Difference between revisions of "C-cell hyperplasia"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = C-cell hyperplasia in MEN 2 -- intermed mag.jpg
| Width      =
| Width      =
| Caption    =  
| Caption    = C-cell hyperplasia. [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      =
| Micro      =
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| LMDDx      = [[medullary thyroid carcinoma]]
| LMDDx      = [[medullary thyroid carcinoma]]
| Stains    =
| Stains    =
| IHC        =
| IHC        = CEA +ve, chromogranin A +ve, synaptophysin +ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      = not apparent
| Gross      = not apparent; mid portion of lobe to upper third of lobe
| Grossing  =
| Grossing  =
| Site      = [[thyroid gland]]
| Site      = [[thyroid gland]]
| Assdx      =
| Assdx      =
| Syndromes  = [[Multiple endocrine neoplasia type 2A]]
| Syndromes  = [[Multiple endocrine neoplasia type 2A]], [[Multiple endocrine neoplasia type 2B]]
| Clinicalhx =  
| Clinicalhx = +/-family history of thyroid cancer or MEN 2A or MEN 2B
| Signs      =
| Signs      = +/-marfanoid habitus (seen in MEN 2B)
| Symptoms  =
| Symptoms  =
| Prevalence = uncommon
| Prevalence = uncommon
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| Prognosis  = benign in itself
| Prognosis  = benign in itself
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    =  
| Tx        = prophylatic surgery
| Tx        = prophylatic surgery
}}
}}
'''C-cell hyperplasia''' is a pathology of the [[thyroid gland]] and considered the precursor for [[medullary thyroid carcinoma]].
'''C-cell hyperplasia''', abbreviated '''CCH''', is a pathology of the [[thyroid gland]] and considered the precursor for [[medullary thyroid carcinoma]].


==General==
==General==
*Screening for C-cell hyperplasia/[[medullary thyroid carcinoma]] done with ''serum calcitonin level''.<ref name=pmid19726541>{{cite journal |author=Machens A, Hoffmann F, Sekulla C, Dralle H |title=Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer |journal=Endocr. Relat. Cancer |volume=16 |issue=4 |pages=1291–8 |year=2009 |month=December |pmid=19726541 |doi=10.1677/ERC-09-0136 |url=http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291}}</ref>
*Screening for C-cell hyperplasia/[[medullary thyroid carcinoma]] done with ''serum calcitonin level''.<ref name=pmid19726541>{{cite journal |author=Machens A, Hoffmann F, Sekulla C, Dralle H |title=Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer |journal=Endocr. Relat. Cancer |volume=16 |issue=4 |pages=1291–8 |year=2009 |month=December |pmid=19726541 |doi=10.1677/ERC-09-0136 |url=http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291}}</ref>
*Associated with [[multiple endocrine neoplasia type 2A]].<ref name=pmid21134882>{{Cite journal  | last1 = Tyer | first1 = NM. | last2 = Braunstein | first2 = GD. | last3 = Frishberg | first3 = D. | title = Unusual case of multiple endocrine neoplasia type 2A syndrome without medullary thyroid carcinoma. | journal = Endocr Pract | volume = 17 | issue = 2 | pages = e4-7 | month =  | year =  | doi = 10.4158/EP10157.CR | PMID = 21134882 }}</ref>
 
