Two Cases of Mixed Medullary and Follicular Cell Carcinoma with Literature Review

ENT Updates

Case Report

Two Cases of Mixed Medullary and Follicular Cell Carcinoma with Literature Review

Downloads

https://doi.org/10.54963/entu.v16i1.1892
Guo, Y., Qin, Z., Qiu, J., Xu, Z., Shen, B., & Zhang, W. (2026). Two Cases of Mixed Medullary and Follicular Cell Carcinoma with Literature Review. ENT Updates, 16(1), 19–25. https://doi.org/10.54963/entu.v16i1.1892
Volume 16 Issue 1 (2026): In Progress
Copyright (c) 2026 Yekun Guo, Zuorong Qin, Jie Qiu, Zhenju Xu, Bingying Shen, Wenwei Zhang
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors

  • Yekun Guo

    Department of Otolaryngology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Zuorong Qin

    Department of Otolaryngology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Jie Qiu

    Department of Otolaryngology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Zhenju Xu

    Department of Otolaryngology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Bingying Shen

    Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Wenwei Zhang

    Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China

Received: 20 November 2025; Revised: 25 December 2025; Accepted: 20 January 2026; Published: 3 February 2026

Mixed Medullary and Follicular Cell Carcinoma (MMFCC) is a rare thyroid cancer combining medullary and follicular (often papillary) elements. The lack of standard clinical signs and imaging characteristics makes it difficult to diagnose before surgery. At present, the main approach to treatment is surgical removal, and the outlook for patients is primarily influenced by how advanced the medullary carcinoma is. We report two cases of MMFCC confirmed by postoperative pathology. Case 1 involved a 46-year-old woman with bilateral thyroid nodules and left cervical lymph node metastasis. Preoperative ultrasound classified the nodules as TI-RADS 4c, and fine-needle aspiration cytology suggested papillary thyroid carcinoma. Total thyroidectomy with bilateral neck lymph node dissection was performed. Postoperative pathology revealed MMFCC, with a medullary component accounting for approximately 95% and extensive lymph node metastasis. Six weeks postoperatively, serum calcitonin was 73.00 pg/mL. Case 2 involved a 54-year-old man presenting with neck pain. Ultrasound showed a hypoechoic left thyroid nodule (TI-RADS 4b) with bilateral cervical lymphadenopathy. Fine-needle aspiration suggested medullary thyroid carcinoma, and serum calcitonin and carcinoembryonic antigen levels were markedly elevated. Following total thyroidectomy with bilateral neck lymph node dissection, pathology confirmed MMFCC with an approximately 80% medullary component. Postoperative tumor markers decreased significantly, and long-term follow-up was initiated. MMFCC is a rare thyroid carcinoma with considerable diagnostic difficulty. Fine-needle aspiration alone may be insufficient for accurate diagnosis, whereas preoperative serum calcitonin testing provides important diagnostic clues. Total thyroidectomy with systematic lymph node dissection is advised, plus long-term monitoring per both carcinoma guidelines.

Keywords:

