Skip to main content

Histopathology of C Cells and Medullary Thyroid Carcinoma

  • Chapter
  • First Online:
Medullary Thyroid Carcinoma

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 204))

Abstract

The human thyroid gland contains less than 0.01–0.1 % calcitonin producing and secreting C cells, which in men are almost exclusively situated in an intrafollicular location; the vast majority of C cells are embryologically derived of remnants of the ultimobranchial body and ultimately of the neural crest, a small subset, however, is presumed to originate from endodermal stem cells. Thyroid tumours with C cell differentiation have been named medullary thyroid carcinoma (MTC); calcitonin is also produced and secreted by MTC which makes this peptide hormone a very useful serum marker both for early detection and clinical follow-up of patients with MTC. About 70–80 % of MTC are sporadic tumours, whereas 20–30 % are familial MTC which are autosomal-dominant inherited and caused by germline mutations of the RET proto-oncogene located on chromosome 10. This article summarizes the histological, immunhistochemical and molecular genetic features of C cells, C-cell hyperplasia (CCH) and MTC, emphasizing the role of diagnostic pathology.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Agaimy A, Erlenbach-Wünsch K, Konukiewitz B et al (2013) ISL1 expression is not restricted to pancreatic well differentiated neuroendocrine neoplasms, but is also commonly found in well and poorly differentiated neuroendocrine neoplasms of extrahepatic origin. Mod Pathol 26:995–1003

    Article  CAS  PubMed  Google Scholar 

  • Albores-Saavedra JA, Krueger JE (2001) C-cell hyperplasia and medullary thyroid microcarcinoma. Endocr Pathol 12:365–377

    Article  CAS  PubMed  Google Scholar 

  • Albores-Saavedra J, Monforte H, Nadji M, Morales AR (1988) C-cell hyperplasia in thyroid tissue adjacent to follicular cell tumors. Hum Pathol 19:795–799

    Article  CAS  PubMed  Google Scholar 

  • Baber EC (1876) Contributions to the minute anatomy of the thyroid gland of the dog. Phil Trans R Soc 166:557–568

    Article  Google Scholar 

  • Baschieri L, Castagna M, Fierabracci A, Antonelli A, Del Guerra P, Squartini F (1989) Distribution of calcitonin- and somatostatin-containing cells in thyroid lymphoma and in Hashimoto’s thyroiditis. Appl Pathol 7:99–104

    CAS  PubMed  Google Scholar 

  • Bergholm U, Bergström R, Ekbom A (1997) Long-term follow-up of patients with medullary carcinoma of the thyroid. Cancer 79:132–138

    Article  CAS  PubMed  Google Scholar 

  • Bockhorn M, Frilling A, Rewerk S et al (2004) Lack of elevated serum carcinoembryonic antigen and calcitonin in medullary thyroid carcinoma. Thyroid 14:468–470

    Article  PubMed  Google Scholar 

  • Bockhorn M, Sheu SY, Frilling A, Molmenti E, Schmid KW, Broelsch CE (2005) Paraganglioma-like medullary thyroid carcinoma: a rare entity. Thyroid 15:1363–1367

    Article  PubMed  Google Scholar 

  • Bussolati G, Foster GV, Clark MB, Pearse AG (1969) Immunofluorescent localisation of calcitonin in medullary C-cell thyroid carcinoma, using antibody to the pure porcine hormone. Virchows Arch B Cell Pathol 2:234–238

    Google Scholar 

  • Chan JKC (2007) Tumors of the thyroid and parathyroid glands (Chapter 18). In: Fletcher CDM (ed) Diagnostic histopathology of tumors, vol 2, 3rd edn. Churchill Livingstone, London, pp 997–1079

    Google Scholar 

  • Chan JK, Tse CC (1989) Solid cell nest-associated C-cells: another possible explanation for “C-cell hyperplasia” adjacent to follicular cell tumors. Hum Pathol 20:498–499

    Article  CAS  PubMed  Google Scholar 

  • Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  • Copp DH, Cameron EC (1961) Demonstration of a hypocalcemic factor (calcitonin) in commercial parathyroid extract. Science 134:2038