**May be found in specimen of a surgery done to exclude [[medullary thyroid carcinoma|MTC]] in the context of [[MEN 2A]].<ref name=pmid18976013>{{Cite journal  | last1 = Etit | first1 = D. | last2 = Faquin | first2 = WC. | last3 = Gaz | first3 = R. | last4 = Randolph | first4 = G. | last5 = DeLellis | first5 = RA. | last6 = Pilch | first6 = BZ. | title = Histopathologic and clinical features of medullary microcarcinoma and C-cell hyperplasia in prophylactic thyroidectomies for medullary carcinoma: a study of 42 cases. | journal = Arch Pathol Lab Med | volume = 132 | issue = 11 | pages = 1767-73 | month = Nov | year = 2008 | doi = 10.1043/1543-2165-132.11.1767 | PMID = 18976013 }}</ref>
Associated with:
*[[Multiple endocrine neoplasia type 2A]]<ref name=pmid21134882>{{Cite journal  | last1 = Tyer | first1 = NM. | last2 = Braunstein | first2 = GD. | last3 = Frishberg | first3 = D. | title = Unusual case of multiple endocrine neoplasia type 2A syndrome without medullary thyroid carcinoma. | journal = Endocr Pract | volume = 17 | issue = 2 | pages = e4-7 | month =  | year =  | doi = 10.4158/EP10157.CR | PMID = 21134882 }}</ref> - may be found in specimen of a surgery done to exclude [[medullary thyroid carcinoma|MTC]] in the context of [[MEN 2A]].<ref name=pmid18976013>{{Cite journal  | last1 = Etit | first1 = D. | last2 = Faquin | first2 = WC. | last3 = Gaz | first3 = R. | last4 = Randolph | first4 = G. | last5 = DeLellis | first5 = RA. | last6 = Pilch | first6 = BZ. | title = Histopathologic and clinical features of medullary microcarcinoma and C-cell hyperplasia in prophylactic thyroidectomies for medullary carcinoma: a study of 42 cases. | journal = Arch Pathol Lab Med | volume = 132 | issue = 11 | pages = 1767-73 | month = Nov | year = 2008 | doi = 10.1043/1543-2165-132.11.1767 | PMID = 18976013 }}</ref>
*[[Multiple endocrine neoplasia type 2B]].<ref name=pmid20301434>{{Cite journal  | last1 = Pagon | first1 = RA. | last2 = Adam | first2 = MP. | last3 = Ardinger | first3 = HH. | last4 = Wallace | first4 = SE. | last5 = Amemiya | first5 = A. | last6 = Bean | first6 = LJH. | last7 = Bird | first7 = TD. | last8 = Fong | first8 = CT. | last9 = Mefford | first9 = HC. | title = Multiple Endocrine Neoplasia Type 2 | journal =  | volume =  | issue =  | pages =  | month =  | year =  | doi =  | PMID = 20301434 }}</ref>


==Gross==
==Gross==
*Not visible.
*Not visible on gross.
 
Location:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf]. Accessed on: 7 April 2012.</ref>
*Mid portion of lobe to upper third of lobe.
**Not at the poles.
**Not in the isthmus.


==Microscopic==
==Microscopic==
Features:
Features:
*Location:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf]. Accessed on: 7 April 2012.</ref>
*Definitions vary.<ref>Raphael S. 17 January 2011.</ref>
**Mid portion of lobe to upper third of lobe.
**One definition - either of the following:<ref name=pmid19726541>{{cite journal |author=Machens A, Hoffmann F, Sekulla C, Dralle H |title=Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer |journal=Endocr. Relat. Cancer |volume=16 |issue=4 |pages=1291–8 |year=2009 |month=December |pmid=19726541 |doi=10.1677/ERC-09-0136 |url=http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291}}</ref>
***Not at the poles.
**#>50 C-cells per low-power field (x100).
***Not in the isthmus.
**#*This part of the definition suffers from [[LPFitis]].
**#"[[Medullary thyroid carcinoma]] confined to the thyroid gland and no larger than 10 mm in greatest dimension."
**Another definition:
***Invasion of the basement membrane with stromal reaction.
**A third definition:
***"Several clusters" of more than six C cells.


*Definitions vary.<ref>SR. 17 January 2011.</ref>
===Images===
<gallery>
Image: C-cell hyperplasia in MEN 2 -- very low mag.jpg | CCH in MEN - very low mag. (WC)
Image: C-cell hyperplasia in MEN 2 -- low mag.jpg | CCH in MEN - low mag. (WC)
Image: C-cell hyperplasia in MEN 2 - alt -- low mag.jpg | CCH in MEN - low mag. (WC)
Image: C-cell hyperplasia in MEN 2 -- intermed mag.jpg | CCH in MEN - intermed. mag. (WC)
Image: C-cell hyperplasia in MEN 2 -- high mag.jpg | CCH in MEN - high mag. (WC)
Image: C-cell hyperplasia in MEN 2 - alt -- high mag.jpg | CCH in MEN - high mag. (WC)
Image: C-cell hyperplasia in MEN 2 -- very high mag.jpg | CCH in MEN - very high mag. (WC)
Image: C-cell hyperplasia in MEN 2 - alt -- very high mag.jpg | CCH in MEN - very high mag. (WC)
</gallery>


