Case Report
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Year 2025, Volume: 11 Issue: 6, 1 - 9
https://doi.org/10.18621/eurj.1670211

Abstract

References

  • 1. Trimboli P, Crescenzi A. Diagnosing medullary thyroid carcinoma is facilitated by measuring calcitonin in FNA washout fluids: Alea iacta est. Cancer Cytopathol. 2024;132(3):139. doi: 10.1002/cncy.22797.
  • 2. Ogmen BE, Ince N, Aksoy Altınboga A, et al. An old friend, a new insight: Calcitonin measurement in serum and aspiration needle washout fluids significantly increases the early and accurate detection of medullary thyroid cancer. Cancer Cytopathol. 2024 Mar;132(3):161-168. doi: 10.1002/cncy.22779.
  • 3. Liu S, Zhao H, Li X. Serum Biochemical Markers for Medullary Thyroid Carcinoma: An Update. Cancer Manag Res. 2024;16:299-310. doi: 10.2147/CMAR.S440477.
  • 4. Nikas IP, Kazamias G, Vrontaki M, Rapti AS, Mastorakis E. Medullary thyroid carcinoma diagnosed with liquid-based cytology and immunocytochemistry. J Immunoassay Immunochem. 2022;43(5):502-515. doi: 10.1080/15321819.2022.2070025.
  • 5. Liu CY, Chen CC, Bychkov A, et al. Constitutive Cytomorphologic Features of Medullary Thyroid Carcinoma Using Different Staining Methods. Diagnostics (Basel). 2021;11(8):1396. doi: 10.3390/diagnostics11081396.
  • 6. Ahmed M, Abi-Raad R, Fu L, Holt EH, Adeniran AJ, Cai G. Performing Calcitonin Immunocytochemistry on an Additional ThinPrep Slide in Fine-Needle Aspiration Diagnosis of Medullary Thyroid Carcinoma. Am J Clin Pathol. 2022;157(3):426-433. doi: 10.1093/ajcp/aqab141.
  • 7. Trimboli P, Treglia G, Guidobaldi L, et al. Detection rate of FNA cytology in medullary thyroid carcinoma: a meta-analysis. Clin Endocrinol (Oxf). 2015;82(2):280-285. doi: 10.1111/cen.12563.
  • 8. Kang M, Kim NR, Seok JY. Non-papillary thyroid carcinoma diagnoses in The Bethesda System for Reporting Thyroid Cytopathology categories V and VI: An institutional experience. Ann Diagn Pathol. 2024;71:152263. doi: 10.1016/j.anndiagpath.2023.152263.
  • 9. Agarwal C, Raychaudhuri S, Batra A, Pujani M, Dhingra S. Medullary carcinoma of thyroid mimicking Hurthle cell neoplasm on cytology: a diagnostic dilemma. Diagn Cytopathol. 2019;47(9):943-947. doi: 10.1002/dc.24220.
  • 10. Kaushal S, Iyer VK, Mathur SR, Ray R. Fine needle aspiration cytology of medullary carcinoma of the thyroid with a focus on rare variants: a review of 78 cases. Cytopathology. 2011;22(2):95-105. doi: 10.1111/j.1365-2303.2010.00747.x.
  • 11. Schreiner AM, Yang GC. Medullary thyroid carcinoma presenting as rectangular cell type on fine-needle aspiration. Diagn Cytopathol. 2009;37(3):213-216. doi: 10.1002/dc.21041.
  • 12. Trivedi D, George L. An Aggressive Form of Medullary Thyroid Carcinoma-Melanocytic Subtype: A Case Report. Cureus. 2023;15(12):e50310. doi: 10.7759/cureus.50310.
  • 13. Yamao N, Hirokawa M, Suzuki A, et al. High-grade medullary thyroid carcinoma with papillary-like nuclear features: A report of five cases. Diagn Cytopathol. 2024;52(1):58-64. doi: 10.1002/dc.25243.
  • 14. Aksoy YA, Xu B, Viswanathan K, et al. Novel prognostic nomogram for predicting recurrence-free survival in medullary thyroid carcinoma. Histopathology. 2024;84(6):947-959. doi: 10.1111/his.15141.
  • 15. Wang Z, Fan X, Zha X, et al. A Proposed Modified Staging System for Medullary Thyroid Cancer: A SEER Analysis With Multicenter Validation. Oncologist. 2024;29(1):e59-e67. doi: 10.1093/oncolo/oyad165.
  • 16. Najdawi F, Ahmadi S, Capelletti M, Dong F, Chau NG, Barletta JA. Evaluation of grade in a genotyped cohort of sporadic medullary thyroid carcinomas. Histopathology. 2021;79(3):427-436. doi: 10.1111/his.14370.
  • 17. Toraih E, Hussein M, Anker A, et al. Survival Outcomes of Medullary Thyroid Cancer With and Without Amyloid Deposition. Endocr Pract. 2024;30(4):311-318. doi: 10.1016/j.eprac.2024.01.001.
  • 18. Fuchs TL, Nassour AJ, Glover A, et al. A Proposed Grading Scheme for Medullary Thyroid Carcinoma Based on Proliferative Activity (Ki-67 and Mitotic Count) and Coagulative Necrosis. Am J Surg Pathol. 2020;44(10):1419-1428. doi: 10.1097/PAS.0000000000001505.
  • 19. Alzumaili B, Xu B, Spanheimer PM, et al. Grading of medullary thyroid carcinoma on the basis of tumor necrosis and high mitotic rate is an independent predictor of poor outcome. Mod Pathol. 2020;33(9):1690-1701. doi: 10.1038/s41379-020-0532-1.
  • 20. Xu B, Fuchs TL, Ahmadi S, et al. International Medullary Thyroid Carcinoma Grading System: A Validated Grading System for Medullary Thyroid Carcinoma. J Clin Oncol. 2022;40(1):96-104. doi: 10.1200/JCO.21.01329.
  • 21. Dvoráková S, Václavíková E, Sýkorová V, et al. New multiple somatic mutations in the RET proto-oncogene associated with a sporadic medullary thyroid carcinoma. Thyroid. 2006;16(3):311-316. doi: 10.1089/thy.2006.16.311.

