SIGNIFICANCE OF THE PREVENTIVE ULTRASOUND DIAGNOSTICS IN THE EARLY DETECTION OF RARE AND AGGRESSIVE THYROID CARCINOMAS – CASE REPORT
Abstract
Introduction: Medullary thyroid carcinoma (MTC) is an aggressive tumor associated with a significantly poorer prognosis compared to other types of thyroid cancer. Doppler ultrasound and familiarity with the Thyroid Imaging Reporting and Data System (TIRADS) nodule classification are essential.
Objective: This case highlights the significance of precise ultrasound imaging, crucial for early detection and subsequent management of such aggressive disease.
Case report: We describe the case of a 31-year-old woman who underwent systemic ultrasound imaging. Upon ultrasound examination, a 5 mm x 4 mm x 3 mm hypoechoic, ill-defined solid nodule with echogenic foci (TIRADS 4, score 6) was identified in the mid portion of the left thyroid lobe. Given the suspicious ultrasound features, the location of the nodule, and the elevated serum calcitonin level, the micronodule raised concerns for malignancy, particularly suggesting medullary thyroid microcarcinoma. The patient underwent thyroidectomy, and histopathological analysis confirmed the diagnosis. The histopathology report described a small white nodule (5 mm) in the left lobe. There was no remarkable necrosis, and amyloid deposits were inconspicuous. Lymphovascular invasion was not observed, and mitoses were rare. The tumor stage was T1 (pTNM), and no distant metastases were found. C-cell hyperplasia was noted around the tumor. Immunohistochemical analysis showed positive reactions for calcitonin, chromogranin, and mCEA. The proliferative index was low, approximately 4%. After surgery, serum calcitonin levels decreased. Three years after the surgery, the patient is in good general condition and is under regular monitoring. In the meantime, the patient has become a mother.
Conclusion: Early detection and treatment of micro-MTC are crucial, as these tumors have the potential for aggressive behavior. Adequate ultrasound imaging assessment could significantly improve the prognosis and outcome for these patients.
References
Pillarisetty VG, Katz SC, Ghossein RA, Tuttle RM, Shaha AR. Micromedullary thyroid cancer: how micro is truly micro? Ann Surg Oncol. 2009 Oct;16(10):2875-81. doi: 10.1245/s10434-009-0595-1.
Samulski TD, Livolsi VA, Montone K, Baloch Z. The variable pathologic presentations of medullary and micro-medullary thyroid carcinoma: an institutional experience. Pathol Res Pract. 2014 Mar;210(3):182-5. doi: 10.1016/j.prp.2013.12.004.
Zhao J, Yang F, Wei X, Mao Y, Mu J, Zhao L, et al. Ultrasound features value in the diagnosis and prognosis of medullary thyroid carcinoma. Endocrine. 2021 Jun;72(3):727-34. doi: 10.1007/s12020-020-02510-2.
Trimboli P, Mian C, Piccardo A, Treglia G. Diagnostic tests for medullary thyroid carcinoma: an umbrella review. Endocrine. 2023 Aug;81(2):183-93. doi: 10.1007/s12020-023-03326-6.
Ospina NS, Maraka S, Donegan D, Morris JC. Clinical features of a family with multiple endocrine neoplasia type 2A caused by the D631Y RET mutation. Thyroid. 2017 Oct;27(10):1332-4. doi: 10.1089/thy.2016.0536.
Grani G, Sponziello M, Filetti S, Durante C. Thyroid nodules: diagnosis and management. Nat Rev Endocrinol. 2024 Dec;20(12):715-28. doi: 10.1038/s41574-024-01025-4.
Matrone A, Gambale C, Biagini M, Prete A, Vitti P, Elisei R. Ultrasound features and risk stratification systems to identify medullary thyroid carcinoma. Eur J Endocrinol. 2021 Jun 28;185(2):193-200. doi: 10.1530/EJE-21-0313.
Sipos JA. the history of thyroid ultrasound: past, present, and future directions. Endocr Pract. 2024 Dec;30(12):1220-6. doi: 10.1016/j.eprac.2024.08.010.
