Prognosis is good in patients with an incidentally detected medullary
thyroid carcinoma
(July 2004)
The background of the study. Patients with a nodular
goiter who are operated on are sometimes unexpectedly found to have
a small thyroid carcinoma. Most are papillary or follicular carcinomas,
but a few are medullary carcinomas. The study was done to review
the clinical findings and course of patients with an incidental
medullary carcinoma.
How the study was done. Among 261 patients with
medullary carcinoma seen at a single hospital in Germany, the carcinoma
was incidental in 15. The diagnosis was based on histology and immunostaining
(positive for calcitonin and negative for thyroglobulin).
The results of the study. In 11 patients, surgery
was for a multinodular goiter; they underwent bilateral partial
or subtotal thyroidectomy. In three patients, surgery was for a
single hypofunctioning nodule; two of these patients underwent thyroid
lobectomy and one bilateral partial thyroidectomy. One patient was
operated on to remove a hyperfunctioning adenoma; a small medullary
carcinoma was found adjacent to the adenoma. The carcinomas ranged
in size from 0.1 to 2.5 cm; most were ≤0.8 cm. No patient
had a RET proto-oncogene mutation.
During a 0.5- to 10-year follow-up period (mean, 4.6), one patient
had a recurrence of tumor in the neck, and underwent a second operation.
At last follow-up, all the patients were alive, and none had evidence
of persistent or recurrent medullary carcinoma.
The conclusions of the study. Patients in whom
an incidental medullary thyroid carcinoma is detected during surgery
for other thyroid disorders have a good prognosis.
The original article. Raffel A, Cupisti K, Krausch
M, Wolf A, Schulte KM, Roher HD. Incidentally found medullary thyroid
cancer: treatment rationale for small tumors. World J Surg 2004;28:397-401.
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