RESUMO
OBJECTIVE: Medullary thyroid carcinoma (MTC) is a rare disease, and its classic tumor marker is calcitonin. However, recently, very aggressive cases have been reported to also secrete carbohydrate antigen 19-9 (CA19-9), and its role as a marker of worse prognosis has been questioned. The aim of this study was to analyze the relationship between CA19-9 serum levels and MTC outcomes. METHODS: We retrospectively reviewed 122 MTC patients followed in a tertiary cancer center from 1985 to 2017. Clinical-pathologic characteristics, therapeutic approaches, and outcomes were recorded and CA19-9 was collected. RESULTS: Of the 122 patients included in the study, 48 had distant metastases, and at the end of follow-up 18.1% had structural persistent disease and 32.7% had progressive disease. CA19-9 was significantly higher in those who had disease progression than in those who had not (21.4 [14.3-110.9] vs. 7.27 [0.6-44.75] U/mL, p = 0.01) and was also higher in patients who died from MTC (18.4 [14.3-110.9] vs. 7.59 [0.6-67.8] U/mL, p < 0.001). Furthermore, using a ROC curve analysis, the cutoff point for CA19-9 in MTC patients was lower than that observed in pancreatic tumors. CONCLUSION: CA19-9 might have a role as a prognostic factor in addition to calcitonin and carcinoembryonic antigen in metastatic MTC.
RESUMO
The incidence of differentiated thyroid cancer (DTC) is increasing worldwide, especially among small (≤2 cm) tumors. Overall, small DTC have an excellent prognosis and low mortality rate. Still, a proportion of these patients will experience recurrent/persistent disease. Careful risk stratification makes it possible to individualize treatment, avoiding unnecessary procedures and guarantees a good long-term prognosis with low recurrence risk. Recent studies evaluated the impact of the extent of surgery and radioiodine therapy, providing new evidence regarding treatment approach. Therefore, is time to reconsider clinical management and treatment of small DTC. Based on current data, in patients with small tumors and no additional risk factors, a conservative surgical approach without radioiodine therapy might be appropriated. More extensive surgery and radioiodine therapy could be proposed for small tumors exhibiting more aggressive features, such as lymph node metastasis, multifocality, vascular involvement, extra-thyroidal invasion or unfavorable molecular biology.
Assuntos
Carcinoma de Células Pequenas/terapia , Diferenciação Celular , Neoplasias da Glândula Tireoide/terapia , Carcinoma de Células Pequenas/patologia , Gerenciamento Clínico , Humanos , Neoplasias da Glândula Tireoide/patologiaRESUMO
A 30-year-old man diagnosed with follicular thyroid carcinoma treated previously with total thyroidectomy was referred to radioiodine treatment. Post-therapy scan performed 10 days after a 150 mCi 131NaI revealed radioiodine uptake in left temporal region. To elucidate the abnormal head uptake, Tc-99m MDP bone scan and head magnetic resonance image was performed. No anomalous uptake was observed in the bone scan. Head magnetic resonance image found a well-circumscribed lesion in temporal was compatible with a vascular malformation. Angioresonance confirmed the diagnosis of cavernous angioma, a benign vascular tumor.