Difference between revisions of "Medullary thyroid carcinoma"

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#redirect [[Thyroid_gland#Medullary_thyroid_carcinoma]]
'''Medullary thyroid carcinoma''', abbreviated '''MTC''', is an uncommon epithelial [[malignancy]] of the thyroid gland that may be syndromic.


==General==
Medical school memory device - 3 M's:
*[[amyloid|aMyloid]].
*Median node dissection done.
*[[MEN IIa syndrome]]/[[MEN IIb syndrome]].
**Medullary thyroid carcinoma.
**[[Pheochromocytoma]].
**[[Parathyroid adenoma]].
Epidemiology:
*Very rare.
*Poor prognosis.
*May be genetic (MEN IIa/b syndrome).
*Arises from C cells (which produce calcitonin).
Syndromic tumours - typically:<ref name=pmid21455198>{{Cite journal  | last1 = Nosé | first1 = V. | title = Familial thyroid cancer: a review. | journal = Mod Pathol | volume = 24 Suppl 2 | issue =  | pages = S19-33 | month = Apr | year = 2011 | doi = 10.1038/modpathol.2010.147 | PMID = 21455198 |URL = http://www.nature.com/modpathol/journal/v24/n2s/full/modpathol2010147a.html }}</ref>
*Present in 30s or 40s.
*+/-Multifocal.
*+/-Bilateral.
*[[C-cell hyperplasia]].
==Gross==
Features:<ref name=pmid21455198/>
*Usu. well-circumscribed.
*White, gray or yellow.
*Gritty.
*Firm.
Image:
*[http://www.nature.com/modpathol/journal/v24/n2s/fig_tab/modpathol2010147f2.html MTC (nature.com)].
==Microscopic==
Features:
*Nuclei with "neuroendocrine features".
**Small, round nuclei.
**Coarse chromatin (''salt and pepper nuclei'').
*+/-[[Amyloid]] deposits - fluffy appearing acellular eosinophilic material in the cytoplasm.
*+/-[[C-cell hyperplasia]] - seen with familial forms of MTC.
**C cells (AKA ''parafollicular cell''): abundant cytoplasm - clear/pale.
Note:
*The amyloid is formed from ''calcitonin''.<ref name=pmid15459123>{{Cite journal  | last1 = Khurana | first1 = R. | last2 = Agarwal | first2 = A. | last3 = Bajpai | first3 = VK. | last4 = Verma | first4 = N. | last5 = Sharma | first5 = AK. | last6 = Gupta | first6 = RP. | last7 = Madhusudan | first7 = KP. | title = Unraveling the amyloid associated with human medullary thyroid carcinoma. | journal = Endocrinology | volume = 145 | issue = 12 | pages = 5465-70 | month = Dec | year = 2004 | doi = 10.1210/en.2004-0780 | PMID = 15459123 }}</ref>
===Images===
www:
*[http://jcp.bmj.com/content/vol57/issue3/images/large/cp8474.f16.jpeg Medullary thyroid carcinoma (bmj.com)].
*[http://www.nature.com/ki/journal/v70/n11/fig_tab/5001888f2.html C cell hyperplasia (nature.com)].
*[http://lifesci.rutgers.edu/~babiarz/Review3/Lp6/scope8.htm C cell (rutgers.edu)].
*[http://www.anatomyatlases.org/MicroscopicAnatomy/Images/Plate287.jpg Parafollicular cells (anatomyatlases.org)].
<gallery>
Image:Medullary_thyroid_carcinoma_-_low_mag.jpg | MTC - low mag. (WC)
Image:Medullary_thyroid_carcinoma_-_high_mag.jpg | MTC - high mag. (WC)
Image:Medullary_thyroid_carcinoma_-_2_-_high_mag.jpg | MTC and amyloid - high mag. (WC)
</gallery>
==IHC==
Features:<ref>URL: [http://pathologyoutlines.com/thyroid.html#medullary http://pathologyoutlines.com/thyroid.html#medullary]. Accessed on: 17 January 2011.</ref>
*[[Calcitonin]] +ve - it arises from C cells (which produce calcitonin).
*Congo-red +ve (amyloid present) - mnemonic: ''CRAP'' -- congo red amyloid protein.
*Neuroendocrine markers.
**[[Chromogranin A]].
**[[Synaptophysin]].
*CEA +ve (often better staining than calcitonin).<ref>SB. 7 January 2010.</ref>
*Thyroglobulin usu. -ve.<ref name=pmid8454270>{{Cite journal  | last1 = de Micco | first1 = C. | last2 = Chapel | first2 = F. | last3 = Dor | first3 = AM. | last4 = Garcia | first4 = S. | last5 = Ruf | first5 = J. | last6 = Carayon | first6 = P. | last7 = Henry | first7 = JF. | last8 = Lebreuil | first8 = G. | title = Thyroglobulin in medullary thyroid carcinoma: immunohistochemical study with polyclonal and monoclonal antibodies. | journal = Hum Pathol | volume = 24 | issue = 3 | pages = 256-62 | month = Mar | year = 1993 | doi =  | PMID = 8454270 }}</ref>
==EM==
*Neurosecretory granules.
**Feature seen in neuroendocrine tumours.
Images: [http://pathhsw5m54.ucsf.edu/case7/image77.html Neurosecretory granules (ucsf.edu)].
==See also==
*[[Thyroid gland]].
*[[Medullary carcinoma]].
==References==
{{reflist|2}}
[[Category:Thyroid gland]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 05:18, 16 February 2014

