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. 2024 Apr 22;10(1):92.
doi: 10.1186/s40792-024-01898-7.

Selpercatinib for treating recurrent mixed medullary and follicular cell-derived thyroid carcinoma: a case report

Mei Kadoya  1 , Nobuyasu Suganuma  2 , Yuka Matsubara  2 , Hiroki Takase  3 , Eita Kumagai  4 , Soji Toda  5 , Haruhiko Yamazaki  5 , Katsuhiko Masudo  6 , Satoshi Fujii  3 , Aya Saito  2
Affiliations

Selpercatinib for treating recurrent mixed medullary and follicular cell-derived thyroid carcinoma: a case report

Mei Kadoya et al. Surg Case Rep. .

Abstract

Background: Mixed medullary and follicular cell-derived thyroid carcinoma (MMFCC) is characterized by the coexistence of follicular and C cell-derived tumour cell populations within the same lesion. Due to its rarity, its etiology and clinical course remain unclear, and treatment for advanced or recurrent cases has not been established.

Case presentation: We report a case of MMFCC treated with selpercatinib. The patient was a 69-year-old male presenting with tumors in the right thyroid lobe and in the upper mediastinum. Fine-needle aspiration (FNA) cytology of the right thyroid lobe tumor revealed a medullary carcinoma; germline RET mutations were not detected. After resection of the right thyroid lobe with central node dissection, rapid intraoperative diagnosis of the mediastinal mass confirmed malignancy, leading to total thyroidectomy with excision of the upper mediastinal tumor. Histologically, the tumor in the right thyroid lobe and the pretracheal lymph node revealed a mixture of medullary and follicular carcinoma components, diagnosed as MMFCC. The mediastinal lymph node exhibited only medullary carcinoma components. At 11 months postoperatively, computed tomography scans showed enlargement of the right supraclavicular and upper mediastinal lymph nodes. FNA cytology of the right supraclavicular lymph node suggested the recurrence of medullary thyroid carcinoma. The gene panel testing (The Oncomine Dx Target Test Multi-CDx system®, Thermo Fisher SCIENTIFIC) of metastatic lymph node revealed RET somatic mutation (M918T). Treatment with selpercatinib was initiated, and both the cervical and mediastinal lymph nodes showed a reduction in size.

Conclusions: We report a rare case of selpercatinib use for MMFCC. Since RET mutations may occur frequently in MMFCC, selpercatinib could be effective in treating MMFCC.

Keywords: RET mutation; Mixed medullary and follicular cell-derived thyroid carcinoma; Selpercatinib.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative ultrasonography and computed tomography (CT) scan. Ultrasonography revealed a hypoechoic nodule with internal calcification in the right thyroid lobe (a) and a hypoechoic mass in the superior mediastinum (b). CT scan showed a solid tumor with internal calcification in the right thyroid lobe (c) and a solid tumor with contrast enhancement in the superior mediastinum (d)
Fig. 2
Fig. 2
Macroscopic appearance of the right thyroid lobe mass. A 9 × 6 × 6 mm grayish-white tumor was identified in the right thyroid lobe
Fig. 3
Fig. 3
Microscopic examination of the right lobe thyroid mass. The tumor was mixture of two components: one component showed features of medullary thyroid carcinoma with positive immunostaining for calcitonin and negative for thyroglobulin, whereas the other component resembled follicular structures with positive staining for thyroglobulin and negative staining for calcitonin. a H&E × 40, b H&E × 400, c Calcitonin, d Thyroglobulin
Fig. 4
Fig. 4
Microscopic examination of peritracheal lymph node metastasis. Immunohistochemical findings of peritracheal lymph node metastasis with mixed medullary and follicular cell-derived thyroid carcinoma: a H&E × 40, b H&E × 200, c Calcitonin, d Thyroglobulin
Fig. 5
Fig. 5
Computed tomography (CT) scans before and after selpercatinib treatment. CT scans at 11 months postoperatively revealed recurrence of mixed medullary and follicular cell-derived thyroid carcinoma at the right cervical lymph nodes (a) and upper mediastinal lymph nodes (b). After 9 weeks of treatment with selpercatinib, the cervical (c) and mediastinal lymph nodes (d) showed a reduction in size
Fig. 6
Fig. 6
Treatment and clinical course after initiation of selpercatinib
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References

    1. Hanna AN, Michael CW, Jing X. Mixed medullary-follicular carcinoma of the thyroid: diagnostic dilemmas in fine-needle aspiration cytology. Diagn Cytopathol. 2011;39:862–865. doi: 10.1002/dc.21560. - DOI - PubMed
    1. Sobin LH. Histological typing of thyroid tumours. Histopathology. 1990;16:513. doi: 10.1111/j.1365-2559.1990.tb01559.x. - DOI - PubMed
    1. Volante M, Papotti M, Roth J, Saremaslani P, Speel EJ, Lloyd RV, et al. Mixed medullary-follicular thyroid carcinoma. Molecular evidence for a dual origin of tumor components. Am J Pathol. 1999;155:1499–1509. doi: 10.1016/S0002-9440(10)65465-X. - DOI - PMC - PubMed
    1. Orlandi F, Chiefari E, Caraci P, Mussa A, Gonzatto I, De Giuli P, et al. RET proto-oncogene mutation in a mixed medullary-follicular thyroid carcinoma. J Endocrinol Invest. 2001;24:51–55. doi: 10.1007/BF03343809. - DOI - PubMed
    1. Gupta V. Simultaneous presentation of giant pheochromocytoma, primary hyperparathyroidism, and mixed-medullary-papillary thyroid cancer in MEN 2A. Indian J Endocrinol Metab. 2013;17:751–755. doi: 10.4103/2230-8210.113776. - DOI - PMC - PubMed

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