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  Table of Contents    
LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 414-415
Synchronous occurrence of anaplastic, follicular and papillary carcinomas with follicular adenoma in thyroid gland


1 Department of Surgery, Mamata Medical College and Hospital (MMC/MGH), Khammam - 507 002, Andhra Pradesh, India
2 Department of Gynaecology, Mamata Medical College and Hospital (MMC/MGH), Khammam - 507 002, Andhra Pradesh, India

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Date of Web Publication27-May-2011
 

How to cite this article:
Bhargav P, Gayathri K B. Synchronous occurrence of anaplastic, follicular and papillary carcinomas with follicular adenoma in thyroid gland. Indian J Pathol Microbiol 2011;54:414-5

How to cite this URL:
Bhargav P, Gayathri K B. Synchronous occurrence of anaplastic, follicular and papillary carcinomas with follicular adenoma in thyroid gland. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Dec 10];54:414-5. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/414/81600


Sir,

Authors deserve appreciation for resurfacing the issue of multiple tumors in the thyroid gland by reporting this interesting case. [1] The simultaneous occurrence of multiple thyroid tumors of different histopathological types in the same thyroid gland is a rare presentation and known as mixed or hybrid tumours or composite tumours. I have few comments and queries to put forth. First, the downhill differentiation of well-differentiated thyroid cancer occurs with long-standing tumors and elderly patients due to accumulating mutations like p53. Second, the pathogenetic mechanisms of hybrid tumors are common stem cell theory, collision theory which postulates simultaneous multifocal origin from different cell clones, [2] or hostage theory which states that adenomatous areas are sequestrated by another tumour type, though the exact etiology is elusive. A major prognostic determinant is the most aggressive type, as shown by anaplastic cancer (AC) which might have led to early mortality in this case. Third, simultaneous occurrence of medullary and follicular cancers is not an uncommon entity and can occur either sporadically or as part of the MEN 2 syndrome. [3] Fourth, many studies confirm that mixed tumours can occur as part of familial cancer syndromes such as Carney's complex [4] causing follicular adenoma (FA), papillary cancer (PC), and follicular cancer (FC), Werner's [5] syndrome predisposing FC, PC, and AC, and Cowden's syndrome causing FA and FC. These familial or syndromic thyroid cancers arise at an earlier age compared to sporadic hybrid tumors. Lastly, a thorough clinical evaluation of a patient with mixed tumors to look for endocrine and nonendocrine manifestations is recommended for appropriate counseling and cancer surveillance of the patient and the family.

 
   References Top

1.Ganguly R, Mitra S, Datta AK. Synchronous occurrence of anaplastic, follicular and papillary carcinomas with follicular adenoma in thyroid gland. Indian J Pathol Microbiol 2010;53:337-9.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Matias- Guiu X. Compound medullary-papillary carcinoma of the thyroid: Ture mixed versus collision tumour. Histopathology 1994;25:183-5.  Back to cited text no. 2
    
3.Mizukami Y, Michigishi T, Nonomura A, Nakamura S, Noguchi M, Hashimoto T, et al. Mixed medullary-follicular carcinoma of the thyroid occurring in familial form. Histopathology 1993;22:284-7.  Back to cited text no. 3
[PUBMED]    
4.Stratakis CA, Courcoutsakis NA, Abati A, Filie A, Doppman JL, Carney JA, et al. Thyroid gland abnormalities in patients with the syndrome of spotty skin pigmentation, myxomas, endocrine overactivity, and schwannomas (Carney complex). J Clin Endocrinol Metab 1997;82: 2037-43.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Ishikawa Y, Sugano H, Matsumoto T, Furuichi Y, Miller RW, Goto M. Unusual features of thyroid carcinomas in Japanese patients with Werner syndrome and possible genotype- phenotype relations to cell type and race. Cancer 1999;85:1345-52.  Back to cited text no. 5
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Correspondence Address:
PRK Bhargav
Mamata Medical College and Hospital (MMC/MGH), Khammam - 507 002, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


Read associated Letter to Editor: Author's Reply with this article

DOI: 10.4103/0377-4929.81600

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1 Authoręs Reply
Ganguly, R., Mitra, S., Datta, A.K.
Indian Journal of Pathology and Microbiology. 2011; 54(2): 415
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