One definition - either of the following:<ref name=pmid19726541>{{cite journal |author=Machens A, Hoffmann F, Sekulla C, Dralle H |title=Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer |journal=Endocr. Relat. Cancer |volume=16 |issue=4 |pages=1291–8 |year=2009 |month=December |pmid=19726541 |doi=10.1677/ERC-09-0136 |url=http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291}}</ref>
<gallery>
#>50 C-cells per low-power field (x100).
Image: C-cell hyperplasia in MEN 2 - chromo A -- intermed mag.jpg | CCH in MEN - chromo A - intermed. mag. (WC)
#*This part of the definition suffers from [[LPFitis]]. The paper should have been rejected.
Image: C-cell hyperplasia in MEN 2 - chromo A -- high mag.jpg | CCH in MEN - chromo A - high mag. (WC)
#Confined to the thyroid gland and no larger than 10 mm in greatest dimension.
Image: C-cell hyperplasia in MEN 2 - chromo A -- very high mag.jpg | CCH in MEN - chromo A - very high mag. (WC)


Another definition:
Image: C-cell hyperplasia in MEN 2 - CEA -- low mag.jpg | CCH in MEN - CEA - low mag. (WC)
*Invasion of the basement membrane with stromal reaction.
Image: C-cell hyperplasia in MEN 2 - CEA -- intermed mag.jpg | CCH in MEN - CEA - intermed. mag. (WC)
Image: C-cell hyperplasia in MEN 2 - CEA -- high mag.jpg | CCH in MEN - CEA - high mag. (WC)
Image: C-cell hyperplasia in MEN 2 - CEA -- very high mag.jpg | CCH in MEN - CEA - very high mag. (WC)
</gallery>


A third definition:
====www====
*"Several clusters" of more than six C cells.
 
===Images===
*[http://www.nature.com/modpathol/journal/v16/n8/fig_tab/3880836f2.html CCH - crappy B&W image (nature.com)].<ref>{{Cite journal  | last1 = Guyétant | first1 = S. | last2 = Josselin | first2 = N. | last3 = Savagner | first3 = F. | last4 = Rohmer | first4 = V. | last5 = Michalak | first5 = S. | last6 = Saint-André | first6 = JP. | title = C-cell hyperplasia and medullary thyroid carcinoma: clinicopathological and genetic correlations in 66 consecutive patients. | journal = Mod Pathol | volume = 16 | issue = 8 | pages = 756-63 | month = Aug | year = 2003 | doi = 10.1097/01.MP.0000081727.75778.0C | PMID = 12920219 }}</ref>
*[http://www.nature.com/modpathol/journal/v16/n8/fig_tab/3880836f2.html CCH - crappy B&W image (nature.com)].<ref>{{Cite journal  | last1 = Guyétant | first1 = S. | last2 = Josselin | first2 = N. | last3 = Savagner | first3 = F. | last4 = Rohmer | first4 = V. | last5 = Michalak | first5 = S. | last6 = Saint-André | first6 = JP. | title = C-cell hyperplasia and medullary thyroid carcinoma: clinicopathological and genetic correlations in 66 consecutive patients. | journal = Mod Pathol | volume = 16 | issue = 8 | pages = 756-63 | month = Aug | year = 2003 | doi = 10.1097/01.MP.0000081727.75778.0C | PMID = 12920219 }}</ref>
*[http://www.nature.com/modpathol/journal/v16/n8/fig_tab/3880836f3.htm CCH - crappy B&W image (nature.com)].
*[http://www.nature.com/modpathol/journal/v16/n8/fig_tab/3880836f3.htm CCH - crappy B&W image (nature.com)].
Line 67: Line 88:
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=4849 CCH (unibas.ch)].
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=4849 CCH (unibas.ch)].
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=10739 Nodular CCH (unibas.ch)].
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=10739 Nodular CCH (unibas.ch)].
==IHC==
*Chromogranin A +ve.
*[[CEA]] +ve.
*Synaptophysin +ve.


