Skip to main content
SpringerLink
Log in

Papillary and Medullary Thyroid Carcinomas Presenting as Collision Tumors: A Case Series of 21 Cases at a Tertiary Care Cancer Center

  • Original Paper
  • Published:
Head and Neck Pathology Aims and scope Submit manuscript

Abstract

Collision tumor is the occurrence of two histologically and morphologically distinct tumors within the same organ with no histological admixture. Collision tumors of the thyroid are extremely rare constituting < 1% of all thyroid tumors. Clinical profiles and pathological features of Medullary thyroid carcinoma (MTC) and Papillary thyroid carcinoma (PTC) presenting as Collision tumors of thyroid, diagnosed between 2009 and 2019, at a tertiary care cancer center were retrospectively analyzed. Collision tumors comprised 4.7% of all MTC cases diagnosed over 10 years. A total of 21 cases (11males, 11 females, M:F = 1) were retrieved with the mean age of patients being 45.33 years (range 26–77 years). More than half of PTCs involved the right lobe of the thyroid (66.6%). About half (53.4%) of MTCs affected the left lobe. Imaging done pre-operatively failed to identify the smaller second tumor in 60% of the cases with both tumours in separate lobes. Pre-operative FNAC showed only MTC in all 8 cases in which it was done. Papillary microcarcinoma (m-PTC) was seen in 85.7% cases, with one case of multifocal m-PTC. MTC (mean size 3.12 cm), on an average, was 3 times larger than the PTC (mean size 0.91 cm). The histological variants of MTC included-oncocytic (1/21, 4.7%), spindle cell (1/21, 4.7%), epithelial (3/21, 14.2%) and classical (16/21, 76.2%) and of PTC included classic PTC (12/21, 57.14%), Hurthle cell (2/21, 9.52%), tall cell (1/21, 4.76%) and follicular variant of PTC (6/21, 28.57%). The microscopic extrathyroidal extension (ETE) due to MTC and PTC component was 42.8% and 9.5% respectively. Lymph node metastasis was seen in 16 (76.2%) cases; 87.5% (14/16) of which were contributed by MTC, 12.5% (2/16) by PTC alone, and 12.5% (2/16) cases showed metastasis from both MTC and PTC. MTC had a higher stage than PTC in 85.5% of cases. Collision tumors of the thyroid are exceedingly rare, and possibly underdiagnosed due to variation in sampling techniques, especially of the grossly “normal lobe”. The low incidence in our cohort is in favor of the “Chance theory” of co-occurrence. This diagnosis is important due to its therapeutic and prognostic implications.

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
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brandwein-Gensler M, Urken M, Wang B. Collision tumor of the thyroid: a case report of metastatic liposarcoma plus papillary thyroid carcinoma. Head Neck. 2004;26(7):637–41. https://doi.org/10.1002/hed.20024.

    Article  PubMed  Google Scholar 

  2. Goyal R, Parwani AV, Gellert L, Hameed O, Giannico GA. A collision tumor of papillary renal cell carcinoma and oncocytoma: case report and literature review. Am J Clin Pathol. 2015;144(5):811–6. https://doi.org/10.1309/AJCPQ0P1YHDBZUFL.

    Article  CAS  PubMed  Google Scholar 

  3. Kim VM, Goicochea L, Fang SH. Case report: collision tumour of colon leiomyosarcoma and adenocarcinoma. J Clin Diagn Res. 2016;10(6):PD03-4. https://doi.org/10.7860/JCDR/2016/16949.7956.

    Article  PubMed  Google Scholar 

  4. Kitagawa H, Kaneko M, Kano M, Ibuki Y, Amatya VJ, Takeshima Y, Hirabayashi N, Hirota S. Coexistence of gastrointestinal stromal tumor and leiomyosarcoma of the stomach presenting as a collision tumor: a case report and review of literature. Pathol Int. 2018;68(5):313–7. https://doi.org/10.1111/pin.12662.

    Article  PubMed  Google Scholar 

  5. McGregor SM, Schoolmeester JK, Lastra RR. Collision signet-ring stromal tumor and steroid cell tumor of the ovary: report of the first case. Int J Gynecol Pathol. 2017;36(3):261–4. https://doi.org/10.1097/PGP.0000000000000321.

    Article  PubMed  Google Scholar 

  6. Abbi KK, Hameed MK, Jiang Y, De Las Casas LE, Schwann TA. Pulmonary collision tumor consisting of adenocarcinoma and typical carcinoid-a case report and review of literature. Am J Ther. 2014;21(6):e234–8. https://doi.org/10.1097/MJT.0b013e318293b0b0.

