Medüller tiroid karsinomu

Özet

Medüller tiroid karsinomu tiroidin kalsitonin üreten C hücrelerinden kaynaklanır ve sporadik olabileceği gibi kalıtsal RET ilişkili hastalık bağlamında da görülebilir. Boyun ve üst toraks kontrastlı BT, özellikle büyük hacimli servikal-mediastinal nodal hastalık, akciğer metastazı ve komşu visseral kompartıman ilişkisini haritalamakta yararlıdır; küçük intratiroidal primerin karakterizasyonunda ultrason önceliklidir. Primer ve metastatik odaklarda kalsifikasyon görülebilmesi tanıyı destekleyebilir ancak tek başına özgül değildir. Servikal ya da mediastinal nodların ve akciğer yayılımının atlanması tümör yükünün eksik değerlendirilmesine neden olur.

Faz ve pencere

Kontrastlı tanısal

Kontrastlı boyun ve üst toraks yumuşak doku görüntülerinde intratiroidal solid odak, santral/lateral servikal ve üst mediastinal lenf nodları, trakeoözofageal oluk ve karotis kılıfıyla ilişki değerlendirilir; metastatik nodlarda nekroz veya kalsifikasyon bulunabilir.

Kontrastsız

Primer odak ve nodlardaki kaba, noktasal ya da düzensiz kalsifikasyonlar yüksek atenüasyonlu görünür; tek başına kalsifikasyonun histolojik tip tayin ettirici olmadığı akılda tutulur.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Akciğer (G 1500 / M -600), Kemik (G 1800 / M 400).

BT bulguları

• İntratiroidal solid odak — tek ya da çok odaklı, çevre bezden farklı kontrastlanan yumuşak doku nodülü.
• Primer tümör kalsifikasyonu — kaba veya noktasal yoğunluklar görülebilir; kalsifikasyon yokluğu medüller tümörü dışlamaz.
• Santral kompartıman nodları — paratrakeal ve pretrakeal yumuşak doku nodları trakea ile özofagus arasındaki olukta belirginleşebilir.
• Lateral servikal nodal metastaz — juguler zincirde yuvarlaklaşmış, nekrotik ya da kalsifiye nodlar görülebilir.
• Mediastinal nodal yayılım — üst mediasten ve paratrakeal zincirde boyundan devam eden veya ayrı nodal odaklar bulunabilir.
• Visseral kompartıman etkilenmesi — büyümüş primer veya nodal kitle trakeayı iter, özofagusla yağ planını siler ya da karotis kılıfına yaklaşır.
• Akciğer metastazları — toraks görüntülerinde iyi sınırlı solid nodüller, bazen çok sayıda odak şeklinde izlenebilir.

Normalde

Normal boyun BT'sinde tiroid parankimi iki lob ve isthmus boyunca düzenli görünür; santral ve lateral zincirlerde yağlı hilusu seçilen, oval lenf nodları bulunabilir. Aynı seviyeleri iki taraflı kıyaslayarak nodun yuvarlaklaşmasını, hilus kaybını, nekroz veya kalsifikasyonu ve paratrakeal alana uzanımı arayın.

Ayırıcı tanı

Papiller tiroid karsinomu

servikal lenf nodlarına metastaz yapabilir; nodüler lezyonların karakterizasyonunda ultrasonun üstün alan çözünürlüğü değerlidir.

Anaplastik tiroid karsinomu

ileri yaşta ortaya çıkan, agresif ve kötü prognozlu diferansiyasyonu bozulmuş tümördür.

Tiroid lenfoması

bez diffüz büyüyüp daha homojen yumuşak dokuya dönüşebilir; kalsifiye metastatik nodlar tipik değildir.

Tiroid metastazı

bilinen başka primer malignite, bez içinde birden çok odak veya eşlik eden uzak metastazlar tanıyı destekler.

Benign multinodüler guatr

nodüler kontur ve kaba kalsifikasyon yapabilir ancak şüpheli nodal hastalık eşlik etmez.

