Endocrine Abstracts

Background: Surgery is the standard treatment in patients with medullary thyroid carcinoma (MTC), 43% being biochemically cured postoperative in a large series, the most important prognostic factor being the stage of the disease.

Material and methods: We present 3 cases of biochemical cured patients after surgery with different preoperative presentation. Calcitonin and carcinoembryonic antigen (CEA) were measured by chemiluminescence. Histological examination and immunohistochemistry (IHC) were used for the analysis of the thyroidectomy specimen.

Cases presentation: Case 1. A 41 years old female patient with high calcitonin levels (>2000 pg/ml), normal CEA (3.02 ng/ml), bilateral suspicious lymph nodes on US evaluation of the neck. A total thyroidectomy with dissection of cervical lymph node compartments was performed and a 3/2.1 cm MTC was identified. No RET mutations were identified. She had normal calcitonin (<2 pg/ml) at 3 month after surgery and after 9 years of follow-up (<1 pg/ml). Case 2. A 56 years old female patient with high levels of calcitonin (4339 pg/ml), high levels of CEA (115.84 ng/ml), no suspicious lymph nodes on ultrasound (US) evaluation of the neck, negative MEN2 biochemical screening, RET mutation analysis is pending. A total thyroidectomy with dissection of cervical lymph node compartments was performed and a 3.8/2.6 cm MTC with 2 ipsilateral lymph node metastases were identified. She had high calcitonin levels after surgery (80.6 pg/ml) that continued to rise during 1 year of follow-up (203.5 pg/ml). The tumor stained positive at IHC for SSTR2. An Octreoscan was performed, showing 2 lesions in the left lateral cervical area. A second surgery was performed with successful normalization of calcitonin levels at 3 month after surgery (5.58 pg/ml) and at 1 year follow-up (9.1 pg/ml). Case 3. A 63 years old female patient with modestly elevated calcitonin levels (39.1 pg/ml), normal CEA (2.5 ng/ml), no suspicious lymph nodes on ultrasound (US) evaluation of the neck. A total thyroidectomy without dissection of cervical lymph node compartments was performed. Morphological examination showed a 0.4/0.3 cm microMTC. No RET mutations were identified. She had normal calcitonin (1.07 pg/ml) at 3 month after surgery and after 5 years of follow-up (0.5 pg/ml).

Conclusion: We aim to highlight the importance of adequate surgical treatment, pre and postoperative evaluation.