Endocrine Abstracts

Introduction: Medullary thyroid carcinoma (MTC) represents 3–10% of all thyroid cancer. The presence of papillary thyroid microcarcinoma (mPTC) in patients undergoing thyroidectomy for multinodular goiter has been reported as 3–7%.

The occurrence of multiple thyroid cancers of different origin in one individual patient is a rare event. We report the case of synchronous papillary and medullary thyroid cancer developed in heterogynous recurrent goiter of a patient with sarcoidosis.

Observation

A 68-year-old female patient was followed up in our endocrinology department for a heterogynous recurrent goiter for 7 years. The biggest nodule measured 10 mm and was assessed as EU-TIRADS 3. She reported a history of a thyroid nodule(s) operation 2 decades ago and a cutaneous and pulmonary sarcoidosis 5 years ago. Due to a recent size increase of the left thyroid nodule, becoming in EU-TIRADS 4 class, a fine needle aspiration (FNA) and plasma calcitonin (PC) were indicated. Although the cytology exam was benin, high PC levels were noted (266 and 803 ng/l). A second FBA classified the nodule as Bethesda 4. MTC was highly suspected as calcitonin in FNA biopsy and plasma carcino‐embryonic antigen (CEA) were elevated (2000 ng/l and ng/ml, respectively). We could not find any sign of an accompanying multiple endocrine neoplasia syndromes and the metastatic work-up was negative. A total thyroidectomy and bilateral mediastino-recurrent lymph node dissection were performed. The anatomopathological study disclosed a MTC and a mPTC. The PC and CEA were normal postoperatively.

Conclusion: The particularity of our case are, besides the simultaneous coexistence of 2 types of thyroid cancer, their slow evolution and their nonmetastatic invasion. The carcinogenic transformation can be due to a potential neoplastic sarcoidosis effect. Further investigations are needed in order to understand and validate the pathogenetic link between sarcoidosis and thyroid neoplasia.