Document Detail

Medullary carcinoma of the thyroid as a cause of Cushing's syndrome: a case with ectopic adrenocorticotropin secretion characterized by double enzyme immunostaining.
MedLine Citation:
PMID:  1568756     Owner:  NLM     Status:  MEDLINE    
A case of a medullary carcinoma of the thyroid gland that secreted both calcitonin and adrenocorticotropin (ACTH) is reported. The patient was a 32-year-old man who was referred to the Clinical Center of the National Institutes of Health with radiologic evidence of intrathoracic and hepatic masses accompanied by florid Cushing's syndrome. Serum levels of calcitonin and ACTH were elevated. The thoracic and hepatic masses were resected. The histologic findings were typical of medullary carcinoma of the thyroid with extensive metastases to the liver. The neoplasm had a predominantly solid pattern, and the neoplastic cells were either round or spindled, many with cytologic atypia. Immunohistochemical analysis of fixed, paraffin-embedded sections demonstrated chromogranin, calcitonin, and ACTH in the neoplastic cells. The immunostaining for chromogranin was intense in all of the cells, whereas weaker staining for calcitonin and ACTH was present in scattered cells. Electron microscopy revealed sparse secretory granules in the majority of tumor cells; a minority of neoplastic cells contained numerous granules. We further characterized this neoplasm by performing dual immunohistochemical analysis. This technique clearly demonstrated the presence of ACTH and calcitonin within the same neoplastic cells. Thus, the medullary carcinoma of the thyroid in this patient was the source of ectopic ACTH secretion causing Cushing's syndrome. In addition, this report highlights the value of using double immunostaining to localize both the ACTH and calcitonin within the same cells.
Y M Hijazi; L K Nieman; L J Medeiros
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Human pathology     Volume:  23     ISSN:  0046-8177     ISO Abbreviation:  Hum. Pathol.     Publication Date:  1992 May 
Date Detail:
Created Date:  1992-05-28     Completed Date:  1992-05-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9421547     Medline TA:  Hum Pathol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  592-6     Citation Subset:  IM    
Surgical Pathology Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
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MeSH Terms
ACTH Syndrome, Ectopic / complications*
Calcitonin / secretion
Carcinoma / complications*,  pathology,  secretion
Cushing Syndrome / etiology*
Immunoenzyme Techniques
Microscopy, Electron
Thyroid Neoplasms / complications*,  pathology,  secretion
Reg. No./Substance:

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