Thymic carcinoma involving the thyroid gland: Report of two cases
Yuji MizukamiHiroshi KurumayaTetsuji YamadaHiroshi MinatoAkitaka NonomuraMasakuni NoguchiFujitsugu Matsubara
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Keywords:
Medullary carcinoma
Thyroglobulin
Anaplastic carcinoma
Calcitonin gene-related peptide (CGRP) is a recently discovered peptide whose existence was first predicted following sequence analysis of the rat calcitonin gene. In the present study, plasma levels of CGRP were measured in patients with medullary thyroid carcinoma, both basally and following calcium or pentagastrin stimulation. Using a sensitive radioimmunoassay for CGRP, 19 of 21 patients with medullary thyroid carcinoma had elevated plasma levels of immunoreactive CGRP (median value 114 pmol/l) while 23 normal subjects had plasma CGRP levels below the detection limit of the assay (less than 10 pmol/l). Calcium or pentagastrin infusion in medullary thyroid carcinoma patients were potent stimuli to CGRP release, increasing plasma levels two- to five-fold. Chromatographic characterization using high pressure liquid chromatography of the CGRP immunoreactivity in plasma from two patients with medullary carcinoma of the thyroid demonstrated the presence of two molecular forms, neither of which co-eluted with synthetic human CGRP. The role of CGRP in the pathophysiology of medullary thyroid carcinoma is not clear but it may contribute to some of the clinical features associated with the disease. Furthermore, measurement of CGRP in conjunction with calcitonin could help in determining the prognosis of these patients.
Pentagastrin
Medullary carcinoma
Basal (medicine)
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A patient with the medullary thyroid carcinoma showed no elevation of the plasma calcitonin level. Light microscopic findings confirmed typical medullary thyroid carcinoma. Calcium and gastrin infusion tests did not increase the calcitonin level. Immunoperoxidase study revealed very slight calcitonin within the tumor cells. Electron microscopy showed very few granules in the tumor cells.This patient was considered to have a poorly differentiated type of medullary thyroid carcinoma different from the typical kind.
Medullary carcinoma
Immunoperoxidase
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Carcinoembryonic antigen
Medullary carcinoma
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There is limited published data on the stability of calcitonin, chromogranin A, thyroglobulin and anti-thyroglobulin antibodies in serum. The aim of this study was to determine stability at three temperature conditions over 7 days, reflecting current laboratory practices.Surplus serum was stored at room temperature, refrigerated and in the freezer; for 1, 3, 5 and 7 days. Samples were analysed in batch and analyte concentrations compared to that of a baseline sample. Measurement Uncertainty of the assay was used to determine the Maximal Permissible Difference and thus the stability of the analyte.Calcitonin was found to be stable for at least 7 days in the freezer but only 24 h refrigerated. Chromogranin A was stable for 3 days when refrigerated and only 24 h at room temperature. Thyroglobulin and anti-thyroglobulin antibodies were stable under all conditions for 7 days.This study has enabled the laboratory to increase the add-on time limit of Chromogranin A to 3 days, and up to 60 min for calcitonin and inform optimal storage and transportation conditions for referring specimens.
Thyroglobulin
Chromogranin A
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The presence of calcitonin and of carcinoembryonic antigen (CEA) was studied in six cases of medullary carcinoma of the thyroid using an immunoperoxidase technique. In five cases the material was obtained surgically and in one at autopsy. Tissue from primary tumours as well as from metastases was studied. Calcitonin and CEA were identified within all the tumours studied, although their pattern of distribution and staining intensity varied both within the cells and within the tumour. Some parts of the tumour contained both CEA and calcitonin, while others stained positively only for one of these substances. In some parts of the tumour there was no positive staining for either substance. Within the cells, CEA showed a typical linear distribution along cell surfaces, while calcitonin showed a more even cytoplasmic distribution and the deposits were more granular. Normal tissue surrounding tumour deposits did not show positive staining. It is considered that cells of medullary carcinoma of the thyroid contain both calcitonin and CEA. Identification of CEA and calcitonin in tumour tissue can be used as a diagnostic aid to identify medullary carcinoma of the thyroid. It is considered that these substances are being produced by this tumour and can be used as tumour markers.
Carcinoembryonic antigen
Immunoperoxidase
Medullary carcinoma
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Medullary carcinoma
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To investigate the expression and clinical significance of Ki67 and calcitonin in medullary thyroid carcinoma(MTC).The expression level of Ki67 and calcitonin was studied in 44 cases of medullary thyroid carcinoma tissue and 20 cases of adjacent nontumor tissue by SP immunohistochemistry.The positive expression of Ki67 and calcitonin in medullary thyroid carcinoma tissue were 86.36% (38/44) and 100.00% (44/44) respectively. There was a significant difference between carcinoma and normal thyroid tissue (P<0.01). The overexpression of Ki67 and calcitonin in medullary thyroid carcinoma had no relationship with gender and age of patients,but had relationship with size of tumor,clinical staging and lymph node metastasis (P<0.05). Meanwhile, Ki67 and calcitonon had no significant correlation with each other.The overexpression of Ki67 and calcitonin may play important role in occurrence, development and metastasis of medullary thyroid carcinoma. It may be used as an important judgement for the biological behavior of medullary thyroid carcinoma.
Medullary carcinoma
Clinical Significance
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The authors describe histologically confirmed medullary carcinoma of the thyroid gland in a living patient. The tumor produces excessive amounts of calcitonin and releases it into the blood stream. In healthy subjects, the plasma concentration of calcitonin is 0.2-1.0 mU MRC/ml plasma; in medullary carcinoma it is 5.66 mU/ml. The tumor responds to artificially induced hypercalcemia by a further increase of plasma calcitonin. 60-120 minutes after a hypercalcemic stimulus, the calcitonin level declines well below the initial value but remains elevated. The patient has a permanently normal blood calcium level. This is probably due to secondary hyperparathyroidism, a compensatory phenomenon. (Author's modified)
Medullary carcinoma
Parathyroid gland
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Carcinoembryonic antigen
Medullary carcinoma
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