Rising CEA Levels in a Patient with Colon Carcinoma: Metachronous Medullary Thyroid Cancer

2014 ◽  
Vol 29 (2) ◽  
pp. 184-186 ◽  
Author(s):  
Sema Sezgin Göksu ◽  
Uğur A. Göksu ◽  
Seyda Gündüz ◽  
Hasan S. Coşkun
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Medullary Thyroid Carcinoma ◽  
Medullary Carcinoma ◽  
Needle Aspiration ◽  
Medullary Thyroid ◽  
Normal Ranges ◽  
Positron Emission

Introduction Carcinoembryonic antigen (CEA) is a commonly used tumor marker, and its value in colon cancer is well established. However it is overexpressed in many different tumors. Here we report a case of colorectal cancer with high postoperative CEA levels that were associated with medullary thyroid carcinoma. Case A 60-year old man was operated for colon cancer. Postoperative CEA level was 107.6 ng/mL, while preoperative CEA level was unknown. For the detection of distant metastasis or local recurrence, we performed 18-flouro deoxyglycose (FDG) positron emission tomography (PET) and computed tomography (CT). We observed an increased FDG accumulation in the right lobe of the thyroid. The patient had cystic and non-metabolic lesions in the liver, and started a treatment with FOLFOX regimen. After 3 months of chemotherapy CEA was still as high as 146 ng/mL. There was no pathologic FDG uptake other than the thyroid nodule in PET-CT. Fine needle aspiration of the thyroid nodule revealed a follicular neoplasia. The patient underwent total thyroidectomy and histopathology revealed a medullary thyroid carcinoma. Postoperative CEA levels then lowered to normal ranges. Conclusion The case we here report was a stage III colorectal cancer with high CEA levels. Our focus on searching a residual/metastatic disease made us blind to other possible explanations; in fact, none of us noticed the thyroid nodule. This case reminds us not to forget that high CEA levels can be associated with conditions other than colon cancer, such as thyroid medullary carcinoma.

scholarly journals Atypical Presentation of a Medullary Thyroid Carcinoma Producing Acth and Serotonin

2019 ◽  
Vol 12 (3) ◽  
pp. 742-748 ◽  
Author(s):  
Mariana Ferreira ◽  
Christianne Toledo de Souza Leal ◽  
Lize Vargas Ferreira ◽  
Danielle Guedes Andrade Ezequiel ◽  
Mônica Barros Costa
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Distant Metastases ◽  
Medullary Carcinoma ◽  
Needle Aspiration ◽  
Disease Stage ◽  
Medical Attention ◽  
Medullary Thyroid ◽  
Superior Mediastinum ◽  
Increased Risk

Medullary carcinoma accounts for about 5% of all thyroid malignancies. The tumor may produce other hormones in addition to calcitonin that typically occurs in the presence of distant metastases. The aim of this report is to present a case of invasive medullary thyroid carcinoma producing ACTH and serotonin. A male patient sought medical attention due to facial plethora and distal paresthesia. On thyroid ultrasound, he presented a hypoechoic nodule measuring 6.7 × 3.2 × 3.5 cm, with punctate calcifications and central vascular pattern. The chest computed tomography showed an extensive solid lesion with epicenter in the superior mediastinum and absence of a cleavage plane with the left thyroid lobe. The lesion extended from the glottic area to the lower portion of the trachea and invaded esophagus, posterior tracheal wall, and left jugular. The patient presented hyperglycemia, hypokalemia, increased free urinary cortisol, calcitonin, ACTH and 5-hydroxyindoleacetic acid levels. The nodule cytological examination obtained by fine-needle aspiration was inconclusive, and the open biopsy confirmed the diagnosis of medullary thyroid carcinoma. Due to the advanced disease stage and increased risk of large caliber vessels injury in case of surgery, local chemotherapy and radiotherapy were recommended. With this report, we want to draw attention to an unusual association between advanced medullary thyroid carcinoma with an aggressive course and ectopic production of ACTH and serotonin.

scholarly journals Imaging Medullary Thyroid Carcinoma with Persistent Elevated Calcitonin Levels

