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Medullary thyroid carcinoma (view source)
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'''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]] | ||