Sporadic medullary microcarcinoma of thyroid is a rare disease detected usually in 0.15% of all thyroid malignancy. We report a case of sporadic medullary microcarcinoma (MMC) of thyroid in a 24 year old male presenting as solitary thyroid nodule. There was no family history of medullary carcinoma of thyroid. Although medullary carcinoma in a familial setting have been reported, sporadic MMC is rare especially in a young patient

D, Manjunath

K, Amita

M, Abhishek

S, Vijayshankar

English

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Case Report:
Sporadic Medullary Microcarcinoma in a Young Patient - A Rare Case
Vijayshankar S Assistant Professor, Department of Pathology,
Amita K, Assistant Professor Department of Pathology,
Abhishek M, Assistant Professor, Department of Pathology,
Manjunath D, Assistant Professor, Department of ENT,
Adichunchanagiri Institute of Medical Sciences, BG Nagara, Bellur cross, Mandya district, Karnataka, India.
Address For Correspondence:
Dr. Amita K,
Assistant Professor,
Department of Pathology,
Adichunchanagiri Institute of Medical Sciences,
BG Nagara, Bellur cross,
Mandya district, Karnataka, India.
E-mail: dramitay@rediffmail.com
Citation:  Vijayshankar S, Amita K, Abhishek M, Manjunath D. Sporadic Medullary Microcarcinoma in a Young Patient - A Rare  
Case. Online J Health Allied Scs. 2010;9(3):20
URL: http://www.ojhas.org/issue35/2010-3-20.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Aug 7, 2010; Accepted: Sep 10, 2010; Published: Oct 15, 2010
Abstract:
Sporadic medullary microcarcinoma of thyroid is a rare dis-
ease detected usually in 0.15% of all thyroid malignancy. We 
report a case of sporadic medullary microcarcinoma (MMC) 
of thyroid in a 24 year old male presenting as solitary thyroid 
nodule. There was no family history of medullary carcinoma 
of thyroid. Although medullary carcinoma in a familial setting 
have  been  reported,  sporadic  MMC  is  rare  especially  in  a 
young patient. 
Key Words:  Medullary microcarcinoma;  Sporadic;  Solitary 
thyroid nodule
Introduction:
Sporadic medullary microcarcinoma of thyroid is a rare dis-
ease detected usually in 0.15% of all thyroid malignancy. Usu-
ally these cases have been diagnosed in thyroidectomies per-
formed for other benign thyroid diseases. Medullary microcar-
cinomas  are  common  in  familial  settings.  Case  reports  of 
sporadic MMC is rare especially in a young patient.
Case Report:
A  23  years  old  male  presented  with  a  right  sided  solitary 
thyroid nodule (STN) measuring 2 x 2 cm. On examination, 
no lymphadenopathy was noted. Ultrasound (USG) neck re-
vealed  a  solitary  hypoechoic  lesion  measuring  one  cm  in 
greatest dimension with fine specks of calcification. 
FNAC was  performed.  Smears  showed  round  to  polygonal 
cells in clusters showing overcrowding, overlapping and fine 
stippled  chromatin.  Possibility  of  medullary  carcinoma  was 
considered after which serum calcitonin was done which was 
found to be elevated.
Total thyroidectomy was done. Gross examination revealed a 
well circumscribed, solid grey white nodule one cm in greatest 
dimension in  mid portion of  lateral lobe (Figure 1).
Histopathological examination showed a well encapsulated tu-
mor with cells arranged in papillary pattern with amyloid and 
calcification (Figure 2). Cells showed moderate amount of am-
phophilic  cytoplasm  and  stippled  nuclear  chromatin.  Full 
thickness  capsular  and  vascular  invasion  was  demonstrated 
(Figure 3). Surrounding thyroid tissue showed non nodular C 
cell hyperplasia.
Figure 1: A well circumscribed, solid grey white lesion in the 
mid portion of lateral lobe of thyroid
Figure 2:  Photomicrograph showing solid and papillary pat-
tern  along  with  amyloid  deposition  and  calcification. 
(Haematoxylin and Eosin, X 400)
1
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Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 9, Issue 3; Jul-Sep 2010
Figure  3:  Photomicrograph  showing  capsular  invasion. 
(Haematoxylin and Eosin, X 400)
Family history of thyroid disease, pheochromocytoma, sudden 
death, hypercalcemia or history of neck surgery was absent.
A final diagnosis of sporadic MMC of thyroid – papillary vari-
ant with capsular and vascular invasion was made.
A central compartment neck dissection was performed. There 
was no evidence of lymph node metastasis.  Patient is doing 
well eight months postoperatively.
Discussion:
Incidence of MMC of thyroid is 0.20% in patients treated sur-
gically for benign thyroid disease. S-MMC usually occurs in 
older  age  group,  mean  age  being  fourth  to  fifth  decade.1 
Sporadic MMC in younger age group is rare. 
Most  of  the  cases are diagnosed usually  in  thyroidectomies 
performed for other reasons or at autopsy. Very few cases are 
symptomatic,  present  as  STN  and  have  unfavourable  out-
come.2 Other common symptoms being diarrhoea and cervical 
lymphadenopathy. As a result the diagnosis is usually delayed. 
However ultrasound and FNAC has immensely contributed to 
the preoperative diagnosis of MMC.3
At  histopathology,  the  presence  of  amyloid  indicates  unfa-
vourable outcome as is capsular and vascular invasion.2
Studies have suggested that most of the MMC behave in be-
nign fashion. However, presence of capsular and lymph angio 
invasion indicates bad prognosis and needs prophylactic cent-
ral compartment neck dissection. 
Conclusion:
MMC is an uncommon challenging malignancy. The present 
case report underscores the utility of USG and FNAC in the 
diagnosis and planning management in these cases. We report 
this case because of its rarity in young patients and to  illus-
trate the necessity of total thyroidectomy with modified neck 
dissection in such cases.
References:
1. Chan JKC. Tumors of the thyroid and parathyroid 
glands. In: Fletcher CDM. (ed). Diagnostic Histo-
pathology of Tumors. 3rd ed. Churchill Living-
stone. London, England. 2007. PP 997–1097
2. Guyetant S, Dupre F, Bigorgne JC et al. Medullary 
thyroid microcarcinoma: A clinicopathologic retro-
spective study of 38 patients with no prior familial 
disease. Hum Pathol. 1999;30:957–963
3. Yang GCH, Livolsi VA, Baloch ZW. Thyroid Mi-
crocarcinoma: Fine Needle Aspiration Diagnosis 
and Histologic Follow up. International Journal of  
Surgical Pathology. 2002;10:133-139
2


Medullary thyroid microcarcinoma: A clinicopathologic retrospective study of 38 patients with no prior familial disease. Hum Pathol.

Thyroid Microcarcinoma: Fine Needle Aspiration Diagnosis and Histologic Follow up.

Tumors of the thyroid and parathyroid glands. In:

Sporadic Medullary Microcarcinoma in a Young Patient - A Rare Case

Vijayshankar S

Amita K

Abhishek M

Manjunath D

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Sporadic Medullary Microcarcinoma in a Young Patient - A Rare Case

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