Sadat Alavi Mehr, Azarpira Negar
Department of Pathology, Organ Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
J Med Case Rep. 2011 Dec 20;5:590. doi: 10.1186/1752-1947-5-590.
Papillary thyroid carcinoma and medullary thyroid carcinoma are two different thyroid neoplasia. The simultaneous occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma as a collison tumor with metastases from both lesions in the regional lymph nodes is a rare phenomenon.
A 32-year-old Iranian man presented with a fixed anterior neck mass. Ultrasonography revealed two separate thyroid nodules as well as a suspicious neck mass that appeared to be a metastatic lesion. The results of thyroid function tests were normal, but the preoperative calcitonin serum value was elevated. Our patient underwent a total thyroidectomy with neck exploration. Two separate and ill-defined solid lesions grossly in the right lobe were noticed. Histological and immunohistochemical studies of these lesions suggested the presence of medullary thyroid carcinoma and papillary thyroid carcinoma. The lymph nodes isolated from a neck dissection specimen showed metastases from both lesions.
The concomitant occurrence of papillary thyroid carcinoma and medullary thyroid carcinoma and the exact diagnosis of this uncommon event are important. The treatment strategy should be reconsidered in such cases, and genetic screening to exclude multiple endocrine neoplasia 2 syndromes should be performed. For papillary thyroid carcinoma, radioiodine therapy and thyroid-stimulating hormone suppressive therapy are performed. However, the treatment of medullary thyroid carcinoma is mostly radical surgery with no effective adjuvant therapy.
甲状腺乳头状癌和甲状腺髓样癌是两种不同的甲状腺肿瘤。甲状腺髓样癌与甲状腺乳头状癌同时发生，且区域淋巴结出现两种病变的转移，这种碰撞瘤现象较为罕见。
一名32岁的伊朗男性因颈部前方肿块固定前来就诊。超声检查发现两个独立的甲状腺结节以及一个可疑的颈部肿块，似乎是转移性病变。甲状腺功能检查结果正常，但术前血清降钙素值升高。我们的患者接受了全甲状腺切除术及颈部探查。术中发现右侧叶有两个独立且边界不清的实性病变。对这些病变进行组织学和免疫组化研究提示存在甲状腺髓样癌和甲状腺乳头状癌。颈部清扫标本分离出的淋巴结显示有两种病变的转移。
甲状腺乳头状癌和甲状腺髓样癌的同时发生以及对这种罕见情况的准确诊断很重要。在此类病例中应重新考虑治疗策略，并进行基因筛查以排除多发性内分泌腺瘤2型综合征。对于甲状腺乳头状癌，需进行放射性碘治疗和促甲状腺激素抑制治疗。然而，甲状腺髓样癌的治疗主要是根治性手术，尚无有效的辅助治疗方法。