    Article  PubMed  Google Scholar 

  7. Sizemore GW. Medullary carcinoma of the thyroid gland. Semin Oncol. 1987;14(3):306–14.

    CAS  PubMed  Google Scholar 

  8. Jain M, Verma D, Thomas S, Chauhan R. Mixed medullary - papillary carcinoma thyroid: an uncommon variant of thyroid carcinoma. J Lab Phys. 2014;6(2):133–5. https://doi.org/10.4103/0974-2727.141520.

    Article  Google Scholar 

  9. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 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):1–133. https://doi.org/10.1089/thy.2015.0020.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth Edition AJCC Cancer Staging Manual Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9.

    Article  Google Scholar 

  11. Mishra V, Kowtal P, Rane P, Sarin R. Genetic risk association of CDKN1A and RET gene SNPs with medullary thyroid carcinoma: results from the largest MTC cohort and meta-analysis. Cancer Med. 2019;8(13):6151–61. https://doi.org/10.1002/cam4.2443.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Liu J, Singh B, Tallini G, Carlson DL, Katabi N, Shaha A, Tuttle RM, Ghossein RA. Cancer. 2006;107(6):1255–64. https://doi.org/10.1002/cncr.22138.

    Article  PubMed  Google Scholar 

  13. Nikiforov YE, Seethala RR, Tallini G, Baloch ZW, Basolo F, Thompson LD, Barletta JA, Wenig BM, Al Ghuzlan A, Kakudo K, Giordano TJ, Alves VA, Khanafshar E, Asa SL, El-Naggar AK, Gooding WE, Hodak SP, Lloyd RV, Maytal G, Mete O, Nikiforova MN, Nosé V, Papotti M, Poller DN, Sadow PM, Tischler AS, Tuttle RM, Wall KB, LiVolsi VA, Randolph GW, Ghossein RA. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016;2(8):1023–9. https://doi.org/10.1001/jamaoncol.2016.0386.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Volante M, Hunt JL, Komminoth P, et al. Mixed medullary and follicular thyroid carcinoma. In: Lloyd RV, Osamura RY, Kloppel G, Rosai J, editors., et al., World Health Organization (WHO) classification of tumours of endocrine organs. 4th ed. WHO International Agency for Research on Cancer (IARC) Press: Lyon; 2017. p. 108–16.

    Google Scholar 

  15. Walvekar RR, Kane SV, D’Cruz AK. Collision tumor of the thyroid: follicular variant of papillary carcinoma and squamous carcinoma. World J Surg Oncol. 2006;19(4):65. https://doi.org/10.1186/1477-7819-4-65.

    Article  Google Scholar 

  16. Sung CT, Shetty A, Menias CO, Houshyar R, Chatterjee S, Lee TK, Tung P, Helmy M, Lall C. Collision and composite tumors; radiologic and pathologic correlation. Abdom Radiol (NY). 2017;42(12):2909–26. https://doi.org/10.1007/s00261-017-1200-x.

    Article  Google Scholar 

  17. Lamberg BA, Reissel P, Stenman S, Koivuniemi A, Ekbolm M, Mäkinen J, Franssila K. Concurrent medullary and papillary thyroid carcinoma in the same thyroid lobe and in siblings. Acta Med Scand. 1981;209(5):421–4. https://doi.org/10.1111/j.0954-6820.1981.tb11620.x.

    Article  CAS  PubMed  Google Scholar 

  18. Tanaka T, Yoshimi N, Kanai N, Mori H, Nagai K, Fujii A, Sakata S, Tokimitsu N. Simultaneous occurrence of medullary and follicular carcinoma in the same thyroid lobe. Hum Pathol. 1989;20(1):83–6. https://doi.org/10.1016/0046-8177(89)90208-6.

    Article  CAS  PubMed  Google Scholar 

  19. Pastolero GC, Coire CI, Asa SL. Concurrent medullary and papillary carcinomas of thyroid with lymph node metastases. A collision phenomenon. Am J Surg Pathol. 1996;20(2):245–50. https://doi.org/10.1097/00000478-199602000-00014.

    Article  CAS  PubMed  Google Scholar 

  20. 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(4):441–7. https://doi.org/10.1007/BF00190568.

    Article  CAS  PubMed  Google Scholar 

  21. Rossi S, Fugazzola L, De Pasquale L, Braidotti P, Cirello V, Beck-Peccoz P, Bosari S, Bastagli A. 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. https://doi.org/10.1677/erc.1.00901.

