manifested. Serum CEA levels were elevated and CEA immunofluorescences in the tumor cells were positive. Moreover, in one patient, serotonin concentration was raised in the tumor tissue, and gastrin level was also elevated in the peripheral blood. These results suggest that the tumors may produce several substances.
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Capella C, Bordi C, Monga G, Buffa R, Fontana P, Bonfanti S, Bussolati G, Solcia E. Multiple endocrine cell types in thyroid medullary carcinoma. Evidence for calcitonin, somatostatin, ACTH, 5HT and small granule cells. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1978; 377:111-28. [PMID: 205037 DOI: 10.1007/bf00427000] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
10 cases of thyroid medullary carcinoma (TMC) have been studied ultrastructurally and histochemically. Well differentiated calcitonin-producing C cells were present in all tumours, being prevalent in 9 cases. 5-Hydroxytryptamine (5HT) storing cells were found in two cases, somatostatin immunoreactive cells in at least 5 cases and ACTH-immunoreactive cells in 4 cases. Ultrastructurally, at least 3 types of apparently non-C cells were observed. Type 1 cells with large, poorly osmiophilic granules resembling those of gastroenteropancreatic D cells, were present in 6 cases; they appeared to correlate well with somatostatin immunoreactive cells. Type 2 cells with large osmiophilic granules were found in 5 cases; they resembled ACTH-MSH cells of the human pituitary and may correspond to the ACTH-immunoreactive cells of light microscopy. Type 3 cells with small granules and an unknown function were found in 6 cases, always in scarce number. It is concluded that TMC, although mainly made up of C cells, usually contains large proportions of other endocrine cell types.
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Kameya T, Shimosato Y, Adachi I, Abe K, Kasai N, Kimura K, Baba K. Immunohistochemical and ultrastructural analysis of medullary carcinoma of the thyroid in relation to hormone production. THE AMERICAN JOURNAL OF PATHOLOGY 1977; 89:555-74. [PMID: 202164 PMCID: PMC2032247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Eighteen cases of medullary carcinoma of the thyroid were analyzed immunohistochemically for calcitonin- and ACTH-containing cells, and tumor cells in 8 cases were examined by an electron microscope and analyzed by manual and computer procedures with particular attention paid to the size and quality of secretory granules. Calcitonin- and ACTH-containing cells were found singly or in clusters in 14 and 11 tumors, respectively. In 4 cases, calcitonin-positive cell clusters and an increase in number of singly scattered C cells were seen apart from the main tumor, suggesting a multicentric nature of certain medullary carcinomas. Some ACTH-containing cells were apparently also positive for calcitonin. In a case of familial Sipple disease, follicular lining cells were replaced in areas with ACTH-containing cells. Three to five frequency distribution curves of the size of secretory granules were obtained in all of 6 cases analyzed, and at least two different types of granule matrix were identified.
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Obara T, Fujimoto Y, Oka A, Fukumitsu M, Abe K, Yamaguchi K, Wada T. Medullary thyroid carcinoma and pheochromocytoma accompanied with nodular hyperplasia in multiple endocrine neoplasia type 2. THE JAPANESE JOURNAL OF SURGERY 1977; 7:235-45. [PMID: 606895 DOI: 10.1007/bf02469356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Three patients with familial multiple endocrine neoplasia type 2 underwent total adrenalectomy and subsequently near-total or total thyroidectomy. The overt pheochromocytomas were present bilaterally in two patients and unilaterally in another patient. In addition, multiple nodules measuring a few mm in diameter were demonstrated in all adrenal medullas examined. All patients exhibited bilateral medullary thyroid carcinomas which varied in size from a few minute nodules accompanied by the microscopic C-cell hyperplasia to distinct large tumors. The thyroid C-cell hyperplasia appeared to be confined to the upper and middle thirds of the lateral lobe, and micronodules of the C-cell hyperplasia enlarged to coalesce, forming one large carcinoma mass. On the other hand, nodular hyperplasia of the chromaffin cells was distributed diffusely throughout the adrenal medulla and each nodule appeared to develop individually into a large pheochromocytoma. These findings suggested that, at least in the family members at a high risk for multiple endocrine neoplasia type 2, the development of both medullary thyroid carcinoma and pheochromocytoma was always preceded by a multicentric nodular hyperplasia. On the basis of the pathogenesis of these tumors, the most rational surgical approach was presented.
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Hazard JB. The C cells (parafollicular cells) of the thyroid gland and medullary thyroid carcinoma. A review. THE AMERICAN JOURNAL OF PATHOLOGY 1977; 88:213-50. [PMID: 18012 PMCID: PMC2032150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bigazzi M, Revoltella R, Casciano S, Vigneti E. High level of a nerve growth factor in the serum of a patient with medullary carcinoma of the thyroid gland. Clin Endocrinol (Oxf) 1977; 6:105-12. [PMID: 844218 DOI: 10.1111/j.1365-2265.1977.tb02001.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The serum of a patient with a familial medullary thyroid carcinoma showed levels of a factor, active in the nerve growth factor (NGF) bioassay and cross-reacting immunologically with mouse NGF, 20-1000 times higher than sera from normal controls or from patients with unrelated tumours. Variations of the level of this factor in the serum closely correlated with the progression of the disease. One of the patient's sons, apparently clinically normal, also showed high levels of this factor in the serum, raising the possibility that abnormality in the production of this factor could be present at an early stage of the disease.
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Abstract
Six cases of C-cell carcinoma of thyroid gland were studied applying histologic and histochemical methods as well as electron microscopy technique. A histologic feature of the carcinoma pattern was the diversity of pictures. Amyloid was commonly found in the carcinoma stroma. In some cells glycogen was present. Histochemically the carcinoma cells were marked by a strong activity of oxidative enzymes (GDH, SDH, LDH and MAO) as well as hydrolitic one (G-6-P and non specific enterases). Serotonin was found in two cases. An ultrastructural feature of carcinoma cells was the presence of cytoplasmic electron-dense, specific "endocrine type" secretory granules.
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Kley HK, Blessing MH, Nieschlag E, Wiegelmann W, Solbach HG, Krüskemper HL. [Virilism due to an adrenal medullary tumor with ectopic ACTH syndrome (author's transl)]. KLINISCHE WOCHENSCHRIFT 1975; 53:321-7. [PMID: 211312 DOI: 10.1007/bf01469059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The case of a 14-year-old girl with hirsutism and virilism due to the secretion of ectopic ACTH by an adrenal medullary tumor is described. At the age of 5 years changes in appearance had begun with masculinization. The effect of ACTH-like material, measured by radioimmunoassay in plasma and in tumor tissue, was compensated partially by the hypothalamo-pituitary-adrenal feedback mechanism. Increased concentrations of dehydroepiandrosterone, estrone and testosterone in plasma and of 17-ketosteroids and free cortisol in urine originated in the adrenals. After operation of the tumor menarche began spontaneously, hirsutism disappeared and testosterone plasma concentrations returned to normal. An adrenogenital syndrome was excluded.
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Beaugie JM, Belchetz PE, Brown CL, Frankel RJ, Lloyd MH. Report of a family with inherited medullary carcinoma of the thyroid and phaeochromocytoma. Br J Surg 1975; 62:264-8. [PMID: 1131504 DOI: 10.1002/bjs.1800620404] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A family in which several members have medullary carcinoma and phaeochromocytoma is described. Four of the 5 patients in this family who had a phaeochromocytoma have died; in one of these the medullary carcinoma may have contributed to death but in general the thyroid cancers were slow growing. In our experience successful diagnosis and treatment of the phaeochromocytomas have presented the greatest challenge. The welfare of future generations with this syndrome would seem to depend upon regular clinical and biochemical surveillance of the individuals and expeditious diagnosis and treatment of their tumours, particularly the phaeochromocytomas.
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Bussolati G, van Noorden S, Bordi C. Calcitonin- and ACTH-producing cells in a case of medullary carcinoma of the thyroid. Immunofluorescence investigations. VIRCHOWS ARCHIV. A, PATHOLOGY. PATHOLOGISCHE ANATOMIE 1973; 360:123-7. [PMID: 4354916 DOI: 10.1007/bf00543223] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hayduk K, Kaufmann W. [Ectopic paraneoplastic endocrinopathies associated with water-electrolyte balance disorders]. KLINISCHE WOCHENSCHRIFT 1973; 51:361-76. [PMID: 4354699 DOI: 10.1007/bf01468084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Knudson AG, Strong LC. Mutation and cancer: neuroblastoma and pheochromocytoma. Am J Hum Genet 1972; 24:514-32. [PMID: 4340974 PMCID: PMC1762170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Modlinger RS, Nicolis GL, Pertsemlidis D, Gabrilove JL. Cushing's syndrome and avascular necrosis of bone associated with carcinoid-islet cell tumor of the pancreas. Cancer 1972; 30:782-90. [PMID: 4342410 DOI: 10.1002/1097-0142(197209)30:3<782::aid-cncr2820300328>3.0.co;2-e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Tateishi R, Takahashi Y, Noguchi A. Histologic and ultracytochemical studies on thyroid medullary carcinoma. Diagnostic significance of argyrophil secretory granules. Cancer 1972; 30:755-63. [PMID: 4116425 DOI: 10.1002/1097-0142(197209)30:3<755::aid-cncr2820300325>3.0.co;2-h] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Differences in thyroid cancer. BRITISH MEDICAL JOURNAL 1972; 2:365. [PMID: 5023907 PMCID: PMC1788238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gorlin RJ, Mirkin BL. Multiple mucosal neuromas, pheochromocytoma, medullary carcinoma of the thyroid and marfanoid body build with muscle wasting. Syndrome of hyperplasia and neoplasia of neural crest derivatives--an unitarian concept. ZEITSCHRIFT FUR KINDERHEILKUNDE 1972; 113:313-25. [PMID: 4649671 DOI: 10.1007/bf00440310] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Neville AM. Ectopic production of hormones by tumours. Pathological aspects of the para-endocrine syndrome. Proc R Soc Med 1972; 65:55-9. [PMID: 4335588 PMCID: PMC1644309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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MacGillivray JB, Anderson CJ. Medullary carcinoma of the thyroid with parathyroid adenoma and hypercalcaemia. J Clin Pathol 1971; 24:851-5. [PMID: 5139990 PMCID: PMC477197 DOI: 10.1136/jcp.24.9.851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A patient with hyperparathyroidism due to a parathyroid adenoma was found to have metastatic medullary carcinoma in lymph nodes close to the thyroid gland. The finding of normal calcitonin and parathormone concentrations after removal of the adenoma suggested that the parathyroid lesion was not the result of the hypocalcaemic action of calcitonin produced by the tumour in the thyroid. Seventeen other examples of the association between medullary carcinoma and parathyroid enlargement are briefly reviewed.The pathogenesis of the parathyroid lesions is discussed, and it is suggested that some may be caused by the hypocalcaemic action of calcitonin, while others may be part of a syndrome of multiple endocrine adenomatosis.
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Kaplan EL, Peskin GW. Physiologic implications of medullary carcinoma of the thyroid gland. Surg Clin North Am 1971; 51:125-37. [PMID: 4932922 DOI: 10.1016/s0039-6109(16)39336-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Die pathologische Morphologie der endokrinen Regulationsstörungen. ENDOKRINE REGULATIONS- UND KORRELATIONSSTÖRUNGEN 1971. [DOI: 10.1007/978-3-642-65168-7_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Melvin KE, Tashjian AH, Cassidy CE, Givens JR. Cushing's syndrome caused by ACTH- and calcitonin-secreting medullary carcinoma of the thyroid. Metabolism 1970; 19:831-8. [PMID: 4319120 DOI: 10.1016/0026-0495(70)90080-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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McDermott FT, Hart JA. Medullary carcinoma of the thyroid with hypocalcaemia. Clinical and ultrastructural observations. Br J Surg 1970; 57:657-61. [PMID: 5471315 DOI: 10.1002/bjs.1800570906] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Johnston CI, Martin TJ, Riddell J. Medullary thyroid carcinoma: a functional peptidesecreting tumour. AUSTRALASIAN ANNALS OF MEDICINE 1970; 19:50-3. [PMID: 5505521 DOI: 10.1111/imj.1970.19.1.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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