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. 1993 Feb;46(2):113–117. doi: 10.1136/jcp.46.2.113

Medullary carcinoma of the thyroid with carcinoid-like features.

H R Harach 1, U Bergholm 1
PMCID: PMC501140  PMID: 8459030

Abstract

AIMS: To show that medullary carcinomas of the thyroid are morphologically indistinguishable from gut carcinoids: the value of histochemistry in their identification and differential diagnosis from metastatic carcinoid tumours to the thyroid and some follicular cell neoplasms. METHODS: 15 thyroid medullary carcinomas with features of gut carcinoids were histochemically studied for the presence of argyrophil and argentaffin granules, and calcitonin, thyroglobulin, and serotonin immunoreaction. RESULTS: Histological features of midgut (classic) carcinoids were observed in two tumours, foregut carcinoids in 12, and hindgut carcinoids in one. All tumours showed, to a greater or lesser extent, a calcitonin immunoreaction and argyrophilia. These markers were present only in a small area showing a classic pattern of thyroid medullary carcinoma in the hindgut carcinoid-like neoplasm. Argentaffin granules and serotonin immunostaining occurred in occasional cells from four foregut carcinoid-like tumours. Thyroglobulin was not expressed in all cases and amyloid stroma was expressed in three. CONCLUSIONS: In some cases a diagnosis of metastatic carcinoid tumour to the thyroid can be considered only after ruling out clinically and histochemically medullary carcinoma of the thyroid. Immunolocalisation techniques are also essential for the differentiation between medullary carcinoma and thyroid follicular cell neoplasms that resemble carcinoid tumours. It is proposed that this tumour variant to be incorporated into current classifications as another histological subtype of C cell carcinoma.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albores-Saavedra J., LiVolsi V. A., Williams E. D. Medullary carcinoma. Semin Diagn Pathol. 1985 May;2(2):137–146. [PubMed] [Google Scholar]
  2. Berge T., Linell F. Carcinoid tumours. Frequency in a defined population during a 12-year period. Acta Pathol Microbiol Scand A. 1976 Jul;84(4):322–330. [PubMed] [Google Scholar]
  3. Carcangiu M. L., Zampi G., Rosai J. Poorly differentiated ("insular") thyroid carcinoma. A reinterpretation of Langhans' "wuchernde Struma". Am J Surg Pathol. 1984 Sep;8(9):655–668. doi: 10.1097/00000478-198409000-00005. [DOI] [PubMed] [Google Scholar]
  4. Carney J. A., Ryan J., Goellner J. R. Hyalinizing trabecular adenoma of the thyroid gland. Am J Surg Pathol. 1987 Aug;11(8):583–591. doi: 10.1097/00000478-198708000-00001. [DOI] [PubMed] [Google Scholar]
  5. Dayal Y., Lin H. D., Tallberg K., Reichlin S., DeLellis R. A., Wolfe H. J. Immunocytochemical demonstration of growth hormone-releasing factor in gastrointestinal and pancreatic endocrine tumors. Am J Clin Pathol. 1986 Jan;85(1):13–20. doi: 10.1093/ajcp/85.1.13. [DOI] [PubMed] [Google Scholar]
  6. Federspiel B. H., Burke A. P., Sobin L. H., Shekitka K. M. Rectal and colonic carcinoids. A clinicopathologic study of 84 cases. Cancer. 1990 Jan 1;65(1):135–140. doi: 10.1002/1097-0142(19900101)65:1<135::aid-cncr2820650127>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  7. Gonzalez-Licea A., Hartmann W. H., Yardley J. H. Medullary carcinoma of the thyroid. Ultrastructural evidence of its origin from the parafollicular cell and its possible relation to carcinoid tumors. Am J Clin Pathol. 1968 Apr;49(4):512–520. doi: 10.1093/ajcp/49.4.512. [DOI] [PubMed] [Google Scholar]
  8. Grimelius L., Wilander E. Silver stains in the study of endocrine cells of the gut and pancreas. Invest Cell Pathol. 1980 Jan-Mar;3(1):3–12. [PubMed] [Google Scholar]
  9. HAZARD J. B., HAWK W. A., CRILE G., Jr Medullary (solid) carcinoma of the thyroid; a clinicopathologic entity. J Clin Endocrinol Metab. 1959 Jan;19(1):152–161. doi: 10.1210/jcem-19-1-152. [DOI] [PubMed] [Google Scholar]
  10. Hales M., Rosenau W., Okerlund M. D., Galante M. Carcinoma of the thyroid with a mixed medullary and follicular pattern: morphologic, immunohistochemical, and clinical laboratory studies. Cancer. 1982 Oct 1;50(7):1352–1359. doi: 10.1002/1097-0142(19821001)50:7<1352::aid-cncr2820500722>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  11. Harach H. R., Bergholm U. Medullary (C cell) carcinoma of the thyroid with features of follicular oxyphilic cell tumours. Histopathology. 1988 Dec;13(6):645–656. doi: 10.1111/j.1365-2559.1988.tb02095.x. [DOI] [PubMed] [Google Scholar]