Gui Z, Wang Z, Xiang J, Sun W, He L, Dong W, et al. Incidental T1 stage medullary thyroid carcinoma: the effect of tumour diameter on prognosis and therapeutic implications. Clin Endocrinol (Oxf). 2022 Sep;97(3):355-62. doi: 10.1111/cen.14702.
Trimboli P, Mian C, Piccardo A, Treglia G. Diagnostic tests for medullary thyroid carcinoma: an umbrella review. Endocrine. 2023 Aug;81(2):183-93. doi: 10.1007/s12020-023-03326-6.
Frank-Raue K, Raue F. Hereditary medullary thyroid cancer: genotype-phenotype correlation. Recent Results Cancer Res. 2025;223:183-209. doi: 10.1007/978-3-031-80396-3_7.
Yip AT, Kim TH, Peluso EM, Jacobsen SE, Yeh MW, Lechner MG. Medullary thyroid carcinoma and clinical outcomes in heterozygous carriers of the RET K666N germline pathogenic variant. JCEM Case Rep. 2025 Feb 17;3(3):luaf002. doi: 10.1210/jcemcr/luaf002.
Pacini F, Castagna MG, Cipri C, Schlumberger M. Medullary thyroid carcinoma. Clin Oncol (R Coll Radiol). 2010 Aug;22(6):475-85. doi: 10.1016/j.clon.2010.05.002.
Hamy A, Pessaux P, Mirallié E, Mucci-Hennekinne S, Gibelin H, Mor-Martinez C, et al. Central neck dissection in the management of sporadic medullary thyroid microcarcinoma. Eur J Surg Oncol. 2005 Sep;31(7):774-7. doi: 10.1016/j.ejso.2005.03.007.
Li X, Yao J, Zhan W, Zhou W. Ultrasonographic differentiation of medullary thyroid carcinoma from papillary thyroid carcinoma: quantitative comparison of morphologic features and different TIRADS risk categorizations. BMC Med Imaging. 2025 May 26;25(1):189. doi: 10.1186/s12880-025-01679-0.
Zhang D, Yang F, Hou W, Wang Y, Mu J, Wang H, et al. Ultrasonic radiomics in predicting pathologic type for thyroid cancer: a preliminary study using radiomics features for predicting medullary thyroid carcinoma. Front Endocrinol (Lausanne). 2025 Feb 19;16:1428888. doi: 10.3389/fendo.2025.1428888.
Gao L, Ma L, Li X, Liu C, Li N, Lian X, et al. Using preoperative ultrasound vascularity characteristics to estimate medullary thyroid cancer. Cancer Imaging. 2023 Jun 20;23(1):64. doi: 10.1186/s40644-023-00583-6.
Viering O, Rinscheid A, Holzleitner N, Dierks A, Kircher M, Wienand G, et al. Biodistribution and radiation dosimetry for 68 Ga-DOTA-CCK-66, a novel CCK 2 R-targeting compound for imaging of medullary thyroid cancer. Clin Nucl Med. 2024 Dec 1;49(12):1091-7. doi: 10.1097/RLU.0000000000005355.
Zhang Q, Hu Y, Chen X, Yang Z, Li X, Ni X, et al. Preoperative prediction of Ki-67 expression in medullary thyroid carcinoma based on ultrasonographic features: a 10-year retrospective study. Eur J Radiol. 2025 Jul;188:112134. doi: 10.1016/j.ejrad.2025.112134.
Deandrea M, Piticchio T, Mormile A, Retta F, Canale G, Caracciolo A, et al. Preoperative neck ultrasound combined with pathological data can significantly impact the outcome of medullary thyroid carcinoma. Endocr J. 2023 Nov 28;70(11):1061-7. doi: 10.1507/endocrj.EJ23-0273.
Delorme S, Raue F, Beuthien-Baumann B. Medullary thyroid carcinoma: imaging. Recent Results Cancer Res. 2025;223:129-53. doi: 10.1007/978-3-031-80396-3_5.