    Article  CAS  PubMed  Google Scholar 

  22. Brauckhoff M, Gimm O, Hinze R, Ukkat J, Brauckhoff K, Dralle H. Papillary thyroid carcinoma in patients with RET proto-oncogene germline mutation. Thyroid. 2002;12(7):557–61. https://doi.org/10.1089/105072502320288393.

    Article  CAS  PubMed  Google Scholar 

  23. 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. https://doi.org/10.1007/s12022-003-0020-4.

    Article  CAS  PubMed  Google Scholar 

  24. Kim WG, Gong G, Kim EY, Kim TY, Hong SJ, Kim WB, 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. https://doi.org/10.1111/j.1365-2265.2009.03622.x.

    Article  Google Scholar 

  25. Biscolla RP, Ugolini C, Sculli M, Bottici V, Castagna MG, Romei C, Cosci B, Molinaro E, Faviana P, Basolo F, Miccoli P, Pacini F, Pinchera A, Elisei R. 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. https://doi.org/10.1089/thy.2004.14.946.

    Article  PubMed  Google Scholar 

  26. Prades JM, Dumollard JM, Timoshenko A, Chelikh L, Michel F, Estour B, Martin C. Multinodular goiter: surgical management and histopathological findings. Eur Arch Otorhinolaryngol. 2002;259(4):217–21. https://doi.org/10.1007/s00405-002-0455-0.

    Article  PubMed  Google Scholar 

  27. Pelizzo MR, Bernante P, Toniato A, Fassina A. Frequency of thyroid carcinoma in a recent series of 539 consecutive thyroidectomies for multinodular goiter. Tumori. 1997;83(3):653–5.

    Article  CAS  Google Scholar 

  28. Kasuga Y, Sugenoya A, Kobayashi S, Masuda H, Iida F. The outcome of patients with thyroid carcinoma and Graves’ disease. Surg Today. 1993;23(1):9–12. https://doi.org/10.1007/BF00308993.

    Article  CAS  PubMed  Google Scholar 

  29. Mazzaferri EL. Thyroid cancer and Graves’ disease. J Clin Endocrinol Metab. 1990;70(4):826–9. https://doi.org/10.1210/jcem-70-4-826.

    Article  CAS  PubMed  Google Scholar 

  30. Schwartz RW, Kenady DE, Bensema M, McGrath PC, Flueck J. Medullary thyroid cancer and Graves’ disease. Surgery. 1989;105(6):804–7.

    CAS  PubMed  Google Scholar 

  31. Joshi P, Nair S, Nair D, Chaturvedi P. Incidence of occult papillary carcinoma of thyroid in Indian population: case series and review of literature. J Cancer Res Ther. 2014;10(3):693–5. https://doi.org/10.4103/0973-1482.138134.

    Article  PubMed  Google Scholar 

  32. Thomas CM, Asa SL, Ezzat S, Sawka AM, Goldstein D. Diagnosis and pathologic characteristics of medullary thyroid carcinoma-review of current guidelines. Curr Oncol. 2019;26(5):338–44. https://doi.org/10.3747/co.26.5539.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567–610. https://doi.org/10.1089/thy.2014.0335.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ryan N, Walkden G, Lazic D, Tierney P. Collision tumors of the thyroid: a case report and review of the literature. Head Neck. 2015;37(10):E125–9. https://doi.org/10.1002/hed.23936.

    Article  PubMed  Google Scholar 

Download references

Funding

No funding obtained.

Author information

Authors and Affiliations

  1. Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, 400012, India

    Ann Thomas, Neha Mittal & Munita Bal

  2. Homi Bhabha National Institute, Mumbai, 400012, India

    Ann Thomas, Neha Mittal, Swapnil U. Rane, Munita Bal, Asawari Patil, Suman Kumar Ankathi & Richa Vaish

  3. Department of Pathology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, India

    Swapnil U. Rane & Asawari Patil

  4. Department of Radiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, 400012, India

    Suman Kumar Ankathi

  5. Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, 400012, India

    Richa Vaish

Authors
  1. Ann Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Neha Mittal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Swapnil U. Rane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Munita Bal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Asawari Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Suman Kumar Ankathi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richa Vaish
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neha Mittal.

Ethics declarations

Conflict of interest

No conflict of interest to disclose.

Ethical Approval

The study complies with the medical ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thomas, A., Mittal, N., Rane, S.U. et al. Papillary and Medullary Thyroid Carcinomas Presenting as Collision Tumors: A Case Series of 21 Cases at a Tertiary Care Cancer Center. Head and Neck Pathol 15, 1137–1146 (2021). https://doi.org/10.1007/s12105-021-01323-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12105-021-01323-7

Keywords

Search

Navigation