    Article  CAS  PubMed  Google Scholar 

  • Copp DH, Cameron EC, Cheney BA, Davidson AG, Henze KG (1962) Evidence for calcitonin—a new hormone from the parathyroid that lowers blood calcium. Endocrinology 70:638–649

    Article  CAS  PubMed  Google Scholar 

  • DeLellis RA, May L, Tashjian AH Jr, Wolfe HJ (1978) C-cell granule heterogeneity in man. An ultrastructural immunocytochemical study. Lab Invest 38:263–269

    CAS  PubMed  Google Scholar 

  • DeLellis RA, Lloyd RV, Heitz PU, Eng C (2004) WHO histological classification of thyroid and parathyroid tumours. In: World Health Organization classification of tumours. Pathology and genetics. Tumours of endocrine organs. IARC Press, Lyon

    Google Scholar 

  • Elisei R, Cosci B, Romei C et al (2008) Prognostic significance of somatic RET oncogene mutations in sporadic medullary thyroid cancer: a 10-year follow-up study. J Clin Endocrinol Metab 93:682–687

    Article  CAS  PubMed  Google Scholar 

  • Elisei R, Schlumberger MJ, Muller SP et al (2013) Cabozantinib in progressive medullary thyroid cancer. J Clin Oncol 31:3639–3646

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Erovic BM, Kim D, Cassol C et al (2012) Prognostic and predictive markers in medullary thyroid carcinoma. Endocr Pathol 23:232–242

    Article  CAS  PubMed  Google Scholar 

  • Foster GV, Baghdiantz A, Kumar MA, Slack E, Soliman HA, MacIntyre I (1964) Thyroid origin of calcitonin. Nature 202:1303–1305

    Article  CAS  PubMed  Google Scholar 

  • Fränkel F (1886) Ein Fall von doppelseitigen, völlig latent verlaufenden Nebennierentumor und gleichzeitiger Nephritis mit Veränderungen am Circulationsapparat und Retinitis. Arch Pathol Anat Physiol Klin Med 103:244–263

    Article  Google Scholar 

  • Frank-Raue K, Machens A, Leidig-Bruckner G et al (2013) Prevalence and clinical spectrum of nonsecretory medullary thyroid carcinoma in a series of 839 patients with sporadic medullary thyroid carcinoma. Thyroid 23:294–300

    Article  CAS  PubMed  Google Scholar 

  • Froebius C (1922) Das aus markhaltigen Nervenfasern bestehende ganglienzellose echte Neurom in Rankenform – zugleich ein Beitrag zu den nervösen Geschwülsten der Zunge und des Augenlides. Virchows Arch Pathol Anat 240:312–327

    Article  Google Scholar 

  • Gibson WC, Peng TC, Croker BP (1980) C-cell nodules in adult human thyroid. A common autopsy finding. Am J Clin Pathol 75:347–350

    Google Scholar 

  • Girelli ME, Nacamulli D, Pelizzo MR et al (1998) Medullary thyroid carcinoma: clinical features and long-term follow-up of seventy-eight patients treated between 1969 and 1986. Thyroid 8:517–523

    Article  CAS  PubMed  Google Scholar 

  • Harach HR (1997) Histogenesis of thyroid C-cell carcinoma. Curr Top Pathol 91:15–20

    Article  CAS  PubMed  Google Scholar 

  • Harach HR, Wilander E, Grimelius L, Bergholm U, Westermark P, Falkmer S (1992) Chromogranin A immunoreactivity compared with argyrophilia, calcitonin immunoreactivity, and amyloid as tumour markers in the histopathological diagnosis of medullary (C-cell) thyroid carcinoma. Pathol Res Pract 188:123–130

    Article  CAS  PubMed  Google Scholar 

  • Hazard JB, Hawk WA, Crile G Jr (1959) Medullary (solid) carcinoma of the thyroid; a clinicopathologic entity. J Clin Endocrinol Metab 19:152–161

    Article  CAS  PubMed  Google Scholar 

  • Hirsch MS, Faquin WC, Krane JF (2004) Thyroid transcription factor-1, but not p53, is helpful in distinguishing moderately differentiated neuroendocrine carcinoma of the larynx from medullary carcinoma of the thyroid. Mod Pathol 17:631–636