Cytological misdiagnosis of high-grade medullary thyroid carcinoma with papillary-like nuclear features: A case report

Year 2025, Volume: 11 Issue: 6, 1 - 9
https://doi.org/10.18621/eurj.1670211

Abstract

Medullary thyroid carcinoma is an uncommon form of thyroid cancer that arises from the parafollicular C cells. In this case report, a high-grade medullary thyroid carcinoma is discussed, which was initially diagnosed as papillary carcinoma due to the presence of papillary-like nuclear features in the cytological evaluation. A 65-year-old female presented to the ear, nose, and throat department with a palpable neck mass. Based on the cytological features of the fine needle aspiration (FNA), a diagnosis of 'malignant, papillary carcinoma', (Bethesda category 6) was made. After surgery, histological and immunohistochemical results led to a diagnosis of medullary thyroid carcinoma. Papillary carcinoma-like nuclear features may also be observed in medullary thyroid carcinoma and some cases could be mistakenly interpreted as papillary carcinoma in cytological examination.

Ethical Statement

Since this is a case report presentation, no ethics committee approval was required; however, informed consent of writing and publication was obtained from the patient prior to the preparation of the manuscript.

References

  • 1. Trimboli P, Crescenzi A. Diagnosing medullary thyroid carcinoma is facilitated by measuring calcitonin in FNA washout fluids: Alea iacta est. Cancer Cytopathol. 2024;132(3):139. doi: 10.1002/cncy.22797.
  • 2. Ogmen BE, Ince N, Aksoy Altınboga A, et al. An old friend, a new insight: Calcitonin measurement in serum and aspiration needle washout fluids significantly increases the early and accurate detection of medullary thyroid cancer. Cancer Cytopathol. 2024 Mar;132(3):161-168. doi: 10.1002/cncy.22779.
  • 3. Liu S, Zhao H, Li X. Serum Biochemical Markers for Medullary Thyroid Carcinoma: An Update. Cancer Manag Res. 2024;16:299-310. doi: 10.2147/CMAR.S440477.
  • 4. Nikas IP, Kazamias G, Vrontaki M, Rapti AS, Mastorakis E. Medullary thyroid carcinoma diagnosed with liquid-based cytology and immunocytochemistry. J Immunoassay Immunochem. 2022;43(5):502-515. doi: 10.1080/15321819.2022.2070025.
  • 5. Liu CY, Chen CC, Bychkov A, et al. Constitutive Cytomorphologic Features of Medullary Thyroid Carcinoma Using Different Staining Methods. Diagnostics (Basel). 2021;11(8):1396. doi: 10.3390/diagnostics11081396.
  • 6. Ahmed M, Abi-Raad R, Fu L, Holt EH, Adeniran AJ, Cai G. Performing Calcitonin Immunocytochemistry on an Additional ThinPrep Slide in Fine-Needle Aspiration Diagnosis of Medullary Thyroid Carcinoma. Am J Clin Pathol. 2022;157(3):426-433. doi: 10.1093/ajcp/aqab141.
  • 7. Trimboli P, Treglia G, Guidobaldi L, et al. Detection rate of FNA cytology in medullary thyroid carcinoma: a meta-analysis. Clin Endocrinol (Oxf). 2015;82(2):280-285. doi: 10.1111/cen.12563.
  • 8. Kang M, Kim NR, Seok JY. Non-papillary thyroid carcinoma diagnoses in The Bethesda System for Reporting Thyroid Cytopathology categories V and VI: An institutional experience. Ann Diagn Pathol. 2024;71:152263. doi: 10.1016/j.anndiagpath.2023.152263.
