C-cell hyperplasia

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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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