FDG uptake in metastatic spreading mucoepidermoid carcinoma of the thyroid.

Department of Nuclear Medicine, University Hospital of Berne (Inselspital), Berne, Switzerland.
Clinical Nuclear Medicine (Impact Factor: 2.96). 06/2007; 32(5):383-7. DOI:10.1097/01.rlu.0000259655.75971.28
Source: PubMed
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    ABSTRACT: The aim of the study was to report a recent case of mucoepidermoid carcinoma (MEC) of the thyroid, review the pertinent literature, and highlight the importance of multimodal treatment in this potentially aggressive malignancy. The study comprise a case report and a review of literature. A 42-year-old woman had initially presented to another hospital with a painful left neck mass. She subsequently underwent left hemithyroidectomy. Surgical pathology was significant for lymphocytic thyroiditis and MEC. One month later, she presented to us with a right neck mass. The patient underwent completion thyroidectomy and selective neck dissection, including level 6, for high-grade MEC. Operative findings included 3 lymph nodes positive for metastasis and tumor invasion of the transverse cervical vein. Postoperative chemoradiation therapy was administered in 2 cycles separated by 1 month. The patient remains disease-free 22 months after the last treatment. Mucoepidermoid carcinoma is a rare malignancy of the thyroid with less than 35 cases reported to date. The origins of this tumor are not completely understood, with debate regarding whether it arises from solid cell nests of the ultimobranchial apparatus or from follicular epithelium. Although MEC of the thyroid has frequently been reported as low grade, the aggressive presentation in our patient suggests the appropriateness of multimodal therapy.
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    ABSTRACT: Clinical and morphological features of three cases of primary mucoepidermoid carcinoma of the thyroid are described. The tumours were composed of two cell types. One of these resembled squamous epithelium and ultrastructurally showed tonofilaments and numerous desmosomes. The other cell type contained Alcian blue and mucicarmine positive mucin and, on electron microscopy, showed mucigen granules. Marked stromal fibrosis and psammoma bodies were seen in all tumours. Immunohistochemical studies showed that the tumour cells were negative for thyroglobulin. A few calcitonin-containing cells were seen in one metastatic tumour. One tumour showed, in addition to the histological features of mucoepidermoid carcinoma, anaplastic areas with obvious transition between the two histological patterns. The same thyroid also had a small thyroglobulin-positive papillary carcinoma in the opposite lobe. All tumours presented lymph node metastases. In two cases the primary tumour was confined within the thyroid capsule but that with anaplastic areas invaded surrounding structures. This patient died 13 months after diagnosis; the other patients are alive and symptomless one and 10 years since diagnosis. Mucoepidermoid carcinoma of the thyroid appears to be a clinicopathological entity that resembles papillary carcinoma in its natural history. The origin of the tumour is unclear. There is, however, some histological and immunohistological data suggesting that the tumour might be related to the ultimobranchial system although some histological features also appear to favour a common origin with papillary carcinoma.
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