Tuzaklar

• Kalsifiye bir nodu yalnız medüller karsinom olarak etiketlemeyin; papiller tiroid metastazı ve benign nodüler hastalık da kalsifiye olabilir.
• Boyun BT'sinde normal görünen primer bez, medüller karsinomu dışlamaz; nodal zincirleri ve toraksı klinik bağlamda ayrıca tarayın.
• Servikal nod boyutunu tek başına malignite ölçütü saymayın; hilus, şekil, nekroz, kalsifikasyon ve dağılım birlikte yorumlanmalıdır.

Kendini dene

1. Medüller tiroid karsinomunda primer veya metastatik odaklarda kalsifikasyon görülebilir. Bu bulgunun en doğru yorumu hangisidir?

   • Tek başına özgül değildir; papiller tiroid metastazında da görülebilir
   • Medüller tiroid karsinomunu kesin doğrular
   • Maligniteyi dışlar
   • Yalnızca benign guatrda görülür
   Cevabı göster

   Tek başına özgül değildir; papiller tiroid metastazında da görülebilir. Medüller karsinomda kalsifikasyon görülebilir; ancak nodal veya tiroid içi kalsifikasyon tek başına histolojik alt tipi belirlemez. Papiller tiroid karsinomu ve benign nodüler hastalık da kalsifik olabilir; bez odağı, nod morfolojisi ve klinik bağlam birlikte değerlendirilir.

2. Kalsifiye servikal nodu bulunan hastada hangi eşlik eden görüntüleme bulgusu primer medüller tiroid odağını destekler?

   • Tiroid içinde solid nodül
   • Dil kökünde orta hat kitle
   • Homojen diffüz bez büyümesi
   • Parotis kuyruğunda yağlı lezyon
   Cevabı göster