==See also==
==See also==

Latest revision as of 17:56, 18 August 2022

C-cell hyperplasia
Diagnosis in short

C-cell hyperplasia. H&E stain.
LM DDx medullary thyroid carcinoma
IHC CEA +ve, chromogranin A +ve, synaptophysin +ve
Gross not apparent; mid portion of lobe to upper third of lobe
Site thyroid gland
Syndromes Multiple endocrine neoplasia type 2A, Multiple endocrine neoplasia type 2B
Clinical history +/-family history of thyroid cancer or MEN 2A or MEN 2B
Signs +/-marfanoid habitus (seen in MEN 2B)
Prevalence uncommon
Blood work calcitonin level elevated
Prognosis benign in itself
Treatment prophylatic surgery

C-cell hyperplasia, abbreviated CCH, is a pathology of the thyroid gland and considered the precursor for medullary thyroid carcinoma.

General

Associated with:

Gross

  • Not visible on gross.

Location:[5]

  • Mid portion of lobe to upper third of lobe.
    • Not at the poles.
    • Not in the isthmus.

Microscopic

Features:

  • Definitions vary.[6]
    • One definition - either of the following:[1]
      1. >50 C-cells per low-power field (x100).
        • This part of the definition suffers from LPFitis.
      2. "Medullary thyroid carcinoma confined to the thyroid gland and no larger than 10 mm in greatest dimension."
    • Another definition:
      • Invasion of the basement membrane with stromal reaction.
    • A third definition:
      • "Several clusters" of more than six C cells.

Images

  • CCH in MEN - very low mag. (WC)

  • CCH in MEN - low mag. (WC)

  • CCH in MEN - low mag. (WC)

  • CCH in MEN - intermed. mag. (WC)

  • CCH in MEN - high mag. (WC)

  • CCH in MEN - high mag. (WC)

  • CCH in MEN - very high mag. (WC)

  • CCH in MEN - very high mag. (WC)

  • CCH in MEN - chromo A - intermed. mag. (WC)

  • CCH in MEN - chromo A - high mag. (WC)

  • CCH in MEN - chromo A - very high mag. (WC)

  • CCH in MEN - CEA - low mag. (WC)

  • CCH in MEN - CEA - intermed. mag. (WC)

  • CCH in MEN - CEA - high mag. (WC)

  • CCH in MEN - CEA - very high mag. (WC)

www

IHC

  • Chromogranin A +ve.
  • CEA +ve.
  • Synaptophysin +ve.

See also

References

  1. ↑ 1.0 1.1 Machens A, Hoffmann F, Sekulla C, Dralle H (December 2009). "Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer". Endocr. Relat. Cancer 16 (4): 1291–8. doi:10.1677/ERC-09-0136. PMID 19726541. http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291.
  2. ↑ Tyer, NM.; Braunstein, GD.; Frishberg, D.. "Unusual case of multiple endocrine neoplasia type 2A syndrome without medullary thyroid carcinoma.". Endocr Pract 17 (2): e4-7. doi:10.4158/EP10157.CR. PMID 21134882.
  3. ↑ Etit, D.; Faquin, WC.; Gaz, R.; Randolph, G.; DeLellis, RA.; Pilch, BZ. (Nov 2008). "Histopathologic and clinical features of medullary microcarcinoma and C-cell hyperplasia in prophylactic thyroidectomies for medullary carcinoma: a study of 42 cases.". Arch Pathol Lab Med 132 (11): 1767-73. doi:10.1043/1543-2165-132.11.1767. PMID 18976013.
  4. ↑ Pagon, RA.; Adam, MP.; Ardinger, HH.; Wallace, SE.; Amemiya, A.; Bean, LJH.; Bird, TD.; Fong, CT. et al. Multiple Endocrine Neoplasia Type 2. PMID 20301434.
  5. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf. Accessed on: 7 April 2012.
  6. ↑ Raphael S. 17 January 2011.
  7. ↑ Guyétant, S.; Josselin, N.; Savagner, F.; Rohmer, V.; Michalak, S.; Saint-André, JP. (Aug 2003). "C-cell hyperplasia and medullary thyroid carcinoma: clinicopathological and genetic correlations in 66 consecutive patients.". Mod Pathol 16 (8): 756-63. doi:10.1097/01.MP.0000081727.75778.0C. PMID 12920219.
  8. ↑ URL: http://www.forpath.org/workshops/0201/html/case_7.asp. Accessed on: 21 May 2013.
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