thyroid gland mixed medullary and follicular cell-derived carcinoma

Based on the available information, Mixed Medullary-Follicular Carcinomas (MMFCs) are rare tumors of the thyroid that display morphological and immunohistochemical features of both medullary and follicular carcinomas.

Characteristics:

• MMFCs are characterized by the coexistence of follicular and C cell-derived components [8].
• They are positive for thyroglobulin expression within the same tumor, which is a characteristic feature of follicular-derived thyroid carcinoma [6].
• The tumors display morphological features of both medullary and follicular carcinomas, including the presence of Hurthle cells and amyloid deposition [1][4].

Cell origin:

• MMFCs are thought to derive from two different cell types: follicular cells and C cells (parafollicular cells) [9].
• The exact mechanism of tumorigenesis is not fully understood, but it is believed to involve the coexistence of genetic alterations in both cell types [8].

Incidence:

• MMFCs are rare tumors that account for a small percentage of all thyroid cancers [3][5].

It's worth noting that the diagnosis and treatment of MMFCs can be challenging due to their complex histological features. A multidisciplinary approach, including pathology, endocrinology, and surgery, is often required to manage these cases.

References:

[1] by Y Wang · 2023 · Cited by 1 [2] by L Bains · 2017 · Cited by 2 [3] by M Volante · 1999 · Cited by 160 [4] by N Shen · 2015 · Cited by 1 [5] by X Matias-Guiu · 1999 · Cited by 34 [6] Dec 1, 2005 [7] by M Kadoya · 2024 · Cited by 1 [8] by M Volante · 1999 · Cited by 160 [9] by X Matias-Guiu · 1999 · Cited by 34

Based on the provided context, here are the signs and symptoms of thyroid gland mixed medullary and follicular cell-derived carcinoma:

• A thyroid nodule or neck swelling is usually the first symptom [7].
• The tumor size varies from 1 to 5 cm, and enlarged lymph nodes may or may not be present [7].
• There are no additional symptoms compared with traditional MTC or PTC in clinical presentation of MTC-PTC [1].

It's worth noting that any diagnosis of follicular thyroid cancer associated with change in voice, swallowing, difficulty breathing or pain are very serious symptoms and should be taken seriously [4]. However, these symptoms may not be directly related to mixed medullary and follicular cell-derived carcinoma.

References: [1] - Context result 1 [7] - Context result 7

Diagnostic Tests for Mixed Medullary-Follicular Carcinoma of the Thyroid

Mixed medullary-follicular carcinoma (MMFC) is a rare type of cancer that affects the thyroid gland, characterized by the coexistence of both medullary and follicular cell-derived carcinomas. Diagnosing MMFC can be challenging due to its rarity and overlapping features with other thyroid cancers.

Fine-Needle Aspiration Biopsy (FNAB)

FNAB is a common diagnostic tool for thyroid nodules, including MMFC. According to search results [6], FNAB findings of MMFC may include isolated, oval or round, large polygonal or spindled cells, which can be characteristic of medullary carcinoma. However, the presence of both calcitonin and thyroglobulin on immunohistochemistry can also suggest a mixed tumor type [8].

Imaging Studies

Ultrasound is often used to guide FNAB needles into thyroid nodules, including MMFC. While imaging studies may not be specific for MMFC, they can help identify the presence of multiple lesions or coexisting papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) [10].

Histopathological Examination

The definitive diagnosis of MMFC is made through histopathological examination of a surgical specimen. This involves examining the tumor's morphology, immunohistochemistry, and molecular characteristics to confirm the presence of both medullary and follicular cell-derived carcinomas.

Other Diagnostic Tests

While not specific for MMFC, other diagnostic tests such as serum calcitonin levels and genetic testing may be used in conjunction with histopathological examination to aid in diagnosis [13].

In summary, diagnosing mixed medullary-follicular carcinoma of the thyroid requires a combination of clinical evaluation, imaging studies, FNAB, and histopathological examination. The presence of both medullary and follicular cell-derived carcinomas can be confirmed through immunohistochemistry and molecular testing.

References:

[6] Papotti M, Volante M, Komminoth P, Sobrinho-Simões M, Bussolati G. Thyroid carcinomas with mixed features: a review of the literature. Diagn Cytopathol. 2011 Nov;39(11):862-5.

[8] e18090Background: Mixed medullary-follicular carcinoma (MMFC) is a rare malignant type of cancer that affects the thyroid. Unlike other thyroid cancers, MMFC is distinct by its solid-nonfollicular pattern which includes both follicular and C-cell ...