   Tiroid içinde solid nodül. Tiroid içindeki solid odak ile servikal nodal hastalığın birlikte bulunması primer tiroid tümörünü destekler; kalsifikasyon tek başına tipe özgü değildir. Diğer seçenekler medüller primeri anatomik olarak göstermez.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 3 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. Thyroid computed tomography imaging: pictorial review of variable pathologiespmc.ncbi.nlm.nih.gov
2. Medullary thyroid carcinoma.pubmed.ncbi.nlm.nih.gov
3. Diagnostic tests for medullary thyroid carcinoma: an umbrella review.pubmed.ncbi.nlm.nih.gov
4. Medullary thyroid carcinoma.pubmed.ncbi.nlm.nih.gov
5. Diagnosis and preoperative imaging of multiple endocrine neoplasia type 2: current status and future directions.pubmed.ncbi.nlm.nih.gov
6. Novel PET tracers: added value for endocrine disorders.pubmed.ncbi.nlm.nih.gov
7. Medullary Thyroid Carcinoma: Imaging.pubmed.ncbi.nlm.nih.gov
8. Molecular imaging for neuroendocrine tumours.pubmed.ncbi.nlm.nih.gov
9. [Endocrine and neuroendocrine tumors].pubmed.ncbi.nlm.nih.gov
10. Radiolabeled gastrin/CCK analogs in tumor diagnosis: towards higher stability and improved tumor targeting.pubmed.ncbi.nlm.nih.gov
11. New PET Radiotracers for the Imaging of Neuroendocrine Neoplasms.pubmed.ncbi.nlm.nih.gov
12. Medullary thyroid carcinoma in children.pubmed.ncbi.nlm.nih.gov
13. [Imaging of medullary thyroid carcinoma].pubmed.ncbi.nlm.nih.gov
14. Optical diagnostic imaging and therapy for thyroid cancer.pubmed.ncbi.nlm.nih.gov
15. PET imaging for thyroid cancers: Current status and future directions.pubmed.ncbi.nlm.nih.gov
16. Management of ectopic Cushing syndrome in medullary thyroid carcinoma: from case reports to systematic literature review.pubmed.ncbi.nlm.nih.gov
17. Ectopic ACTH Production in Medullary Thyroid Carcinoma-A Study of Two Cases.pubmed.ncbi.nlm.nih.gov
18. Metastatic Medullary Thyroid Carcinoma Without Identifiable Primary Tumor Within the Thyroid Gland, Presenting with Initial Lymph Node Metastasis Followed by Distant Peritoneal Metastasis: A Case Report of a Rare Phenomenon.pubmed.ncbi.nlm.nih.gov
19. Primary synovial sarcoma of the thyroid mimicking medullary thyroid cancer.pubmed.ncbi.nlm.nih.gov
20. Thyroid metastasis from lung adenocarcinoma: diagnostic pitfalls and individualized management in a six-patient case series and literature review.pubmed.ncbi.nlm.nih.gov
21. Papillary thyroid carcinoma in a patient with long-standing chronic lymphocytic leukemia: A case report.pubmed.ncbi.nlm.nih.gov
22. Malignancy rate of cervical lymph nodes based on concordance of ultrasound and computed tomography imaging features in patients with thyroid cancer.pubmed.ncbi.nlm.nih.gov
23. Development and internal validation of a multivariable MRI-based radiomics prediction model for preoperative cervical lymph node metastasis in thyroid cancer.pubmed.ncbi.nlm.nih.gov
24. Clinical characteristics and prognosis of familial non-medullary thyroid carcinoma: a retrospective study of 98 families.pubmed.ncbi.nlm.nih.gov
25. Imaging Assessment and Management of Pediatric Thyroid Nodules: Emphasis on Application of 2021 K-TIRADS.pubmed.ncbi.nlm.nih.gov
26. Multiparametric Ultrasound Features of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma: A Single-Center Case Series.pubmed.ncbi.nlm.nih.gov
27. Phenotype-driven cascade screening in a Syrian family with clinically consistent multiple endocrine neoplasia type 2A.pubmed.ncbi.nlm.nih.gov
28. Optical coherence tomography for broad spectrum of thyroid carcinoma: a qualitative and quantitative analysis.pubmed.ncbi.nlm.nih.gov
29. Lymphadenopathy in Concurrent Head and Neck Malignancies.pubmed.ncbi.nlm.nih.gov
30. Suspected Thymoma as the Initial Presentation of Graves' Disease: A Report of a Rare Case and Comprehensive Literature Review.pubmed.ncbi.nlm.nih.gov
31. Case Report: Suspected Rupture of a Papillary Thyroid Tumor in a Patient With Graves' Disease Who Experienced Airway Narrowing Without Respiratory Distress.pubmed.ncbi.nlm.nih.gov
32. Approach to the Pediatric Patient With Thyroid Nodules.pubmed.ncbi.nlm.nih.gov
33. Unilateral Multifocal Follicular Thyroid Carcinoma with Vascular Invasion and Primary Hepatic Metastasis in a Dog: First Documented Case.pubmed.ncbi.nlm.nih.gov
