Case report of a medullary carcinoma of the thyroid with small-cell carcinoma-like features.

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Background: Medullary carcinomas of the thyroid are comparatively rare. We report a case in which medullary carcinoma cells of the thyroid were difficult to cytologically distinguish from metastatic small-cell carcinoma cells. Case: An 85-year-old woman was admitted to our hospital complaining of a swollen lymph node. She had a history of an excision of the right thyroid gland 50 years previously. A laboratory examination revealed a serum carcinoembryonic antigen (CEA) level of 644 ng/ml. Fine needle aspiration cytology and a needle biopsy were performed, and the tumor was suspected to be a metastatic small-cell carcinoma of the cervical lymph node. No primary tumor was found during a whole-body examination, and the tumor was resected. Cytologically, the tumor cells were loosely attached to each other; the nuclei were round and coarse, with scant cytoplasm visible in the cells. Calcitonin, chromogranin A and CEA were positive immunohistochemically, and the tumor was diagnosed as a medullary carcinoma of the thyroid. Conclusion: The possible resemblance of tumor cells from medullary carcinomas of the thyroid and small-cell lung cancer should be considered in cytological differential diagnoses of small-cell tumors in the neck.
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