Department of Endocrinology, Diabetes Mellitus and Metabolic Disorders, University of Crete, School of Medicine, Heraklion, Crete, Greece.
Hormones (Athens). 2012 Apr-Jun;11(2):210-4. doi: 10.14310/horm.2002.1350.
To describe a rare case of occult (<1 cm in diameter) medullary thyroid carcinoma (MTC) in a 45-year-old woman, presenting as an asymptomatic mediastinal mass.
The diagnostic methodology included laboratory measurements of relevant biochemical and hormonal parameters including calcitonin (CT), carcinoembryonic antigen (CEA) and chromogranin A, and imaging techniques including ultrasound (U/S), computed tomography (C/T), magnetic resonance imaging (MRI) and radio labeled somatostatin analog ((111)In-DTPA-octreotide).
Chest CT revealed a mediastinal mass measuring 5 cm in diameter abutting the right thyroid lobe. CEA was elevated and an association with thyroid malignancies was considered. CT was found to be markedly elevated, pointing to the diagnosis of MTC metastatic to the mediastinum. The patient underwent total thyroidectomy, lymph node dissection and removal of the mediastinal mass. Histological examination revealed MTC of the right thyroid lobe measuring 0.5 cm, metastatic to regional and superior mediastinal lymph nodes.
Occult MTC can infrequently present as an asymptomatic mediastinal mass. Elevated serum CT and CEA along with imaging techniques leads to the correct diagnosis and surgical management of the disease.
描述一例直径<1cm 的隐匿性（<1cm）甲状腺髓样癌（MTC）的罕见病例，该患者为无症状的纵隔肿块。
诊断方法包括相关生化和激素参数的实验室测量，包括降钙素（CT）、癌胚抗原（CEA）和嗜铬粒蛋白 A，以及影像学技术，包括超声（U/S）、计算机断层扫描（C/T）、磁共振成像（MRI）和放射性标记生长抑素类似物（(111)In-DTPA-octreotide）。
胸部 CT 显示纵隔肿块直径 5cm，紧邻右甲状腺叶。CEA 升高，考虑与甲状腺恶性肿瘤有关。CT 明显升高，提示诊断为 MTC 转移至纵隔。患者接受了全甲状腺切除术、淋巴结清扫术和纵隔肿块切除术。组织学检查显示右甲状腺叶 MTC 直径 0.5cm，转移至局部和上纵隔淋巴结。
隐匿性 MTC 可罕见表现为无症状的纵隔肿块。血清 CT 和 CEA 升高以及影像学技术有助于正确诊断和手术治疗该疾病。