  12. Harach H. R., Franssila K. O. Thyroglobulin immunostaining in follicular thyroid carcinoma: relationship to the degree of differentiation and cell type. Histopathology. 1988 Jul;13(1):43–54. doi: 10.1111/j.1365-2559.1988.tb02002.x. [DOI] [PubMed] [Google Scholar]
  13. Harach H. R., Skinner M., Gibbs A. R. Biological markers in human lung carcinoma: an immunopathological study of six antigens. Thorax. 1983 Dec;38(12):937–941. doi: 10.1136/thx.38.12.937. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Harach H. R. Thyroid follicles with acid mucins in man: a second kind of follicles? Cell Tissue Res. 1985;242(1):211–215. doi: 10.1007/BF00225578. [DOI] [PubMed] [Google Scholar]
  15. Harach H. R., Wilander E., Grimelius L., Bergholm U., Westermark P., Falkmer S. Chromogranin A immunoreactivity compared with argyrophilia, calcitonin immunoreactivity, and amyloid as tumour markers in the histopathological diagnosis of medullary (C-cell) thyroid carcinoma. Pathol Res Pract. 1992 Feb;188(1-2):123–130. doi: 10.1016/s0344-0338(11)81167-2. [DOI] [PubMed] [Google Scholar]
  16. Harach H. R., Williams E. D. Glandular (tubular and follicular) variants of medullary carcinoma of the thyroid. Histopathology. 1983 Jan;7(1):83–97. doi: 10.1111/j.1365-2559.1983.tb02218.x. [DOI] [PubMed] [Google Scholar]
  17. Kakudo K., Miyauchi A., Ogihara T., Takai S. I., Kitamura H., Kosaki G., Kumahara Y. Medullary carcinoma of the thyroid. Giant cell type. Arch Pathol Lab Med. 1978 Sep;102(9):445–447. [PubMed] [Google Scholar]
  18. Kakudo K., Miyauchi A., Takai S., Katayama S., Kuma K., Kitamura H. C cell carcinoma of the thyroid--papillary type. Acta Pathol Jpn. 1979 Jul;29(4):653–659. doi: 10.1111/j.1440-1827.1979.tb00933.x. [DOI] [PubMed] [Google Scholar]
  19. Lertprasertsuke N., Kakudo K., Satoh S., Tada N., Osamura Y. Rectal carcinoid tumor metastasizing to the thyroid and pancreas. An autopsy case exploiting immunohistochemistry for differentiation from tumors involving multiple endocrine organs. Acta Pathol Jpn. 1990 May;40(5):352–360. doi: 10.1111/j.1440-1827.1990.tb01572.x. [DOI] [PubMed] [Google Scholar]
  20. Ljungberg O., Bondeson L., Bondeson A. G. Differentiated thyroid carcinoma, intermediate type: a new tumor entity with features of follicular and parafollicular cell carcinoma. Hum Pathol. 1984 Mar;15(3):218–228. doi: 10.1016/s0046-8177(84)80183-5. [DOI] [PubMed] [Google Scholar]
  21. Ljungberg O. On medullary carcinoma of the thyroid. Acta Pathol Microbiol Scand Suppl. 1972;231:1–57. [PubMed] [Google Scholar]
  22. Mendelsohn G., Baylin S. B., Bigner S. H., Wells S. A., Jr, Eggleston J. C. Anaplastic variants of medullary thyroid carcinoma: a light-microscopic and immunohistochemical study. Am J Surg Pathol. 1980 Aug;4(4):333–341. doi: 10.1097/00000478-198008000-00002. [DOI] [PubMed] [Google Scholar]
  23. Nesland J. M., Sobrinho-Simões M. A., Holm R., Johannessen J. V. Organoid tumor in the thyroid gland. Ultrastruct Pathol. 1985;9(1-2):65–70. doi: 10.3109/01913128509055487. [DOI] [PubMed] [Google Scholar]
  24. Portela-Gomes G. M., Grimelius L. Identification and characterization of enterochromaffin cells with different staining techniques. Acta Histochem. 1986;79(2):161–174. doi: 10.1016/S0065-1281(86)80077-0. [DOI] [PubMed] [Google Scholar]
  25. Saad M. F., Ordonez N. G., Rashid R. K., Guido J. J., Hill C. S., Jr, Hickey R. C., Samaan N. A. Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients. Medicine (Baltimore) 1984 Nov;63(6):319–342. [PubMed] [Google Scholar]
  26. Uribe M., Fenoglio-Preiser C. M., Grimes M., Feind C. Medullary carcinoma of the thyroid gland. Clinical, pathological, and immunohistochemical features with review of the literature. Am J Surg Pathol. 1985 Aug;9(8):577–594. doi: 10.1097/00000478-198508000-00003. [DOI] [PubMed] [Google Scholar]
  27. WILLIAMS E. D., SANDLER M. The classification of carcinoid tum ours. Lancet. 1963 Feb 2;1(7275):238–239. doi: 10.1016/s0140-6736(63)90951-6. [DOI] [PubMed] [Google Scholar]
  28. Williams E. D., Brown C. L., Doniach I. Pathological and clinical findings in a series of 67 cases of medullary carcinoma of the thyroid. J Clin Pathol. 1966 Mar;19(2):103–113. doi: 10.1136/jcp.19.2.103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Williams E. D. Histogenesis of medullary carcinoma of the thyroid. J Clin Pathol. 1966 Mar;19(2):114–118. doi: 10.1136/jcp.19.2.114. [DOI] [PMC free article] [PubMed] [Google Scholar]

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