A peripheral (gingival) fibroma, a gingival cyst and hyperplastic gingivitis occurred simultaneously in a man with metastatic medullary thyroid carcinoma (MCT). The gingival growths and hyperplasia appeared to be related to poor oral hygiene rather than to the MTC. Despite the patient's improved oral hygiene, the hyperplastic gingivitis and peripheral fibroma recurred, and a new peripheral fibroma and gingival cyst developed, which prompted reconsideration of a link with the MTC. MTC cells secrete calcitonin (CT), procalcitonin (ProCT) and growth factors; the patient's serum CT and ProCT were several fold higher than normal. The patient's salivary CT and ProCT also were elevated, but α-amylase and epidermal growth factor (EGF) were not, compared to three healthy controls. A possible link between the MTC and gingival hyper-reactivity due to CT and/or ProCT promoting inflammatory cytokines, and the utility of salivary ProCT as an indicator of periodontitis in this patient were explored further. Unstimulated whole saliva and serum were collected from the patient followed by a standard periodontal examination before periodontal treatment, and 3 weeks and 3 months after treatment. This cycle was repeated 7 months after the previous periodontal treatment. The saliva was assayed for ProCT and the serum was assayed for ProCT, high sensitivity C-reactive protein (CRP), interleukin-6 (IL-6) and proadrenomedullin (ProADM). The results were analyzed for correlations among the severity of periodontitis and the biomarkers/cytokines. Only the salivary ProCT was correlated with the severity of periodontitis, i.e. it was higher just before and lower at 3 weeks and 3 months after each periodontal treatment. The patient's salivary ProCT content also was much higher than reported elsewhere. The other biomarkers/cytokines were within normal ranges. Our findings indicate that salivary ProCT is independent of serum ProCT and therefore may be a useful marker for moderate to severe periodontitis in patients with MTC. The greatly elevated salivary and serum CT and ProCT, and a trend toward correlation between the serum CRP and ProCT suggest a pro-inflammatory link between the MTC and the hyperreactive gingiva in this patient. Further studies are warranted to determine whether hyperplastic gingivitis and gingival growths, such as cysts and fibromas, occur with unusual frequency in patients with MTC.

中文翻译：

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一名患有转移性甲状腺髓样癌和高反应性牙龈的男性的唾液和血清炎症生物标志物：十四年的旅程。

一名患有转移性甲状腺髓样癌（MCT）的男子同时发生周围性（牙龈）纤维瘤，牙龈囊肿和增生性牙龈炎。牙龈的生长和增生似乎与不良的口腔卫生有关，而不是与MTC有关。尽管患者的口腔卫生有所改善，增生性牙龈炎和周围纤维瘤仍会复发，并且出现了新的周围纤维瘤和牙龈囊肿，这促使人们重新考虑与MTC的联系。MTC细胞分泌降钙素（CT），降钙素（ProCT）和生长因子；患者的血清CT和ProCT比正常人高出几倍。与三个健康对照组相比，患者的唾液CT和ProCT也升高，但α-淀粉酶和表皮生长因子（EGF）并未升高。进一步探讨了由于CT和/或ProCT促进炎症细胞因子而引起的MTC与牙龈反应过度之间的可能联系，以及唾液ProCT作为该患者牙周炎指标的用途。从患者收集未刺激的全唾液和血清，然后在牙周治疗之前以及治疗后3周和3个月进行标准的牙周检查。在之前的牙周治疗之后的7个月，重复此周期。检测唾液中的ProCT，血清中的ProCT，高敏C反应蛋白（CRP），白介素6（IL-6）和肾上腺髓质素（ProADM）。分析了牙周炎严重程度与生物标志物/细胞因子之间的相关性。仅唾液中的ProCT与牙周炎的严重程度相关，即 每次牙周治疗前3周和3个月时，该值较高，而在3周和3个月后较低。患者唾液中的ProCT含量也远高于其他地方报道的水平。其他生物标志物/细胞因子在正常范围内。我们的发现表明，唾液中的ProCT独立于血清ProCT，因此可能是MTC患者中重度牙周炎的有用标志物。唾液和血清CT和ProCT的大大升高，以及血清CRP和ProCT之间趋于相关的趋势表明，该患者的MTC和高反应性牙龈之间存在促炎联系。有必要进行进一步的研究来确定MTC患者是否以异常频率发生增生性牙龈炎和牙龈生长，例如囊肿和纤维瘤。