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Endocrine Abstracts (2015) 37 EP1304 | DOI: 10.1530/endoabs.37.EP1304

1Endocrinology Department, Tekirdag State Hospital, Tekirdag, Turkey; 2Pathology Department, Tekirdag State Hospital, Tekirdag, Turkey; 3General Surgery Department, Namik Kemal University, Tekirdag, Turkey.


Papillary thyroid cancer (PTC) is the most frequent thyroid tumour. Medullary thyroid cancer (MTC) however, is very rare. We report a case of coexistent medullary and papillary carcinomas in two different foci in a patient with family history of TPC in a first-degree relative.

Case: A 65-year-old female was examined for multinodular goiter (MNG). She had a family history of thyroid papillary carcinoma in her elder sister. Free T4, free T3, and TSH levels were within normal limits. Neck ultrasound (US) displayed solid, hypo-echoic nodules >3 cm at the both lobes of the thyroid gland. The results of fine-needle aspiration cytology (FNAC) of the both nodules were benign. Patient preferred surgery because of the nodule size and positive family history. Histopathology results revealed MTC which is 4 mm in diameter in the right lobe and PTC follicular variant 12 mm in diameter in the left lobe. Postoperative calcitonin was 56 pg/ml and CEA was in normal limits. Completion thyroidectomy and lymph node dissection also performed. No residue was detected by post-operative neck US. Neck and chest CT and liver MRI which were performed for MTC metastasis were all negatives. RET protooncogen mutation was negative unless BRAFV600E mutation was positive. Patient’s younger sister was also examined for MNG. Thyroid US displayed solid, hypoechoic nodules >2 cm in both lobes. FNAC of nodules were reported as suspicious for PTC. Patient underwent total thyroidectomy and central lymph node dissection and diagnosed as PTC on both lobes.

Discussion: FNAC is the most accurate method for evaluating thyroid nodules. False negative rate of FNAC is about 5%, so malignancy risk of benign results should be kept in mind especially with a positive family history of thyroid carcinoma in a first-degree relative. We presented a coincidental coexistence of MTC and PTC case to point to this risk.

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