Concurrent Papillary Thyroid Cancer and Medullary Thyroid Cancer

  • Neslihan Kurtulmuş


Concurrent occurrence of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) in a single patient is uncommon. The cell origin, histopathologic features, and prognosis of these two carcinomas are considered completely different. A 40-year-old man was diagnosed MTC after fine needle aspiration biopsy of the right thyroid nodule and the lymph node on the right side. The patient underwent total thyroidectomy with unilateral central compartment and right lateral neck dissection. Histopathological evaluation was identified as MTC in the nodule of the right lobe and the MTC metastasis in the lymph nodes. Besides, papillary microcarcinoma foci were determined on the same thyroid lobe. He had c.1585 > A (p.Glu529Lys) heterozygous variant mutation of RET proto-oncogene. Sixteen months after the operation, his serum calcitonin, carcinoembryonic antigen (CEA), and thyroglobulin levels are undetectable.


Medullary thyroid carcinoma Papillary thyroid carcinoma Concurrent medullary Papillary thyroid carcinoma 


  1. 1.
    Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the Management of Medullary Thyroid Carcinoma: the American Thyroid Association guidelines task force on medullary thyroid carcinoma. Thyroid. 2015;25:567–610. Scholar
  2. 2.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133. Scholar
  3. 3.
    Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics. Cancer J Clin. 2014;64:9–29. Scholar
  4. 4.
    Xing M. Molecular pathogenesis and mechanisms of thyroid cancer. Nat Rev Cancer. 2013;13:184–99. Scholar
  5. 5.
    Accardo G, Conzo G, Esposito D, Gambardella C, Mazzella M, Castaldo F, et al. Genetics of medullary thyroid cancer: an overview. Int J Surg. 2017;41(Suppl 1):2–6.CrossRefGoogle Scholar
  6. 6.
    Lian EY, Maritan SM, Cockburn JG, Kasaian K, Crupi MJ, Hurlbut D, et al. Differential roles of RET isoforms in medullary and papillary thyroid carcinomas. Endocr Relat Cancer. 2017;24:53–69. Scholar
  7. 7.
    Moura MM, Cavaco BM, Pinto AE, Leite V. High prevalence of RAS mutations in RET-negative sporadic medullary thyroid carcinomas. J Clin Endocrinol Metab. 2011;96:E863–8. Scholar
  8. 8.
    Faam B, Ghaffari MA, Ghadiri A, Azizi F. Epigenetic modifications in human thyroid cancer (review). Biomed Rep. 2015;3:3–8. Scholar
  9. 9.
    Tufano RP, Teixeira GV, Bishop J, Carson KA, Xing M. BRAF mutation in papillary thyroid cancer and its value in tailoring initial treatment: a systematic review and meta-analysis. Medicine (Baltimore). 2012;91:274–86. Scholar
  10. 10.
    Kurtulmus N, Duren M, Ince U, Yakicier CM, Peker O, Aydın O, et al. BRAF(V600E) mutation in Turkish patients with papillary thyroid cancer: strong correlation with indicators of tumor aggressiveness. Endocrine. 2012;42:404–10. Scholar
  11. 11.
    Kondo T, Nakazawa T, Ma D, Niu D, Mochizuki K, Kawasaki T, et al. Epigenetic silencing of TTF-1/NKX2,1 through DNA hypermethylation and histon H3 modification in thyroid carcinoma. Lab Investig. 2009;89:791–9. Scholar
  12. 12.
    Eden A, Gaudet F, Waghmare A, Jaenisch R. Chromosomal instability and tumors promoted by DNA hypomethylation. Science. 2003;300:455. Scholar
  13. 13.
    Alvarez-Nuñez F, Bussaglia E, Mauricio D, Ybarra J, Vilar M, Lerma E, et al. Thyroid Neoplasia study group: PTEN promoter methylation in sporadic thyroid carcinomas. Thyroid. 2006;16:17–23. Scholar
  14. 14.
    Lamberg BA, Reissel P, Stenman S, Koivuniemi A, Ekbolm M, Mäkinen J, et al. Concurrent medullary and papillary thyroid carcinoma in the same thyroid lobe and in siblings. Acta Med Scand. 1981;209:421–4.CrossRefGoogle Scholar
  15. 15.
    Machens A, Dralle H. Simultaneous medullary and papillary thyroid cancer: a novel entity? Ann Surg Oncol. 2012;19:37–44. Scholar
  16. 16.
    Ljungberg O, Ericsson UB, Bondeson L, Thorell J. A compound follicular parafollicular cell carcinoma of the thyroid: a new tumor entity? Cancer. 1983;52:1053–61.CrossRefGoogle Scholar
  17. 17.
    Adnan Z, Arad E, Dana J, Shendler Y, Baron E. Simultaneous occurrence of medullary and papillary thyroid microcarcinomas: a case series and review of the literature. J Med Case Rep. 2013;21:7–26. Scholar
  18. 18.
    Kim WG, Gong G, Kim EY. Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental. Clin Endocrinol. 2010;72:256–63. Scholar
  19. 19.
    Lax SF, Beham A, Kronberger-Schönecker 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;424:441–7.CrossRefGoogle Scholar
  20. 20.
    Seki T, Kameyama K, Hayashi H, Nagahama M, Masudo K, Fukunari N, et al. Composite metastatic carcinoma in lymph nodes of patients with concurrent medullary and papillary thyroid carcinoma: a report of two cases. Endocr Pathol. 2004;15:83–8.CrossRefGoogle Scholar
  21. 21.
    Nangue C, Bron L, Portmann L, Volante M, Ris HB, Monnier P, et al. Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature. Head Neck. 2009;31:968–74. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Neslihan Kurtulmuş
    • 1
  1. 1.Department of EndocrinologyAcibadem UniversityIstanbulTurkey

Personalised recommendations