    Article  CAS  PubMed  Google Scholar 

  • Hofstra RM, Landsvater RM, Ceccherini I et al (1994) A mutation in the RET proto-oncogene associated with multiple endocrine neoplasia type 2B and sporadic medullary thyroid carcinoma. Nature 367:375–376

    Article  CAS  PubMed  Google Scholar 

  • Horn HC Jr (1951) Carcinoma of the thyroid: description of a distinctive morphological variant of seven cases. Cancer 4:697–707

    Article  Google Scholar 

  • Horn HC Jr, Dull JA (1951) Carcinoma of the thyroid; a re-evaluation. Ann Surg 139:35–43

    Google Scholar 

  • Hürthle K (1894) Beiträge zur Kenntniss des Secretionsvorgangs in der Schilddrüse. Pflugers Arch 56:1–44

    Article  Google Scholar 

  • Insabato L, De Rosa G, Terracciano LM, Lupoli G, Montedoro D, Ravetto C (1993) A calcitonin-producing neuroendocrine tumor of the larynx: a case report. Tumori 79:227–230

    CAS  PubMed  Google Scholar 

  • Karges W (2010) Kalzitoninbestimmung zur Frühdiagnose des medullären Schilddrüsenkarzinoms. Chirurg 81:620–626

    Article  CAS  PubMed  Google Scholar 

  • Kaserer K, Scheuba C, Neuhold N et al (1998) C-cell hyperplasia and medullary thyroid carcinoma in patients routinely screened for serum calcitonin. Am J Surg Pathol 22:722–728

    Article  CAS  PubMed  Google Scholar 

  • Koperek O, Scheuba C, Puri C et al (2007) Molecular characterization of the desmoplastic tumor stroma in medullary thyroid carcinoma. Int J Oncol 31:59–67

    CAS  PubMed  Google Scholar 

  • Koperek O, Scheuba C, Cherenko M et al (2008) Desmoplasia in medullary thyroid carcinoma: a reliable indicator of metastatic potential. Histopathology 52:623–630

    Article  CAS  PubMed  Google Scholar 

  • Koperek O, Prinz A, Scheuba C, Niederle B, Kaserer K (2009) Tenascin C in medullary thyroid microcarcinoma and C-cell hyperplasia. Virchows Arch 455:43–48

    Article  CAS  PubMed  Google Scholar 

  • Koperek O, Bergner O, Pichlhöfer B et al (2011) Expression of hypoxia-associated proteins in sporadic medullary thyroid cancer is associated with desmoplastic stroma reaction and lymph node metastasis and may indicate somatic mutations in the VHL gene. J Pathol 225:63–72

    Article  CAS  PubMed  Google Scholar 

  • Krisch K, Krisch I, Horvat G, Neuhold N, Ulrich W (1985) The value of immunohistochemistry in medullary thyroid carcinoma: a systematic study of 30 cases. Histopathology 9:1077–1089

    Article  CAS  PubMed  Google Scholar 

  • Liu H, Singla A, Ao M et al (2011) Calcitonin receptor-mediated CFTR activation in human intestinal epithelial cells. J Cell Mol Med 15:2697–2705

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • LiVolsi VA (1990) Surgical pathology of the thyroid. Major problems in pathology, vol 22. W. B. Saunders Company, Philadelphia

    Google Scholar 

  • LiVolsi VA (1997) C cell hyperplasia/neoplasia. J Clin Endocrinol Metab 82:39–41

    Article  CAS  PubMed  Google Scholar 

  • Ljungberg O (1972) On medullary carcinoma of the thyroid. Acta Pathol Microbiol Scand Suppl 231:1–57

    CAS  PubMed  Google Scholar 

  • Lloyd RV, Sisson JC, Marangos PJ (1983) Calcitonin, carcinoembryonic antigen and neuron-specific enolase in medullary thyroid carcinoma. Cancer 51:2234–2239

    Article  CAS  PubMed  Google Scholar 

  • Machens A, Dralle H (2006) Multiple endocrine neoplasia type 2 and the RET protooncogene: from bedside to bench to bedside. Mol Cell Endocrinol 247:34–40

