Dados do Trabalho

Título

Medullary thyroid carcinoma: a case report

Apresentação do caso

Female, 51 years old, with a uterine myoma presented a hard nodule in the cervical region at left, without any other symptoms. Cervical ultrasound reveals a presence of a thyroid nodule in the left lobe and a 3mm cystic image in the right lobe with a very well-defined nodule. She was referred to the general surgery service with a report of suspected papillary carcinoma - Bethesda IV, as a result of aspiractive puncture by fine needle. She underwent total thyroidectomy and left lymphadenectomy, which was difficult to perform, due to the presence of adhered planes, but uneventful, and levothyroxine was started immediately. Histopathological examination showed metastatic carcinoma in 3 out of 3 lymph nodes, size of a metastasis of 3cm, with extranodal extension, focus in 2mm. Histologically, medullary carcinoma was observed with neoplasm-free margins, but very thin with less than 1mm and vascular invasion present, with metastasis to regional lymph nodes. Immunohistochemistry was positive for carcinoembryonic antigen (CEA) and calcitonin.

Discussão

Medullary thyroid carcinoma (MTC) is a rare malignant tumor, representing less than 2% of all carcinomas and 5-10% of all thyroid tumors. It originates in the parafollicular cells of the thyroid and its main secretion product is calcitonin, CEA and occasionally serotonin and others. The clinical symptoms are related to local invasion and hormonal secretion, such as dysphagia, voice changes and ectopic ACTH syndrome (in advanced stages). MTC is represented by three hereditary forms of clinical distinction of great value due to differences in prognosis and management: Multiple endocrine neoplasm (MEN) 2A, MEN 2B and familial MTC not associated with MEN. Diagnosis is made after suspicion of a mass in the cervical region and imaging methods such as ultrasonography and computed tomography, finally confirmed by biopsy. The approach to this entity is surgical, with total or partial resection of the tumor and mediastinal cervical lymph nodes.

Comentários Finais

MTC is a rare entity, but it has a high mortality rate, with a 5-year survival rate reaching 65%. The prognosis is related to the stage of the disease at which the diagnosis was made. Thus, the case presented becomes of great importance because it exposes clinical and surgical criteria of an approach with a positive outcome against the disease.

Palavras Chave

{Medullary thyroid carcinoma} {Fine-needle aspiration biopsy} {Total Thyroidectomy}