J.Jpn. Surg. Soc.. 80(11): 1024-1026, 1979

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Report on the annual meeting

THE DIAGNOSIS AND TREATMENT OF MEDULLARY CARCINOMA OF THE THYROID

Medullary carcinoma of the thyroid is a rare thyroid tumor, which forms only 1.5% of total thyroid malignancies in Japan. Approximately one third of the patients with this tumor are familial cases, and most of familial cases are complicated with pheochromocytoma and/or parathyroid adenopathy, i.e. multiple endocrine neoplasia (MEN) type 2A, or with mucosal neuroma, Marfanoid habitus and pheochromocytoma, i.e. MEN type 2B. Plasma calcitonin determination is very useful in diagnosis of this tumor. The elevation in the plasma calcitonin level by provocative tests with calcium or gastrin injection is essential for screening of members of the family at high risk. Carcinoembryonic antigen (CEA) is elevated in the plasma of the patient with medullary carcinoma of the thyroid, and is also useful as a tumor marker.
In the case complicated with pheochromocytoma, the surgery for pheochromocytoma must be performed prior to the neck surgery. Total thyroidectomy with modified radical neck dissection should be performed for the familial cases. Sporadic cases can be treated by the same treatment policy as that for papillo-follicular carcinoma of the thyroid. Plasma calcitonin is also useful as a marker in evaluating the postoperative course. The prognosis is poor in the case showing a rapid increase in plasma calcitonin level during the postoperative course.

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