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without authorization.
Overview Medullary
thyroid cancer is not actually thyroid cancer, it originates from parathyroid follicular cells that secrete calcitonin, which are neuroendocrine cells and have nothing to do with
thyroid follicular cells.
Medullary thyroid cancer is characterized by the production of melanin and is morphologically defined
by the presence of melanin deposits in the cytoplasm of tumor cells.
Today, let's study together about 1 case
of melanin medullary thyroid cancer.
Description of the disease
A 51-year-old woman presents with neck swelling and physical examination reveals a soft, nontender nodule in the thyroid region with swallowing movement
.
Patients have no clinical signs
of thyroid or parathyroid activity.
At the same time, the patient's past and family history are not special.
Laboratory tests showed serum calcitonin 8643.
0 pg/ml, CEA 86.
2 ng/ml, and chromophilic egg A 123.
2 ng/ml
.
Thyroid ultrasound reveals a nodule about 5.
4×4.
7×4.
3 cm in size, which completely replaces the right thyroid gland
.
Nodular fine-needle aspiration biopsy shows predominantly single scattered plasmacyte-like cells with large round to oval eccentrically positioned nuclei and pronounced nucleoli.
Many cells contain brown-black cytoplasmic granules, which Melan-A highlights on cell block slides (Figure 1).
Figure 1.
Fine needle aspiration biopsy of the right thyroid nodule
In addition, IHC analysis showed that the cells were positive for calcitonin, CEA, synaptophysin, AE1/AE3, CAM5.
2, and HMB-45 (focal); Cells were negative for chromogranin, thyroglobulin, PAX8, TTF-1
.
Therefore, the patient is diagnosed with melanin medullary thyroid cancer
.
The patient underwent a total thyroidectomy in which the right thyroid gland was completely occupied by a mass of approximately 6.
0×4.
2×4.
2 cm in size, which was confined within the thyroid capsule (Figure 2).
Figure 2.
Total thyroidectomy specimen
Microscopic examination showed that 2 tumor cell populations were separated by 1 transition zone
.
Neuroendocrine-like components, characterized by tumor cells with round to oval nuclei, punctate chromatin, inconspicuous nucleoli, and unclear cell boundaries, appear to progress to polygonal cell sheets with eccentric and polymorphic nuclei, pronounced nucleoli, and coarse chromatin (Figure 3).
Figure 3.
Total thyroidectomy
Brown-black intracytoplasmic pigment granules
were present in both cell populations.
IHC analysis showed cells being positive for AE1/AE3, CK7, synaptophysin, CEA, INSM1, TTF-1, HMB-45 (focal), and cells negative for SOX10 (Figure 4).
Figure 4.
Immunohistochemistry
One month after surgery, serum calcitonin had dropped to <2 pg/ml
.
The patient develops new painful, irregular nodules
in the thyroid area.
Fine needle aspiration biopsy reveals atypical large cells with eccentric nuclei and coarse chromatin (Figure 5).
Figure 5.
Fine-needle aspiration biopsy
The patient underwent an open biopsy and tumor resection
.
Medullary thyroid carcinoma of the melanogenic gland suggests the possible presence of metastatic melanoma, and tumor cell expression confirms epithelial and neuroendocrine expression
of thyroid cancer with high transformation and loss of superficial melanocyte differentiation.
This case may represent medullary thyroid carcinoma with metastatic melanoma within tumor, which has undergone a high degree of transformation and loss
of epithelial and neuroendocrine expression.
Due to the close association of neuroendocrine carcinoma components and high-grade components with the transitional regions noted in previous thyroidectomy specimens, and at the same time, there is no obvious primary melanoma in the patient to further support the diagnosis
.
References:
1.
Brzezinska
KA, Bhardwaj S, Teng MS, Si Q, Sun J, Westra WH, Zakowski MF, Szporn AH.
Melanotic medullary thyroid carcinoma: A case report with review of the
literature.
Diagn Cytopathol.
2022 Sep 3.
doi: 10.
1002/dc.
25048.
Epub ahead of
print.
PMID: 36056712.
