THE USE OF MULTIMODALITY TREATMENT FOR AN ATYPICAL, RECURRENT AND AGGRESSIVE MEDULLARY THYROID CANCER

Authors

  • Anna Elvira Arcellana University of the Philippines Manila, Philippine General Hospital
  • Jim Paulo Sarsagat University of the Philippines Manila, Philippine General Hospital
  • Franz Michael Magnaye University of the Philippines Manila, Philippine General Hospital
  • Aylmer Rex Hernandez University of the Philippines Manila, Philippine General Hospital
  • Michael San Juan University of the Philippines Manila, Philippine General Hospital
  • Christelle Almanon University of the Philippines Manila, Philippine General Hospital
  • Benedict Crisostomo University of the Philippines Manila, Philippine General Hospital
  • Johanna Patricia Cañal University of the Philippines Manila, Philippine General Hospital
  • Iris Thiele Isip-Tan University of the Philippines Manila, Philippine General Hospital

DOI:

https://doi.org/10.15605/jafes.036.S4

Keywords:

atypical, medullary, thyroid

Abstract

INTRODUCTION
Medullary thyroid cancer is a rare type of cancer of neuroendocrine origin, comprising about 1 to 3% of all types of thyroid cancers. Its clinical presentation is a complex spectrum. We present an extremely rare case of a calcitonin-negative medullary thyroid cancer that had an aggressive recurrence, presenting with superior vena cava syndrome, and managed with multimodality treatment in the form of radiotherapy and cytotoxic chemotherapy for local control and palliation.


RESULTS
A 53-year-old man presented with a 20-year history of a gradually enlarging anterior neck mass, initially noted as a marble-shaped lesion. Six months prior to consult, the patient observed a marked increase in the size of the mass along with a palpable lymph node on the left side of the neck. The patient underwent total thyroidectomy with radical neck dissection. Histopathology revealed a well-differentiated medullary thyroid carcinoma with lymphovascular invasion. Immunohistochemical staining was positive for calcitonin. Serum carcinoembryonic antigen (3.11 ng/mL, normal value <3.00) and calcitonin (<2.00 pg/mL, normal value 0 to 18.20) were both normal. The patient noted multiple, enlarging neck masses four months after surgery. Radiotherapy was administered for a total of 25 Gy in five fractions. Cytotoxic chemotherapy with cyclophosphamide, vincristine, and dacarbazine was initiated. The combination of radiotherapy and cytotoxic chemotherapy were considered viable treatment modalities in the pursuit of local control and palliation of this unusually aggressive disease.


CONCLUSION
This case demonstrates how non-surgical management through multiple modalities can be utilized for local control and palliation of this aggressive disease. Therapeutic options may be limited in the developing world especially when a tumor is at its advanced stage, but much can still be done for the holistic care of the cancer patient.

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Author Biographies

Anna Elvira Arcellana, University of the Philippines Manila, Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Jim Paulo Sarsagat, University of the Philippines Manila, Philippine General Hospital


Division of Endocrinology, Diabetes and Metabolism,

Franz Michael Magnaye, University of the Philippines Manila, Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Aylmer Rex Hernandez, University of the Philippines Manila, Philippine General Hospital

Division of Medical Oncology

Michael San Juan, University of the Philippines Manila, Philippine General Hospital

Division of Medical Oncology

Christelle Almanon, University of the Philippines Manila, Philippine General Hospital

Department of Surgery

Benedict Crisostomo, University of the Philippines Manila, Philippine General Hospital

Division of Radiation Oncology

Johanna Patricia Cañal, University of the Philippines Manila, Philippine General Hospital

Division of Radiation Oncology

Iris Thiele Isip-Tan, University of the Philippines Manila, Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

References

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Published

2021-07-28

How to Cite

Arcellana, A. E. ., Sarsagat, J. P., Magnaye, F. M. ., Hernandez, A. R. ., San Juan, . . M. ., Almanon, C. ., Crisostomo, . B. ., Cañal, J. P. ., & Isip-Tan, . I. T. (2021). THE USE OF MULTIMODALITY TREATMENT FOR AN ATYPICAL, RECURRENT AND AGGRESSIVE MEDULLARY THYROID CANCER. Journal of the ASEAN Federation of Endocrine Societies, 36, 4. https://doi.org/10.15605/jafes.036.S4

Issue

Section

Abstracts for Oral Presentation | Adult