Bockhorn Maximilian, Frilling Andreja, Rewerk Stephan, Liedke Marc, Dirsch Olaf, Schmid Kurt W, Broelsch Christoph E
Department of General and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Thyroid. 2004 Jun;14(6):468-70. doi: 10.1089/105072504323150813.
Medullary thyroid carcinoma (MTC) originates from C-cells. A wide variety of tumor markers including calcitonin (CT), carcinoembryonic antigen (CEA), and chromogranin A are produced by MTC. Surgery remains the only potentially curative therapy, and early detection of the primary remains the most important prognostic factor for a positive outcome for the patient. The following case concerns a 50-year-old woman with histologically proven MTC, who completely lacked serum elevation of both CT and CEA.
We performed a total thyroidectomy with lymphadenectomy in the central compartment. Histologic sections were stained for CT, CEA, and chromogranin A. Additionally we examined the patient's blood for mutations in the RET proto-oncogene.
Serum CT and CEA were below the detection level in the serum. The tumor showed weak staining for CT, but strong staining for CEA and chromogranin A. Sequencing of the RET-proto-oncogene revealed no mutations. Five years after the operation, the patient remains well and shows no signs of tumor recurrence.
We hereby report of a patient with neither plasma elevation of CT nor CEA. From the clinical standpoint, it is important to determine how this subgroup of MTC should be followed because CT and CEA are of no clinical use.
甲状腺髓样癌（MTC）起源于C细胞。MTC可产生多种肿瘤标志物，包括降钙素（CT）、癌胚抗原（CEA）和嗜铬粒蛋白A。手术仍然是唯一可能治愈的治疗方法，早期发现原发灶仍然是患者获得良好预后的最重要因素。以下病例涉及一名50岁女性，经组织学证实为MTC，但血清CT和CEA均未升高。
我们对患者进行了全甲状腺切除术及中央区淋巴结清扫术。组织切片进行CT、CEA和嗜铬粒蛋白A染色。此外，我们检测了患者血液中RET原癌基因的突变情况。
血清CT和CEA低于检测水平。肿瘤对CT染色较弱，但对CEA和嗜铬粒蛋白A染色较强。RET原癌基因测序未发现突变。术后5年，患者情况良好，无肿瘤复发迹象。
我们在此报告一例血清CT和CEA均未升高的患者。从临床角度来看，由于CT和CEA对临床诊断无帮助，确定如何随访这一亚组的MTC患者非常重要。
