Skip to main content

Advertisement

SpringerLink
Log in

Simultaneous Medullary and Differentiated Thyroid Cancer: A Population-Level Analysis of an Increasingly Common Entity

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Simultaneous medullary thyroid carcinoma (MTC) and differentiated thyroid carcinoma (DTC) is a rare entity. This is the first population-level analysis of the characteristics and outcomes of simultaneous MTC/DTC.

Methods

In the Surveillance, Epidemiology, and End Results (SEER) database (1988–2008), patients with simultaneous MTC/DTC were retrospectively compared with those with MTC alone using χ2, ANOVA, log-rank tests, Cox multivariate regression, and Kaplan–Meier analyses.

Results

A total of 162 patients had simultaneous MTC/DTC; 1,699 had MTC alone. MTC was diagnosed first in 67.9 % of simultaneous MTC/DTC cases. Simultaneous MTC/DTC increased from 2.7 % of all MTCs in 1988–1997 to 12.3 % in 2003–2008. Compared with MTC alone, simultaneous MTC/DTC had smaller mean MTC tumor size (2.9 vs. 2.2 cm; p = 0.005) and lower rates of MTC extrathyroidal extension (25.4 vs. 16.8 %; p = 0.015) and distant metastases (15.7 vs. 9.3 %; p = 0.032). Patients diagnosed with DTC first had smaller mean MTC tumor sizes (p = 0.01), whereas patients diagnosed with MTC first had tumor sizes similar to those of MTC alone. Compared with MTC alone, patients with simultaneous MTC/DTC were more likely to receive thyroidectomy (84.7 vs. 93.2 %; p = 0.003) and radioisotopes (4.4 vs. 25 %; p < 0.001). On Kaplan–Meier analysis, disease-specific survival rates were higher for simultaneous MTC/DTC than for MTC alone (10-year survival rates 87 vs. 81 %; p = 0.056).

Conclusions

Simultaneous MTC/DTC is diagnosed earlier in tumor development than MTC alone, with a trend toward better prognosis. This entity likely represents a primary tumor with an incidental pathologic finding of a second malignancy. Each malignancy should be treated according to its respective stage and current guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ljungberg O, Ericsson UB, Bondeson L, Thorell J. A compound follicular-parafollicular cell carcinoma of the thyroid: a new tumor entity? Cancer. 1983;52(6):1053–61.

    Article  PubMed  CAS  Google Scholar 

  2. Ljungberg O, Bondeson L, Bondeson AG. Differentiated thyroid carcinoma, intermediate type: a new tumor entity with features of follicular and parafollicular cell carcinoma. Hum Pathol. 1984;15(3):218–28.

    Article  PubMed  CAS  Google Scholar 

  3. Harach HR. Thyroglobulin in human thyroid follicles with acid mucin. J Pathol. 1991;164(3):261–3.

    Article  PubMed  CAS  Google Scholar 

  4. Triggs SM, Williams ED. Experimental carcinogenesis in the thyroid follicular and C cells. A comparison of the effect of variation in dietary calcium and of radiation. Acta Endocrinol (Copenh). 1977;85(1):84–92.

    CAS  Google Scholar 

  5. Gonzalez-Campora R, Lopez-Garrido J, Martin-Lacave I, Miralles-Sanchez EJ, Villar JL. Concurrence of a symptomatic encapsulated follicular carcinoma, an occult papillary carcinoma and a medullary carcinoma in the same patient. Histopathology. 1992;21(4):380–2.

    Article  PubMed  CAS  Google Scholar 

  6. Shifrin AL, Xenachis C, Fay A, Matulewicz TJ, Kuo YH, Vernick JJ. One hundred and seven family members with the rearranged during transfection V804M proto-oncogene mutation presenting with simultaneous medullary and papillary thyroid carcinomas, rare primary hyperparathyroidism, and no pheochromocytomas: is this a new syndrome-MEN 2C? Surgery. 2009;146(6):998–1005.

    Article  PubMed  Google Scholar 

  7. Matias-Guiu X, Caixas A, Costa I, Cabezas R, Prat J. Compound medullary-papillary carcinoma of the thyroid: true mixed versus collision tumour [corrected]. Histopathology. 1994;25(2):183–5.

    Article  PubMed  CAS  Google Scholar 

  8. Volante M, Papotti M, Roth J, et al. Mixed medullary-follicular thyroid carcinoma. Molecular evidence for a dual origin of tumor components. Am J Pathol. 1999;155(5):1499–509.

    Article  PubMed  CAS  Google Scholar 

  9. Kim WG, Gong G, Kim EY, Kim TY, Hong SJ, Bae Kim W, Shong YK. Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental. Clin Endocrinol (Oxf). 2010;72(2):256–63.

    Article  Google Scholar 

  10. Fluge Ã, Haugen DRF, Akslen LA, et al. Expression and alternative splicing of c-ret RNA in papillary thyroid carcinomas. Oncogene. 2001;20(7):885–92.

