Sporadic Medullary Thyroid Carcinoma in Grave’s disease : Report of a case
| Autor: | ARIMA Hideo, NAKAJO Akihiro, KIJIMA Yuko, YOSHINAKA Heiji, HIRATA Munetsugu, NAKANO Shizuo, ARIMA Miyako, ISHIGAMI Sumiya, OKUMURA Hiroshi, NATSUGOE Shoji |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: | |
| Zdroj: | 鹿児島大学医学雑誌 = Medical journal of Kagoshima University. 67(1-3):19-25 |
| ISSN: | 0368-5063 |
| Popis: | A 60-year-old man who noted numbness and dyskinesia of his left-hand fingers was admitted to a hospital. After anticoagulant therapy and medication with L-3, 4-dihydroxyphenylalanine (L-DOPA) were started, his symptoms didn’t improve. He was introduced to our institution with gait disturbance and difficulty of articulating properly. L-DOPA was administered under a diagnosis of multiple system atrophy by magnetic resonance imaging. He was also diagnosed as Graves’ disease with hyperthyroidism and expression of TSH receptor antibodies. Cervical ultrasonography revealed diffuse thyroid enlargement with abundant blood flow, which was consistent with Graves’ disease. A nodule of 6.3 x 8.3 x 9.2mm was also detected in the middle of the right lobe. The nodule was diagnosed as medullary thyroid carcinoma (MTC) by fine needle aspiration cytology (FNAC). The serum calcitonin and CEA level were elevated. We diagnosed sporadic MTC because lacking of pituitary or adrenal tumor, and family history of MTC. After medication for Graves’ disease, total thyroidectomy with central lymph nodes dissection was performed. Histopathological examination diagnosed as a MTC the diameter of tumor was 9 mm in the middle of the right lobe without extra thyroidal extension. Most of the thyroid cancers with Graves’ disease have been reported to be papillary thyroid cancer. The case of MTC with Graves’ disease is very rare with only 12 cases having been reported. We report the case of sporadic MTC with Graves’ disease which accidentally diagnosed by episode of multiple system atrophy. 症例は60 歳男性。左手指のしびれ・ジズキネシアを主訴に近医入院。脳梗塞やパーキンソン病を疑われ治療をされるも改善が認められなかった。その後、歩行障害の出現と徐々にろれつが回りにくいことに気付き、当院紹介受診。頭部MRI 施行され多系統萎縮症を疑われ内服加療となった。採血にて甲状腺機能亢進・TRAb 陽性にてバセドウ病（Graves’disease）の診断となった。頚部超音波検査では、血流豊富で腫大した甲状腺が描出され、バセドウ病が疑われた。また、甲状腺右葉中部に6.3 x 8.3 x 9.2mm の低エコー結節を認めた。超音波下穿刺細胞診まで施行し甲状腺髄様癌の診断となった。カルシトニン及びCEA の上昇も認められた。家族歴はなく、全身検索も行ったがその他の腫瘍性病変は認めず、散発性甲状腺髄様癌の診断となり甲状腺全摘術、リンパ節郭清を施行した。病理診断にて甲状腺右葉中部に9x7mm の限局型髄様癌を認めるのみでリンパ節転移も認めなかった。現在まで再発・転移は認めていない。甲状腺髄様癌は全甲状腺癌の中でも2 ～ 3% と稀な疾患で、バセドウ病における甲状腺癌の合併は乳頭癌が一般的に多く、髄様癌の報告はこれまで12 例のみである。今回我々は、多系統萎縮症の精査の際に偶然バセドウ病を合併した散発性甲状腺髄様癌が診断された、貴重な1 例を経験したので報告する。 |
| Databáze: | OpenAIRE |
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