Resumo

DE MILIANI, Yhajaira Zerpa; UZCATEGUI, Lilia Rosa; MILIANI, Nelson  e  GOMEZ-PEREZ, Roald. Ocurrencia simultánea de Carcinoma Tiroideo Papilar, folicular y medular en paciente con bocio recidivante.. Rev. Venez. Endocrinol. Metab. [online]. 2007, vol.5, n.1, pp.22-25. ISSN 1690-3110.

Abstract Objectives: to report an unusual case of a 49 year old patient with recurrent goiter and the simultaneous presence of three types of histological thyroid cancer. Clinical Case: A 49 year old female patient, with the presence of recurrent goiter. There was no history of head or neck irradiation, nor a family or personal history of endocrine neoplasia or others. A subtotal thyroidectomy was preformed in 1986 for benign tumor, without medication of substitutive therapy with L-tiroxine. There was a recurrence of the goiter which was deformant with compressive symptoms and biochemical hypothyroidism (TSH:50uUI/mL and T4L:0.03 ng/dL), the fine needle aspiration biopsy reported possible papillary carcinoma. The thyroid ultrasound revealed a right thyroid lobe with volume greater than 16.8 cc, with multiple cervical lymph nodes to the left side with extensions to the lateral anterior mediastinum. The x-ray of the thorax was normal. A total thyroidectomy was performed with modified radical dissection to the left side of the neck of the levels II to VI. The histological results showed: a) Hashimoto thyroiditis, b) mixed carcinoma: follicular, papillary and solid areas with affinity for congo red dye which is characteristic of amyloid compatible with medullary carcinoma, c) left cervical lymph nodes with metastases of thyroid carcinoma predominantly medullary and follicular carcinoma and d) mediastinal lymph node metastases of follicular carcinoma of thyroid . Radioiodine therapy was performed with 200 mCi of I131. The serum calcitonin was 1282 pg/mL and post-surgical ultrasound of the thyroid showed vascularity and retroesternal LOE, since there was persistence of the tumor, a new cervicothomy was performed to complete the dissection of the lymph nodes from level VII, with histological findings of medullary carcinoma. Levothyroxine therapy was indicated and thirty sessions of radioactive therapy were completed, with levels of post-radioactive calcitonin of 30 pg/mL, TSH 0.3uUI/mL, T4L:1.8 ng/dL and Thyreoglobulin: 14 ng/dL. Conclusions: The simultaneous occurrence of thyroid carcinoma with different histological types in the same individual is a very rare situation. We present a case of papillary, medulary, and follicular carcinoma, all simultaneous in a recurrent goiter.

Palavras-chave : Papillary carcinoma; medulary carcinoma; follicular carcinoma.