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    discussion 15

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    A 40-year-old woman has enlargement of the anterior neck region. Fine needle aspiration of the thyroid yields cells that are consistent with a neoplasm. A chest radiograph is normal. She is euthyroid, but her serum ionized calcium is elevated, and she has a blood pressure of 155/105 mm/Hg. She is taken to surgery, and a thyroidectomy is performed, after frozen sections of several thyroid masses show a malignant neoplasm composed of polygonal cells in nests. Immunoperoxidase staining for calcitonin of the permanent sections is positive, and the neoplasm has an amyloid stroma with Congo red staining. which disease?

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    Medullary Ca

    Medullary Carcinoma ,look for other MEN -II members .Check other family members for mutation in RET oncogene

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    my guess

    I agree, this sounds like MEN

    ref: kaplan path by goljan pg 187

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    but

    But what is cause of raised ionized Ca??

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    re

    Both of you are almost there, please read your notes and the question again, and give more specific answer. (which type of MEN?)

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    yes

    MEN II a

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    re

    Great, you got it.

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    my guess

    I'm not sure, but I'd say MEN IIa because of the increased serum Ca (hyperparathyroidism), increased bp (pheochromocytoma). Add the meduallary carcinoma that's described and you have the triad for MEN IIa of
    1. medullary carcinoma
    2. primary hyperparathyroidism
    3. pheochromocytoma

    MEN IIb, on the other hand, would have mucosal neuromas involving lips and tongue.


    ref: kaplan path by goljan pg 187

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    re

    Great summary, step 1. So nice to study with you.

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