  • 9. Agarwal C, Raychaudhuri S, Batra A, Pujani M, Dhingra S. Medullary carcinoma of thyroid mimicking Hurthle cell neoplasm on cytology: a diagnostic dilemma. Diagn Cytopathol. 2019;47(9):943-947. doi: 10.1002/dc.24220.
  • 10. Kaushal S, Iyer VK, Mathur SR, Ray R. Fine needle aspiration cytology of medullary carcinoma of the thyroid with a focus on rare variants: a review of 78 cases. Cytopathology. 2011;22(2):95-105. doi: 10.1111/j.1365-2303.2010.00747.x.
  • 11. Schreiner AM, Yang GC. Medullary thyroid carcinoma presenting as rectangular cell type on fine-needle aspiration. Diagn Cytopathol. 2009;37(3):213-216. doi: 10.1002/dc.21041.
  • 12. Trivedi D, George L. An Aggressive Form of Medullary Thyroid Carcinoma-Melanocytic Subtype: A Case Report. Cureus. 2023;15(12):e50310. doi: 10.7759/cureus.50310.
  • 13. Yamao N, Hirokawa M, Suzuki A, et al. High-grade medullary thyroid carcinoma with papillary-like nuclear features: A report of five cases. Diagn Cytopathol. 2024;52(1):58-64. doi: 10.1002/dc.25243.
  • 14. Aksoy YA, Xu B, Viswanathan K, et al. Novel prognostic nomogram for predicting recurrence-free survival in medullary thyroid carcinoma. Histopathology. 2024;84(6):947-959. doi: 10.1111/his.15141.
  • 15. Wang Z, Fan X, Zha X, et al. A Proposed Modified Staging System for Medullary Thyroid Cancer: A SEER Analysis With Multicenter Validation. Oncologist. 2024;29(1):e59-e67. doi: 10.1093/oncolo/oyad165.
  • 16. Najdawi F, Ahmadi S, Capelletti M, Dong F, Chau NG, Barletta JA. Evaluation of grade in a genotyped cohort of sporadic medullary thyroid carcinomas. Histopathology. 2021;79(3):427-436. doi: 10.1111/his.14370.
  • 17. Toraih E, Hussein M, Anker A, et al. Survival Outcomes of Medullary Thyroid Cancer With and Without Amyloid Deposition. Endocr Pract. 2024;30(4):311-318. doi: 10.1016/j.eprac.2024.01.001.
  • 18. Fuchs TL, Nassour AJ, Glover A, et al. A Proposed Grading Scheme for Medullary Thyroid Carcinoma Based on Proliferative Activity (Ki-67 and Mitotic Count) and Coagulative Necrosis. Am J Surg Pathol. 2020;44(10):1419-1428. doi: 10.1097/PAS.0000000000001505.
  • 19. Alzumaili B, Xu B, Spanheimer PM, et al. Grading of medullary thyroid carcinoma on the basis of tumor necrosis and high mitotic rate is an independent predictor of poor outcome. Mod Pathol. 2020;33(9):1690-1701. doi: 10.1038/s41379-020-0532-1.
  • 20. Xu B, Fuchs TL, Ahmadi S, et al. International Medullary Thyroid Carcinoma Grading System: A Validated Grading System for Medullary Thyroid Carcinoma. J Clin Oncol. 2022;40(1):96-104. doi: 10.1200/JCO.21.01329.
  • 21. Dvoráková S, Václavíková E, Sýkorová V, et al. New multiple somatic mutations in the RET proto-oncogene associated with a sporadic medullary thyroid carcinoma. Thyroid. 2006;16(3):311-316. doi: 10.1089/thy.2006.16.311.
There are 21 citations in total.

Details

Primary Language English
Subjects Pathology
Journal Section Case Reports
Authors

Ali Mızrak 0000-0002-1096-1660

Early Pub Date July 22, 2025
Publication Date October 10, 2025
Submission Date April 4, 2025
Acceptance Date July 21, 2025
Published in Issue Year 2025 Volume: 11 Issue: 6

Cite

AMA Mızrak A. Cytological misdiagnosis of high-grade medullary thyroid carcinoma with papillary-like nuclear features: A case report. Eur Res J. 11(6):1-9. doi:10.18621/eurj.1670211

e-ISSN: 2149-3189 


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