MEN 2 Syndrome (26) Flashcards
What is the single best test to diagnose cancer?
Fine needle aspiration cytology (FNAC)
Medullary thyroid cancer cell source?
Parafollicular C cells
FNAC report:
- Malignant cell features
- Amyloid deposits
- Calcitonin positive on immunohistochemistry (IHC)
- Thyroxine negative on IHC
Why is it medullary thyroid cancer?
- Amyloid deposits
- Calcitonin positive on IHC
FNAC report:
- Malignant cell features
- Amyloid deposits
- Calcitonin positive on immunohistochemistry (IHC)
- Thyroxine negative on IHC
What type of cancer is it?
Medullary thyroid cancer
How does IHC work?
- Antibodies linked to an enzyme or a fluorescent dye bind to the antigen in the tissue sample
- The enzyme or dye is activated
- The antigen can then be seen under a microscope
TNM Classification for thyroid cancer
- Tx Primary cannot be assessed
- T0 No evidence of primary
- T1 Limited to thyroid, 1 cm or less
- T2 Limited to thyroid > 1 cm but < 4 cm
- T3 Limited to thyroid > 4 cm
- T4 Extending beyond capsule, any size
- Nodes
- Nx Cannot be assessed
- N0 No regional lymph node metastases
- N1 Regional node metastases
- M status
- Mx Cannot be assessed
- M0 No metastases
- M1 Metastases present
What is immunohistochemistry
A method of localizing specific antigens in tissues or cells based on antigen-antibody recognition
What is the type of Ag-Ab reaction in IHC?
Complement fixation
Staging for thyroid cancer
What is the treatment for medullary thyroid cancer?
Total thyroidectomy with block neck dissection
How can you diagnose pheochromocytoma?
Plasma:
- Free metanephrine
- Catecholamines
- Catecholamines stimulation test
Urine:
- Fractionated metanephrine
- Total metanephrine
- Catecholamines
- VMA
Imaging:
- Ultrasound
- CT
- MRI
- MIBG scintigraphy
- PET/CT
If this condition was familial, what other condition do you suspect in patient with pheochromocytoma and medullary thyroid cancer?
Parathyroid hyperplasia (MEN 2A)
or
Mucosal neuromas (MEN 2B)
Types of MEN syndromes? Oncogene mutation? Mode of inheritance?
MEN 1: MENIN gene (chromosome 11)
MEN 2A: Mutations in the RET proto-oncogene
MEN 2B: Mutations in the RET proto-oncogene
MEN 1, 2A & 2B all autosomal dominant