    Article  PubMed  CAS  Google Scholar 

  11. Katoh R, Miyagi E, Nakamura N, et al. Expression of thyroid transcription factor-1 (TTF-1) in human C cells and medullary thyroid carcinomas. Hum Pathol. 2000;31(3):386–93.

    Article  PubMed  CAS  Google Scholar 

  12. Elisei R, Pinchera A, Romei C, et al. Expression of thyrotropin receptor (TSH-R), thyroglobulin, thyroperoxidase, and calcitonin messenger ribonucleic acids in thyroid carcinomas: Evidence of TSH-R gene transcript in medullary histotype. J Clin Endocrinol Metab. 1994;78(4):867–71.

    Article  PubMed  CAS  Google Scholar 

  13. Lax SF, Beham A, Kronberger-Schonecker D, Langsteger W, Denk H. Coexistence of papillary and medullary carcinoma of the thyroid gland-mixed or collision tumour? Clinicopathological analysis of three cases. Virchows Arch. 1994;424(4):441–7.

    Article  PubMed  CAS  Google Scholar 

  14. Fugazzola L, Cerutti N, Mannavola D, Ghilardi G, Alberti L, Romoli R, Beck-Peccoz P. Multigenerational familial medullary thyroid cancer (FMTC): evidence for FMTC phenocopies and association with papillary thyroid cancer. Clin Endocrinol (Oxf). 2002;56(1):53–63.

    Article  CAS  Google Scholar 

  15. Papi G, Corrado S, Pomponi MG, Carapezzi C, Cesinaro A, LiVolsi VA. Concurrent lymph node metastases of medullary and papillary thyroid carcinoma in a case with RET oncogene germline mutation. Endocr Pathol. 2003;14(3):269–76.

    Article  PubMed  CAS  Google Scholar 

  16. Biscolla RP, Ugolini C, Sculli M, et al. Medullary and papillary tumors are frequently associated in the same thyroid gland without evidence of reciprocal influence in their biologic behavior. Thyroid. 2004;14(11):946–52.

    Article  PubMed  Google Scholar 

  17. Rossi S, Fugazzola L, De Pasquale L, et al. Medullary and papillary carcinoma of the thyroid gland occurring as a collision tumour: report of three cases with molecular analysis and review of the literature. Endocr Relat Cancer. 2005;12(2):281–9.

    Article  PubMed  CAS  Google Scholar 

  18. Machens A, Dralle H. Simultaneous medullary and papillary thyroid cancer: a novel entity? Ann Surg Oncol. 2011;19(1):37–44.

    Article  PubMed  Google Scholar 

  19. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. Jm Am Med Assoc. 2006;295(18):2164–7.

    Article  CAS  Google Scholar 

  20. Trimboli P, Ulisse S, Graziano FM, et al. Trend in thyroid carcinoma size, age at diagnosis, and histology in a retrospective study of 500 cases diagnosed over 20 years. Thyroid. 2006;16(11):1151–5.

    Article  PubMed  CAS  Google Scholar 

  21. Colonna M, Guizard AV, Schvartz C, et al. A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983–2000). Eur J Cancer. 2007;43(5):891–900.

    Article  PubMed  CAS  Google Scholar 

  22. Netea-Maier RT, Aben KK, Casparie MK, den Heijer M, Grefte JM, Slootweg P, Hermus A. Trends in incidence and mortality of thyroid carcinoma in The Netherlands between 1989 and 2003: correlation with thyroid fine-needle aspiration cytology and thyroid surgery. Int J Cancer. 2008;123(7):1681–4.

    Article  PubMed  CAS  Google Scholar 

  23. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer. 2009;115(16):3801–7.

    Article  PubMed  Google Scholar 

  24. Enewold L, Zhu K, Ron E, Marrogi AJ, Stojadinovic A, Peoples GE, Devesa SS. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol Biomarkers Prev. 2009;18(3):784–91.

    Article  PubMed  Google Scholar 

  25. Hall SF, Walker H, Siemens R, Schneeberg A. Increasing detection and increasing incidence in thyroid cancer. World J Surg. 2009;33(12):2567–71.

    Article  PubMed  Google Scholar 

  26. Rego-Iraeta A, Perez-Mendez LF, Mantinan B, Garcia-Mayor RV. Time trends for thyroid cancer in northwestern Spain: true rise in the incidence of micro and larger forms of papillary thyroid carcinoma. Thyroid. 2009;19(4):333–40.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

RW was supported in part by the Yale School of Medicine Office of Student Research.

Disclosure

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Risa L. Wong BS, Hadiza S. Kazaure BSc, Sanziana A. Roman MD & Julie A. Sosa MD

Authors
  1. Risa L. Wong BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hadiza S. Kazaure BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sanziana A. Roman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julie A. Sosa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie A. Sosa MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wong, R.L., Kazaure, H.S., Roman, S.A. et al. Simultaneous Medullary and Differentiated Thyroid Cancer: A Population-Level Analysis of an Increasingly Common Entity. Ann Surg Oncol 19, 2635–2642 (2012). https://doi.org/10.1245/s10434-012-2357-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2357-8

Keywords

Search

Navigation