    Article  CAS  PubMed  Google Scholar 

  • Matias-Guiu X, Machin P, Pons C, Lagarda E, De Leiva A, Prat J (1998) Sustentacular cells occur frequently in the familial form of medullary thyroid carcinoma. J Pathol 184:420–423

    Article  CAS  PubMed  Google Scholar 

  • Meyer JS, Abdel-Bari W (1968) Granules and thyrocalcitonin-like activity in medullary carcinoma of the thyroid gland. N Engl J Med 278:523–529

    Article  CAS  PubMed  Google Scholar 

  • Nakazawa T, Cameselle-Teijeiro J, Vinagre J et al (2014) C-cell-derived calcitonin-free neuroendocrine carcinoma of the thyroid: the diagnostic importance of CGRP immunoreactivity. Int J Surg Pathol 22:530–535

    Article  CAS  PubMed  Google Scholar 

  • Neumann HP, Vortmeyer A, Schmidt D et al (2007) Evidence of MEN-2 in the original description of classic pheochromocytoma. N Engl J Med 357:1311–1315

    Article  CAS  PubMed  Google Scholar 

  • Nonidez JF (1932) The origin of the ‘parafollicular’ cells: a second epithelial component of the thyroid gland of the dog. Am J Anat 49:479–505

    Article  Google Scholar 

  • O’Toole K, Fenoglio-Preiser C, Pushparaj N (1985) Endocrine changes associated with the human aging process: III. Effect of age on the number of calcitonin immunoreactive cells in the thyroid gland. Hum Pathol 16:991–1000

    Article  PubMed  Google Scholar 

  • Perry A, Molberg K, Albores-Saavedra J (1996) Physiologic versus neoplastic C-cell hyperplasia of the thyroid: separation of distinct histologic and biologic entities. Cancer 77:750–756

    Article  CAS  PubMed  Google Scholar 

  • Pueblitz S, Weinberg AG, Albores-Saavedra J (1993) Thyroid C cells in the DiGeorge anomaly: a quantitative study. Pediatr Pathol 13:463–473

    Article  CAS  PubMed  Google Scholar 

  • Rosai J, Carcangiu ML, DeLellis RA (1992) Tumors of the thyroid gland. In: Atlas of tumor pathology, 3rd series, vol 5. AFIP, Washington, DC

    Google Scholar 

  • Saggiorato E, Rapa I, Garino F et al (2007) Absence of RET gene point mutations in sporadic thyroid C-cell hyperplasia. J Mol Diagn 9:214–219

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Scheuba C, Kaserer K, Kotzmann H, Bieglmayer C, Niederle B, Vierhapper H (2000) Prevalence of C-cell hyperplasia in patients with normal basal and pentagastrin-stimulated calcitonin. Thyroid 10:413–416

    Article  CAS  PubMed  Google Scholar 

  • Scheuba C, Kaserer K, Kaczirek K, Asari R, Niederle B (2006) Desmoplastic stromal reaction in medullary thyroid cancer-an intraoperative “marker” for lymph node metastases. World J Surg 30:853–859

    Article  PubMed  Google Scholar 

  • Schmid KW, Böcker W (1993) Medulläres Schilddrüsenkarzinom. Immunhistochemische Marker in Histopathololgie und Forschung. Zentralbl Pathol 139:115–129

    CAS  PubMed  Google Scholar 

  • Schmid KW, Ensinger C (1998) “Atypical” medullary thyroid carcinoma with little or no calcitonin expression. Virchows Arch 433:209–215

    Article  CAS  PubMed  Google Scholar 

  • Schmid KW, Sheu SY (2015) Schilddrüse. In: Remmele 3. Auflage, Kapitel 19. Springer, Berlin (im Druck)

    Google Scholar 

  • Schmid KW, Fischer-Colbrie R, Hagn C, Jasani B, Williams ED, Winkler H (1987) Chromogranin A and B and secretogranin II in medullary carcinomas of the thyroid. Am J Surg Pathol 11:551–556

    Article  CAS  PubMed  Google Scholar 

  • Schmid KW, Kirchmair R, Ladurner D, Fischer-Colbrie R, Böcker W (1992) Immunohistochemical comparison of chromogranins A and B and secretogranin II with calcitonin and calcitonin gene-related peptide expression in normal, hyperplastic, and neoplastic C cells of the human thyroid. Histopathology 21:225–232

