Preoperative Diagnosis predicts Outcomes in Patients with Concurrent Medullary and Papillary Thyroid Carcinoma

Abstract

ABSTRACT Aim This study examined patients with concurrent medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) with the primary objective of identifying factors that can determine the dominant subtype that will dictate recurrence. Materials and methods The cancer registry at our tertiary care referral center was reviewed to identify all patients from 1995 to 2015 who had been diagnosed with both MTC and PTC on initial total thyroidectomy. Patient demographic, pathology, and recurrence data were collected and reviewed. Results Nineteen patients met the inclusion criteria. Seventeen patients had separate foci of MTC and PTC, and two patients had mixed tumors of medullary and follicular or medullary and the follicular variant of PTC. Thirteen patients had a preoperative diagnosis of MTC, and all 13 had MTC as the higher stage tumor on final pathology. Of these, eight patients had recurrent disease, all of which recurred as MTC. In the six patients with concurrent MTC and PTC who did not have MTC as the preoperative diagnosis, the PTC was the higher stage tumor. Only one patient in this group recurred with PTC, none with MTC. No patients have had recurrent disease that was a different subtype from their preoperative diagnosis or the higher stage tumor. Conclusion The concurrent findings of MTC and PTC in the same patient may result in challenging patient counseling, management, and follow-up. In this series of 19 patients with concurrent PTC and MTC, the subtype of recurrence in all 9 patients with recurrent disease was determined by the preoperative diagnosis and higher stage tumor. Clinical significance The incidental discovery of a second subtype of differentiated thyroid cancer should not alter management of the primary tumor. Patients should be treated in accordance with the preoperative diagnosis and higher stage tumor. How to cite this article Beninato T, Kluijfhout WP, Drake FT, Shen WT, Suh I, Duh QY, Clark OH, Gosnell JE. Preoperative Diagnosis predicts Outcomes in Patients with Concurrent Medullary and Papillary Thyroid Carcinoma. World J Endoc Surg 2017;9(3):94-99.