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Diagram illustrating the “hostage theory” of the evolution of mixed medullary-follicular thyroid carcinomas. Entrapped nonneoplastic follicles are stimulated by trophic factors leading to hyperplastic follicular foci (“hyperplasia”). Acquired genetic defects in follicular cells lead to neoplastic transformation and development of follicular or papillary carcinoma components that can give rise to mixed metastases.