    Article  CAS  PubMed  Google Scholar 

  • Schmid KW, Sheu SY, Görges R, Ensinger C, Tötsch M (2003) Tumoren der Schilddrüse. Pathologe 24:357–372

    Article  CAS  PubMed  Google Scholar 

  • Schröder S, Klöppel G (1987) Carcinoembryonic antigen and nonspecific cross-reacting antigen in thyroid cancer. An immunocytochemical study using polyclonal and monoclonal antibodies. Am J Surg Pathol 11:100–108

    Article  PubMed  Google Scholar 

  • Sheu SY, Schmid KW (2010) Multiple endocrine neoplasia type 2. Pathologe 31:449–454 (Erratum in: Pathologe (2011) 32:82)

    Google Scholar 

  • Sipple JH (1961) The association of pheochromocytoma with carcinoma oft he thyroid. Am J Med 31:163–166

    Article  Google Scholar 

  • Smets G, Warson F, Dehou MF et al (1990) Metastasizing neuroendocrine carcinoma of the larynx with calcitonin and somatostatin secretion and CEA production, resembling medullary thyroid carcinoma. Virchows Arch A Pathol Anat Histopathol 416:539–543

    Article  CAS  PubMed  Google Scholar 

  • Steiner AL, Goodman AD, Powers SR (1968) Study of a kindred with pheochromocytoma, medullary thyroid carcinoma, hyperparathyroidism and Cushing’s disease: multiple endocrine neoplasia, type 2. Medicine (Baltimore) 47:371–409

    Article  CAS  Google Scholar 

  • Sweeney EC, McDonnell L, O’Brien C (1981) Medullary carcinoma of the thyroid presenting as tumours of the pharynx and larynx. Histopathology 5:263–275

    Article  CAS  PubMed  Google Scholar 

  • Synoracki S, Schmid ST, Ting S, Schmid KW (2015) Thyroid C cells and their pathology. Part 2: Medullary thyroid carcinoma. Pathologe 36:254–260

    Google Scholar 

  • Tauber SD (1967) The ultimobranchial origin of thyrocalcitonin. PNAS 58:1684–1687

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Ting S, Schmid ST, Synoracki S, Schmid KW (2015) Thyroid C cells and their pathology. Part 1: Normal C cells—C cell hyperplasia—precursor of familial medullary thyroid carcinoma. Pathologe 36:246–253

    Google Scholar 

  • Vierhapper H, Raber W, Bieglmayer C, Kaserer K, Weinhäusl A, Niederle B (1997) Routine measurement of plasma calcitonin in nodular thyroid diseases. J Clin Endocrinol Metab 82:1589–1593

    Article  CAS  PubMed  Google Scholar 

  • Wagenmann A (1922) Multiple Neurome des Auges und der Zunge. Ber Dtsch Ophtalmol Ges 43:282–285

    Google Scholar 

  • Wells SA Jr, Robinson BG, Gagel RF et al (2012) Vandetanib in patients with locally advanced or metastatic medullary thyroid cancer: a randomized, double-blind phase III trial. J Clin Oncol 30:134–141

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Williams ED (1966) Histogenesis of medullary carcinoma of the thyroid. J Clin Pathol 19:114–118

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Wohllk N, Schweizer H, Erlic Z et al (2010) Multiple endocrine neoplasia type 2. Best Pract Res Clin Endocrinol Metab 24:371–387

    Article  CAS  PubMed  Google Scholar 

  • Wolfe HJ, Melvin KE, Cervi-Skinner SJ et al (1973) C-cell hyperplasia preceding medullary thyroid carcinoma. N Engl J Med 289:437–441

    Article  CAS  PubMed  Google Scholar 

Download references

Author Disclosure Statement

The author has nothing to disclose, no competing financial interests exist.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kurt Werner Schmid .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Schmid, K.W. (2015). Histopathology of C Cells and Medullary Thyroid Carcinoma. In: Raue, F. (eds) Medullary Thyroid Carcinoma. Recent Results in Cancer Research, vol 204. Springer, Cham. https://doi.org/10.1007/978-3-319-22542-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22542-5_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22541-8

  • Online ISBN: 978-3-319-22542-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics