2023, Number 04
<< Back
Ginecol Obstet Mex 2023; 91 (04)
Complex ovarian lesion. Infrequent localization of metastasis of medullary thyroid cancer. Case report and review of the literature
Palomo-Rodríguez MF, Gallardo-Martínez J, Brenner-Anidjar RD, Aguado-Linares P, Pantoja-Garrido M, Gutiérrez-Domingo Á
Language: Spanish
References: 18
Page: 286-290
PDF size: 181.22 Kb.
ABSTRACT
Background: Medullary thyroid carcinoma is a rare malignant tumor originating
in the calcitonin-producing parafollicular thyroid cells. Although it can occur spontaneously,
familial association is rarely exceptional. Although survival in early stages is
considerable, the possibility of metastasis at the time of diagnosis is frequent.
Clinical case: 72-year-old patient with a lump in the anterior neck region and left
cervical adenopathy of 15 days of evolution. CT, ultrasound, and biopsy reported: bilateral
poorly differentiated ovarian carcinoma. Radical surgery (hysterectomy, double
adnexectomy, pelvic and para-aortic lymphadenectomy, omentectomy and appendectomy)
was performed and complete cytoreduction was achieved. In the definitive study,
metastases of medullary thyroid carcinoma were found in both ovaries, myometrium
and peritoneum. Chemotherapy with vandetanib was then started. After 25 cycles of
treatment, the patient continued with zoledronic acid and was asymptomatic. One
month after the end of the treatment, she began to have comic crises that were treated
with quetiapine, with satisfactory response. Subsequently, the patient had a facial cellulitis
that was treated with antibiotics and corticosteroids; three weeks later she died
due to multiorgan failure.
Conclusions: Medullary thyroid carcinoma is a rare site of metastasis that still requires
research to establish diagnostic and treatment protocols and to estimate survival.
REFERENCES
American Thyroid Association Guidelines Task Force, KloosRT, Eng C, Evans DB, Francis GL, Gagel RF, et al. Medullarythyroid cancer: management guidelines of the AmericanThyroid Association [published correction appears in Thyroid. 2009 Nov;19(11):1295]. Thyroid. 2009;19(6):565-612.doi:10.1089/thy.2008.0403
Ríos A, Rodríguez JM, Febrero B, Acosta JM, Torregrosa N,Parrilla P. Valor pronóstico de las características clínicas,histopatológicas e inmunohistoquímicas en el carcinomamedular de tiroides [Prognostic value of clinical,histopathological and immunohistochemical features inmedullary thyroid cancer] [published correction appears inMed Clin (Barc). 2014 Mar 4;142(5):233]. Med Clin (Barc).2012;139(7):277-283. doi:10.1016/j.medcli.2011.07.021
Al-Qurayshi Z, Sullivan CB, Pagedar N, Lee GS, Tufano R,Kandil E. Prevalence and Risk of Metastatic Thyroid Cancersand Management Outcomes: A National Perspective. Laryngoscope.2021;131(1):237-244. doi:10.1002/lary.28722
Schlumberger M, Carlomagno F, Baudin E, Bidart JM,Santoro M. New therapeutic approaches to treat medullarythyroid carcinoma. Nat Clin Pract Endocrinol Metab.2008;4(1):22-32. doi:10.1038/ncpendmet0717.
Bhatoe HS, Badwal S, Dutta V, Kannan N. Pituitary metastasisfrom medullary carcinoma of thyroid: case reportand review of literature. J Neurooncol. 2008;89(1):63-67.doi:10.1007/s11060-008-9586-5
Jee MS, Chung YI, Lee MW, Choi JH, Moon KC, Koh JK. Cutaneousmetastasis from medullary carcinoma of thyroidgland. Clin Exp Dermatol. 2003;28:670-671.
De Groot JW, Plukker JT, Wolffenbuttel BH, Wiggers T, SluiterWJ, Links TP. Determinants of life expectancy in medullarythyroid cancer: age does not matter. Clin.Endocrinol.(Oxf). 2006 (65): 729-736
Roman S, Lin R, Sosa JA. Prognosis of medullary thyroidcarcinoma: Demographic, clinical, and pathologic predictorsof survival in 1252 cases. Cancer. 2006 107 2134-2142.
Gosnell JE, Maa J, Clark OH, Duh QY. Medullary thyroidcarcinoma manifesting as an ovarian mass: case reportand review of literature. Endocr Pract. 2008;14(3):351-357.doi:10.4158/EP.14.3.351
Saad MF, Ordonez NG, Rashid RK, Guido JJ, Hill Jr CS,Samaan NA. Medullary carcinoma of the thyroid. A studyof the clinical features and prognostic factors in 161 patients.Medicine (Baltimore). 1984;63(6):319-342.
Carlson KM, Dou S, Chi D, Scavarda N, Toshima K, Jackson CEet al. Single missense mutation in the tyrosine kinase catalyticdomain of the RET protooncogene is associated withmultiple endocrine neoplasia type 2B. Proc Natl Acad SciU S A. 1994;91(4):1579-1583. doi:10.1073/pnas.91.4.1579
Lips CJ, Landsvater RM, Höppener JW, Geerdink RA, BlijhamG, Van Veen JM et al. Clinical screening as compared withDNA analysis in families with multiple endocrine neoplasiatype 2A. N Engl J Med. 1994;331(13):828-835. doi:10.1056/NEJM199409293311302
Bergholm U, Adami HO, Auer G, Bergström R, BäckdahlM, Grimelius L et al. Histopathologic characteristics andnuclear DNA content as prognostic factors in medullarythyroid carcinoma. A nationwide study in Sweden. TheSwedish MTC Study Group. Cancer. 1989;64(1):135-
doi:10.1002/1097-0142(19890701)64:1<135::aidcncr2820640123>3.0.co;2-g14. Mendelsohn G, Wells SA Jr, Baylin SB. Relationship of tissuecarcinoembryonic antigen and calcitonin to tumor virulencein medullary thyroid carcinoma. An immunohistochemicalstudy in early, localized, and virulent disseminated stagesof disease. Cancer.1984;54(4):657-662.doi:10.1002/10970142(1984)54:4<657::aid-cncr2820540412>3.0.co;2-v
Scherübl H, Raue F, Ziegler R. Combination chemotherapyof advanced medullary and differentiated thyroid cancer:phase II study. J Cancer Res Clin Oncol. 1990;116: 21-23.
Schlumberger M, Abdelmoumene N, Delisle MJ, CouetteJE (Groupe d’Étude des Tumeurs à Calcitonine [GETC]).Treatment of advanced medullary thyroid cancer with analternating combination of 5 FU- streptozocin and 5 FUdacarbazine.Br J Cancer. 1995;71:363-365.
Moley JF, DeBenedetti MK. Patterns of nodal metastases inpalpable medullary thyroid carcinoma: recommenda- tionsfor extent of node dissection [with discussion]. Ann Surg.1999;229:880-888
Ceolin L, Duval MADS, Benini AF, Ferreira CV, Maia AL.Medullary thyroid carcinoma beyond surgery: advances,challenges, and perspectives. Endocr Relat Cancer.2019;26(9):R499-R518. doi:10.1530/ERC-18-0574