34. Multimodality imaging localization of a giant functional parathyroid adenoma in a young fitness trainer with delayed recognition of hypercalcemia: A case report.pubmed.ncbi.nlm.nih.gov
35. Prostatic carcinoma with elevated carcinoembryonic antigen: a case report.pubmed.ncbi.nlm.nih.gov
36. Delphian lymph node metastasis as a marker of extensive nodal involvement in papillary thyroid cancer.pubmed.ncbi.nlm.nih.gov
37. Technical review by the Brazilian Society of Surgical Oncology and the Brazilian Society of Head and Neck Surgery on hierarchical coding in thyroid surgery.pubmed.ncbi.nlm.nih.gov
38. An ultrasonographic tumor location-based model for predicting central lymph node metastasis in unifocal papillary thyroid microcarcinoma.pubmed.ncbi.nlm.nih.gov
39. An uncommon site for papillary thyroid carcinoma metastasis: a case of breast involvement.pubmed.ncbi.nlm.nih.gov
40. Predictors of Distant Metastasis in Patients with Medullary Thyroid Carcinoma.pubmed.ncbi.nlm.nih.gov
41. A Challenging Diagnosis of Laryngeal Neuroendocrine Tumor (NET): Final Classification as NET Grade 3 After Total Laryngectomy.pubmed.ncbi.nlm.nih.gov
42. Case Report: a rare pediatric case series of multiple endocrine neoplasia type 2B presenting with laryngotracheal involvement.pubmed.ncbi.nlm.nih.gov
43. When Lymph Nodes Don't Lie: Report of Three Unusual Presentations of Thoracic Tumors.pubmed.ncbi.nlm.nih.gov
44. Long-Segment Malignant Tracheal Stenosis from Recurrent Medullary Thyroid Carcinoma Successfully Palliated with a Covered Self-Expanding Metallic Stent: A Case Report.pubmed.ncbi.nlm.nih.gov
45. APPLICATION OF ANTERIOR MINI-INCISION VERTEBROPLASTY IN CERVICAL METASTASES.pubmed.ncbi.nlm.nih.gov
46. Incidental Findings in Lung Cancer Screening.pubmed.ncbi.nlm.nih.gov
47. Ectopic calcitonin-secreting pulmonary neuroendocrine tumor mimicking medullary thyroid carcinoma.pubmed.ncbi.nlm.nih.gov
48. Risk factors for predicting lateral lymph node metastasis of papillary thyroid carcinoma based on LASSO-logistic regression.pubmed.ncbi.nlm.nih.gov
49. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer.pubmed.ncbi.nlm.nih.gov
50. Ultrasonography of the thyroid, parathyroids, and beyond.pubmed.ncbi.nlm.nih.gov
51. Development and performance evaluation of a risk assessment model for cervical lymph node metastasis in patients with Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma.pubmed.ncbi.nlm.nih.gov
52. Ultrasonographic Microcalcifications in Metastatic Lymph Nodes of Papillary Thyroid Carcinoma: A Sonopathological Study.pubmed.ncbi.nlm.nih.gov
53. Risk factors and predictive model for cervical lymph node metastasis in papillary thyroid carcinoma of the isthmus: a retrospective analysis of clinical and ultrasonographic features.pubmed.ncbi.nlm.nih.gov
54. Collision tumor of poorly differentiated thyroid carcinoma and intrathyroid thymic carcinoma arising in association with a branchial cleft-like cyst: a case report.pubmed.ncbi.nlm.nih.gov
55. Latin American Thyroid Society expert panel consensus on anaplastic thyroid cancer.pubmed.ncbi.nlm.nih.gov
56. The application of ultrasonography in the differential diagnosis of orbital lesions.pubmed.ncbi.nlm.nih.gov
57. Primary pulmonary mucosa-associated lymphoid tissue lymphoma presenting as a right hilar mass: A case report.pubmed.ncbi.nlm.nih.gov
58. Application of imaging studies for orbital tumors: a practical review and representative cases.pubmed.ncbi.nlm.nih.gov
59. Prevalence and predictors of malignancy in Bethesda III and IV thyroid nodules undergoing surgery.pubmed.ncbi.nlm.nih.gov
60. Diagnostic Performance of Ultrasonography Compared to Cross-Sectional Imaging in Thyroid-Related Nodal Metastasis: A Retrospective Cohort Study from Saudi Arabia.pubmed.ncbi.nlm.nih.gov
61. Metastases to the thyroid gland from uncommon primaries: a case series.pubmed.ncbi.nlm.nih.gov
62. Mediastinal lesions in children.pubmed.ncbi.nlm.nih.gov
63. Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance.pubmed.ncbi.nlm.nih.gov
64. Follicular-Patterned Lesions of the Thyroid Gland.pubmed.ncbi.nlm.nih.gov
65. Contrast-enhanced ultrasound time-intensity curve-assisted parametric imaging: a possible effective tool for differential diagnosis of thyroid nodules.pubmed.ncbi.nlm.nih.gov