2007 ◽  
Vol 92 (11) ◽  
pp. 4185-4190 ◽  
Author(s):  
Anne Laure Giraudet ◽  
Daniel Vanel ◽  
Sophie Leboulleux ◽  
Anne Aupérin ◽  
Clarisse Dromain ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Bone Scintigraphy ◽  
Axial Skeleton ◽  
Whole Body ◽  
Liver Imaging ◽  
Calcitonin Level ◽  
Medullary Thyroid ◽  
Positron Emission ◽  
Work Up

Abstract Purpose: Because calcitonin level remains elevated after initial treatment in many medullary thyroid carcinoma (MTC) patients without evidence of disease in the usual imaging work-up, there is a need to define optimal imaging procedures. Patients and Methods: Fifty-five consecutive elevated calcitonin level MTC patients were enrolled to undergo neck and abdomen ultrasonography (US); neck, chest, and abdomen spiral computed tomography (CT); liver and whole-body magnetic resonance imaging (MRI); bone scintigraphy; and 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/CT scan (PET). Results: Fifty patients underwent neck US, CT, and PET, and neck recurrence was demonstrated in 56, 42, and 32%, respectively. Lung and mediastinum lymph node metastases in the 55 patients were demonstrated in 35 and 31% by CT and in 15 and 20% by PET. Liver imaging with MRI, CT, US, and PET in 41 patients showed liver in 49, 44, 41, and 27% patients, respectively. Bone metastases in 55 patients were demonstrated in 35% by PET, 40% by bone scintigraphy, and 40% by MRI; bone scintigraphy was complementary with MRI for axial lesions but superior for the detection of peripheral lesions. Ten patients had no imaged tumor site despite elevated calcitonin level (median 196 pg/ml; range 39–816). FDG uptake in neoplastic foci was higher in progressive patients but with a considerable overlap with stable ones. Conclusion: The most efficient imaging work-up for depicting MTC tumor sites would consist of a neck US, chest CT, liver MRI, bone scintigraphy, and axial skeleton MRI. FDG PET scan appeared to be less sensitive and of low prognostic value.

Metastatic Canine Medullary Thyroid Carcinoma: A Case Report

1980 ◽  
Vol 17 (3) ◽  
pp. 323-330 ◽  
Author(s):  
G. G. Long ◽  
R. M. Clemmons ◽  
H. Heath
Keyword(s):  
Case Report ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Distant Metastasis ◽  
Clinical Course ◽  
Medullary Carcinoma ◽  
Neoplastic Tissue ◽  
Medullary Thyroid ◽  
Biochemical Alterations ◽  
Mitotic Figures

A medullary carcinoma of the thyroid in a dog first became evident because of a distant metastasis. The histologic characteristics of the tumor differ from those previously reported in dogs in that this tumor was highly malignant; anaplasia and mitotic figures were common. The diagnosis was substantiated by radioimmunoassay for calcitonin. Serotonin and 5-hydroxytryptophan also were elevated in the neoplastic tissue. The relation of the biochemical alterations to the clinical course was not clear.

Detection Rate of Recurrent Medullary Thyroid Carcinoma Using Fluorine-18 Dihydroxyphenylalanine Positron Emission Tomography

2012 ◽  
Vol 19 (10) ◽  
pp. 1290-1299 ◽  
Author(s):  
Giorgio Treglia ◽  
Fabrizio Cocciolillo ◽  
Francesco Di Nardo ◽  
Andrea Poscia ◽  
Chiara de Waure ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Detection Rate ◽  
Emission Tomography ◽  
Medullary Thyroid ◽  
Positron Emission

Oncocytic variant of medullary thyroid carcinoma; a rare tumor with numerous diagnostic mimics by fine needle aspiration

2017 ◽  
Vol 45 (12) ◽  
pp. 1148-1152 ◽  
Author(s):  
Sharon B. Sams ◽  
Kenneth D. Tompkins ◽  
Sarah Mayson ◽  
Christopher D. Raeburn ◽  
Sanjana Mehrotra
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Rare Tumor ◽  
Medullary Thyroid ◽  
Fine Needle ◽  
Oncocytic Variant
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