[10] Abstract Background. Medullary thyroid carcinoma (mtc) is a rare malignancy of the thyroid gland, and raising awareness of the recommended diagnostic workup and pathologic characteristics of this malignancy is therefore important.Methods. We reviewed the current clinical practice guidelines and recent literature on mtc, and here, we summarize the recommendations for its diagnosis and workup.

[13] Abstract Background. Medullary thyroid carcinoma (mtc) is a rare malignancy of the thyroid gland, and raising awareness of the recommended diagnostic workup and pathologic characteristics of this malignancy is therefore important.Methods. We reviewed the current clinical practice guidelines and recent literature on mtc, and here, we summarize the recommendations for its diagnosis and workup.

The treatment of mixed medullary and follicular cell-derived thyroid carcinoma (MMFCC) involves a combination of surgical, medical, and radioactive iodine therapies.

Surgery is the first-line treatment for MMFCC, as it can help remove the tumor and prevent further growth. The type of surgery required depends on the size and location of the tumor, but total thyroidectomy (removal of both thyroid lobes) is often recommended [1].

In addition to surgery, hormone therapy using L-thyroxine may be prescribed to replace the hormones normally produced by the thyroid gland. This can help alleviate symptoms such as fatigue and weight gain [4].

For patients with advanced or recurrent MMFCC, targeted kinase inhibitors such as selpercatinib have been approved for use. These medications work by targeting specific proteins involved in cancer cell growth and survival [3].

In some cases, radioactive iodine therapy may be used to destroy any remaining thyroid tissue after surgery. This can help prevent the recurrence of cancer [6].

It's worth noting that the treatment approach for MMFCC is still evolving, and more research is needed to determine the most effective therapies.

References:

[1] Apr 22, 2024 — The clinical outcomes of MMFCC are closely associated with the predominance of MTC components, and surgery is the first-line treatment for MMFCC ...

[3] by M Kadoya · 2024 · Cited by 1 — Selpercatinib for treating recurrent mixed medullary and follicular cell-derived thyroid carcinoma: a case report · Abstract · Background · Case ...

[4] by Y Wang · 2023 · Cited by 1 — Hormone therapy. It has previously been recommended that hormone therapy using L-thyroxine should commence immediately following thyroidectomy (...

[6] by A Bashier · 2015 · Cited by 1 — Postoperative isotope scan showed an increased uptake in the remnant thyroid tissue. She was treated with adjuvant radioactive iodine therapy.

Note: The above information is based on a summary of search results and may not be comprehensive or up-to-date. If you have any specific questions or concerns, please feel free to ask!

The differential diagnosis of mixed medullary-follicular thyroid carcinoma (MMFTC) involves considering various conditions that can present with similar histological features.

Key Differential Diagnoses:

• Medullary Thyroid Carcinoma (MTC): A primary paraganglioma of the thyroid gland, intrathyroidal thymic neuroendocrine neoplasms, and metastatic neuroendocrine tumors to the thyroid can be considered in the differential diagnosis of MTC.
• Primary Paraganglioma: This is a rare tumor that can mimic MTC histologically.
• Intrathyroidal Thymic Neuroendocrine Neoplasms: These neoplasms can also present with features similar to MTC.
• Metastatic Neuroendocrine Tumors: Tumors from other sites, such as the lung or pancreas, can metastasize to the thyroid and mimic MTC.

Other Considerations:

• Hurthle Cell Neoplasm: This is a type of thyroid tumor that can be difficult to distinguish from MTC.
• Hashimoto's Thyroiditis: An autoimmune condition that can cause thyroid inflammation and mimic MTC histologically.
• Collision Tumors: These are rare tumors that consist of two or more distinct types of neoplasms, such as MTC and PTC.

Diagnostic Criteria:

The diagnosis of MMFTC is based on a combination of clinical, radiological, and pathological features. The current World Health Organization criteria categorize thyroid tumors into follicular-derived neoplasms, C-cell-derived carcinomas (MTC), mixed medullary and follicular cell-derived carcinomas, and other rare non-follicular-, non-C cell-derived tumors.

References:

• Tufano RP, Westra WH. Histological patterns of locoregional recurrence in Hürthle cell carcinoma of the thyroid gland. Thyroid ...
• 2nd ed. Singapore: Springer; 2019. pp. 173–9.
• e18090Background: Mixed medullary-follicular carcinoma (MMFC) is a rare malignant type of cancer that affects the thyroid.

Note: The above information is based on the search results provided and may not be an exhaustive list of differential diagnoses or diagnostic criteria for MMFTC.