Mixed Medullary and Follicular Cell Carcinoma Thyroid Mixed Tumor

References

  1. Evman, M.D.; Erdogan, B.A. Relationship between Carotid Body Tumor and Thyroid Papillary Cancer. ENT Updat. 2025, 15, 56–61.
  2. Appetecchia, M.; Lauretta, R.; Barnabei, A.; et al. Epidemiology of Simultaneous Medullary and Papillary Thyroid Carcinomas (MTC/PTC): An Italian Multicenter Study. Cancers 2019, 11, 1516.
  3. Haugen, B.R.; Alexander, E.K.; Bible, K.C.; et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016, 26, 1–133.
  4. Gild, M.L.; Clifton-Bligh, R.J.; Wirth, L.J.; et al. Medullary Thyroid Cancer: Updates and Challenges. Endocr. Rev. 2023, 44, 934–946.
  5. Jung, C.K.; Bychkov, A.; Kakudo, K. Update from the 2022 World Health Organization Classification of Thyroid Tumors: A Standardized Diagnostic Approach. Endocrinol. Metab. 2022, 37, 703–718.
  6. Ceolin, L.; da Silveira Duval, M.A.; Benini, A.F.; et al. Medullary thyroid carcinoma beyond surgery: advances, challenges, and perspectives. Endocr. Relat. Cancer 2019, 26, R499–R518.
  7. Staniforth, J.U.L.; Erdirimanne, S.; Eslick, G.D. Thyroid Carcinoma in Graves’ Disease: A Meta-Analysis. Int. J. Surg. 2016, 27, 118–125.
  8. Kadoya, M.; Suganuma, N.; Matsubara, Y.; et al. Selpercatinib for Treating Recurrent Mixed Medullary and Follicular Cell-Derived Thyroid Carcinoma: A Case Report. Surg. Case Rep. 2024, 10, 92.
  9. Zhang, D.; Yang, M.; Zhang, X.; et al. Thirty Synchronous Medullary and Papillary Thyroid Carcinomas. Front. Endocrinol. 2023, 14, 1153248.
  10. Kakitani Toyoshima, M.T.; Domingues, R.B.; Soares, I.C.; et al. Thyroid collision tumor containing oncocytic carcinoma, classical and hobnail variants of papillary carcinoma and areas of poorly differentiated carcinoma. Arch. Endocrinol. Metab. 2021, 65, 495–499.
  11. Ryan, N.; Walkden, G.; Lazic, D.; et al. Collision Tumors of the Thyroid: A Case Report and Review of the Literature. Head Neck 2015, 37, E125–E129.
  12. Feng, J.-W.; Ye, J.; Hu, J.; et al. Synchronous Papillary Thyroid Carcinoma and Follicular Thyroid Carcinoma: Case Report and Review of Literature. Int. J. Clin. Exp. Pathol. 2020, 13, 2767–2771.
  13. Chambers, M.; Tafe, L.J.; Gutmann, E.J.; et al. Cytologic Features of a Case of Mixed Medullary and Follicular Cell-Derived Thyroid Carcinoma with Review of the Literature. Diagn. Cytopathol. 2021, 49, E125–E129.
  14. Shahi, S.; Bhandari, T.R.; Pantha, T.; et al. A Rare Coexistence of Papillary Carcinoma and Anaplastic Carcinoma of Thyroid in Multinodular Goitre: Case Report and Literature Review. Ann. Med. Surg. 2020, 56, 161–164.
  15. Hanna, A.N.; Michael, C.W.; Jing, X. Mixed Medullary-Follicular Carcinoma of the Thyroid: Diagnostic Dilemmas in Fine-Needle Aspiration Cytology. Diagn. Cytopathol. 2011, 39, 862–865.
  16. Jain, M.; Verma, D.; Thomas, S.; et al. Mixed medullary–papillary carcinoma thyroid: An uncommon variant of thyroid carcinoma. J. Lab. Physicians 2014, 6, 133–135.
  17. Koh, H.H.; Oh, Y.L. Papillary and medullary thyroid carcinomas coexisting in the same lobe, first suspected based on fine-needle aspiration cytology: a case report. J. Pathol. Transl. Med. 2022, 56, 301–308.
  18. Subramanian, N.; Agarwal, S.K.; Agarwal, A.; et al. Rare Mixed Thyroid Carcinomas: A Report of Two Cases. Iran. J. Otorhinolaryngol. 2022, 34, 55–57.
  19. Duymaz, Y.K.; Erkmen, B.; Şahin, Ş.; et al. Impact of Drain Usage on Postoperative Outcomes in Thyroidectomy Patients: Pain Intensity and Hospital Stay Duration. ENT Updat. 2023, 13, 61–64.
  20. Fallahi, P.; Patrizio, A.; Stoppini, G.; et al. Simultaneous Occurrence of Medullary Thyroid Carcinoma and Papillary Thyroid Carcinoma: A Case Series with Literature Review. Curr. Oncol. 2023, 30, 10237–10248.
  21. Jiménez, C.; Hu, M.I.-N.; Gagel, R.F. Management of Medullary Thyroid Cancer. Endocrinol. Metab. Clin. North Am. 2008, 37, 481–496.
  22. Filetti, S.; Durante, C.; Hartl, D.; et al. Thyroid Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Ann. Oncol. 2019, 30, 1856–1883.
  23. Nordhausen, K.; Deutschbein, T.; Heinrichs, V.; et al. The Co-Occurrence of Medullary and Papillary Thyroid Carcinoma—A Literature Review Based on a Case Report. Case Rep. Endocrinol. 2024, 2024, 2393186.
  24. Wells Jr, S.A.; Asa, S.L.; Dralle, H.; et al. Revised American thyroid association guidelines for the management of medullary thyroid carcinoma: The American thyroid association guidelines task force on medullary thyroid carcinoma. Thyroid 2015, 25, 567–610.
  25. Haddad, R.I.; Bischoff, L.; Ball, D.; et al. Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Canc. Netw. 2022, 20, 925–951.
  26. Sierra Castillo, S.; Henao Rincón, M.A.; Aristizabal Colorado, D.; et al. Coexisting Medullary and Papillary Thyroid Carcinomas: A Case of Dual Neoplasia With a High Risk of Misdiagnosis. Cureus 2024, 16, e71581.
  27. American Thyroid Association Guidelines Task Force; Kloos, R.T.; Eng, C.; et al. Medullary Thyroid Cancer: Management Guidelines of the American Thyroid Association. Thyroid 2009, 19, 565–612.