Medullary thyroid carcinoma, abbreviated MTC, is an uncommon epithelial malignancy of the thyroid gland that may be syndromic.

General

Medical school memory device - 3 M's:

Epidemiology:

  • Very rare.
  • Poor prognosis.
  • May be genetic (MEN IIa/b syndrome).
  • Arises from C cells (which produce calcitonin).

Syndromic tumours - typically:[1]

Gross

Features:[1]

  • Usu. well-circumscribed.
  • White, gray or yellow.
  • Gritty.
  • Firm.

Image:

Microscopic

Features:

  • Nuclei with "neuroendocrine features".
    • Small, round nuclei.
    • Coarse chromatin (salt and pepper nuclei).
  • +/-Amyloid deposits - fluffy appearing acellular eosinophilic material in the cytoplasm.
  • +/-C-cell hyperplasia - seen with familial forms of MTC.
    • C cells (AKA parafollicular cell): abundant cytoplasm - clear/pale.

Note:

  • The amyloid is formed from calcitonin.[2]

Images

www:

  • MTC - low mag. (WC)

  • MTC - high mag. (WC)

  • MTC and amyloid - high mag. (WC)

IHC

Features:[3]

  • Calcitonin +ve - it arises from C cells (which produce calcitonin).
  • Congo-red +ve (amyloid present) - mnemonic: CRAP -- congo red amyloid protein.
  • Neuroendocrine markers.
  • CEA +ve (often better staining than calcitonin).[4]
  • Thyroglobulin usu. -ve.[5]

EM

  • Neurosecretory granules.
    • Feature seen in neuroendocrine tumours.

Images: Neurosecretory granules (ucsf.edu).

See also

References

  1. ↑ 1.0 1.1 Nosé, V. (Apr 2011). "Familial thyroid cancer: a review.". Mod Pathol 24 Suppl 2: S19-33. doi:10.1038/modpathol.2010.147. PMID 21455198.
  2. ↑ Khurana, R.; Agarwal, A.; Bajpai, VK.; Verma, N.; Sharma, AK.; Gupta, RP.; Madhusudan, KP. (Dec 2004). "Unraveling the amyloid associated with human medullary thyroid carcinoma.". Endocrinology 145 (12): 5465-70. doi:10.1210/en.2004-0780. PMID 15459123.
  3. ↑ URL: http://pathologyoutlines.com/thyroid.html#medullary. Accessed on: 17 January 2011.
  4. ↑ SB. 7 January 2010.
  5. ↑ de Micco, C.; Chapel, F.; Dor, AM.; Garcia, S.; Ruf, J.; Carayon, P.; Henry, JF.; Lebreuil, G. (Mar 1993). "Thyroglobulin in medullary thyroid carcinoma: immunohistochemical study with polyclonal and monoclonal antibodies.". Hum Pathol 24 (3): 256-62. PMID 8454270.
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