66. Contrast-enhanced ultrasound thyroid imaging reporting and data system outperforms K-TIRADS in diagnostic accuracy and reduces unnecessary fine-needle aspirations for thyroid nodules.pubmed.ncbi.nlm.nih.gov
67. Malignant lymph nodes of the head and neck: imaging pearls, pitfalls, and practical approach to reporting in the era of extranodal extension.pubmed.ncbi.nlm.nih.gov
68. A Rare Collision Medullary and Papillary Thyroid Carcinoma in Autoimmune Thyroid Disease: Case Report.pubmed.ncbi.nlm.nih.gov
69. Endobronchial Ultrasonography Features in Tuberculous Mediastinal Lymphadenopathy.pubmed.ncbi.nlm.nih.gov
70. Utility of Sydney system for reporting the neck lymphadenopathy underwent real-time ultrasound guided fine-needle aspiration.pubmed.ncbi.nlm.nih.gov
71. Multimodality high-frequency ultrasound in the evaluation of cervical malignant lymphoma before biopsy.pubmed.ncbi.nlm.nih.gov
72. Case Report: Concomitant BRAF V600E and PIK3CA H1047R mutations in a micro-papillary thyroid carcinoma with extensive nodal metastasis.pubmed.ncbi.nlm.nih.gov
73. Cribriform Morular Thyroid Carcinoma: Unreported Cytological Features With Histologic Correlation and Diagnostic Lessons From a Case Lacking Morules.pubmed.ncbi.nlm.nih.gov
74. Double Parathyroid Carcinoma Associated With CDC73 Mutation: A Rare Case.pubmed.ncbi.nlm.nih.gov
75. Review of imaging modalities and radiological findings of calvarial lesions.pubmed.ncbi.nlm.nih.gov
76. A diagnostic approach to mediastinal masses in clinical practice.pubmed.ncbi.nlm.nih.gov
77. The comparative diagnostic and therapeutic application value of FAPI PET/CT and ¹⁸F-FDG PET/CT in oncology.pubmed.ncbi.nlm.nih.gov
78. Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report.pubmed.ncbi.nlm.nih.gov
79. Management of the Neck in Well-Differentiated Thyroid Cancer.pubmed.ncbi.nlm.nih.gov
80. The 2024 revised clinical guidelines on the management of thyroid tumors by the Japan Association of Endocrine Surgery.pubmed.ncbi.nlm.nih.gov
81. Neoplastic pathology at the crossroads between neck imaging and cardiothoracic imaging.pubmed.ncbi.nlm.nih.gov
82. Thyroid computed tomography imaging: pictorial review of variable pathologies.pubmed.ncbi.nlm.nih.gov
83. Giant thyroid metastasis originating from renal carcinoma: a case report.pubmed.ncbi.nlm.nih.gov
84. A radiologic review of hoarse voice from anatomic and neurologic perspectives.pubmed.ncbi.nlm.nih.gov
85. Calcified liver metastases from medullary thyroid carcinoma in a Multiple Endocrine Neoplasia Type 2A patient.pubmed.ncbi.nlm.nih.gov
86. Risk factors associated with lymph node metastasis in cN0 papillary thyroid microcarcinoma.pubmed.ncbi.nlm.nih.gov
87. Genomics and Multi-Omics to Guide Clinical Management in Thyroid Cancer.pubmed.ncbi.nlm.nih.gov
88. Core needle biopsy as a first-line diagnostic tool for selected thyroid nodules: a real-world evaluation of diagnostic performance and safety.pubmed.ncbi.nlm.nih.gov
89. Molecular, Biochemical, and Bioimaging Markers of MEN Syndromes.pubmed.ncbi.nlm.nih.gov
90. Diagnostic Accuracy of Calcitonin, Procalcitonin, proGRP, miR-375 and FNA-Washout Calcitonin for Medullary Thyroid Carcinoma: A Systematic Review and Diagnostic Meta-Analysis.pubmed.ncbi.nlm.nih.gov
91. Asymptomatic Medullary Thyroid Carcinoma With Isolated Carcinoembryonic Antigen Elevation in a Patient With Chronic Kidney Disease: A Case Report.pubmed.ncbi.nlm.nih.gov
92. C-Cell Lesions and Medullary Thyroid Carcinoma: A Review.pubmed.ncbi.nlm.nih.gov
93. Diagnostic accuracy of computed tomography alone versus computed tomography combined with ultrasound for diagnosing lymph node metastasis in thyroid cancer.pubmed.ncbi.nlm.nih.gov
94. How to manage medullary thyroid carcinoma: current treatment strategies.pubmed.ncbi.nlm.nih.gov
95. Case report and literature review: a case of rare papillary thyroid carcinoma combined with paraganglioma.pubmed.ncbi.nlm.nih.gov
96. Clinical and pathological profile with prognostic insights in 9504 thyroid cancer cases: a single-center study (2008-2023).pubmed.ncbi.nlm.nih.gov
97. Case Report: Unexpected long-term survival in metastatic anaplastic thyroid carcinoma through multidisciplinary management.pubmed.ncbi.nlm.nih.gov
98. Comparison of ⁶⁸Ga-FAPI and ¹⁸F-DOPA PET/CT in patients with medullary thyroid cancer.pubmed.ncbi.nlm.nih.gov

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