Introduction: The collision of medullary (MTC) and papillary thyroid carcinoma (PTC) in the same cervical lymph node can occur, but its growth kinetics has not been reported. Case Presentation: We report a 27-year-old male patient who had collision nodal metastases from PTC and sporadic MTC in the central compartment. This was treated with total thyroidectomy and central neck dissection. The collision nodal metastasis persisted and presented with a single sonographically enlarging central compartmental lymph node postoperatively. The volume of the collision nodal metastasis increased from 226 to 507 mm³ over the first 8 months, from 507 to 572 mm³ over the next 6 months, and from 572 to 762 mm³ over the next 31 months. The calcitonin and carcinoembryonic antigen (CEA) fluctuated in the first 19 months followed by a steady increase at a doubling time of 1.97 and 8.42 years, respectively. Unstimulated thyroglobulin remained at 0.2 ng/mL or lower during the same period while thyrotropin (TSH) was not suppressed. Revision central neck dissection performed 4.5 years later resulted in undetectable serum calcitonin, CEA of 2 ng/mL, and thyroglobulin of 0.1 ng/mL from a preoperative calcitonin of 212 ng/L, CEA of 10 ng/mL, and thyroglobulin of 0.2 ng/mL. Further structural imaging 13.5 months later revealed no evidence of disease. Discussion: The growth kinetics of collision nodal metastasis from PTC and MTC can be similar to conventional PTC and MTC. Furthermore, the growth rate of such collision nodal metastases can be slow. Guided by tumor marker doubling time and regular structural imaging, surgical salvage performed after a period of active surveillance may still result in biochemical and structural remission.
Eur Thyroid J

中文翻译：

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甲状腺髓样癌和乳头状癌碰撞淋巴结转移的生长动力学：病例报告

引言：髓质（MTC）和甲状腺乳头状癌（PTC）在同一颈部淋巴结内可发生碰撞，但其生长动力学尚未见报道。病例介绍：我们报告了一名 27 岁的男性患者，他有 PTC 的碰撞淋巴结转移和中央隔室中散发的 MTC。采用全甲状腺切除术和中央颈清扫术治疗。碰撞淋巴结转移持续存在，术后表现为单个超声增大的中央区室淋巴结。碰撞淋巴结转移的体积在前 8 个月从 226 增加到 507 mm ³，在接下来的 6 个月从 507 增加到 572 mm ^{3 ，从 572 增加到 762 mm 3}在接下来的 31 个月内。降钙素和癌胚抗原 (CEA) 在前 19 个月波动，随后分别以 1.97 年和 8.42 年的倍增时间稳步上升。在同一时期，未刺激的甲状腺球蛋白保持在 0.2 ng/mL 或更低，而促甲状腺激素 (TSH) 没有受到抑制。4.5 年后进行的翻修中央颈清扫术导致血清降钙素检测不到，CEA 为 2 ng/mL，甲状腺球蛋白为 0.1 ng/mL，而术前降钙素为 212 ng/L，CEA 为 10 ng/mL，甲状腺球蛋白为 0.2 ng /毫升。13.5 个月后进一步的结构成像显示没有疾病证据。讨论：来自 PTC 和 MTC 的碰撞淋巴结转移的生长动力学可以类似于传统的 PTC 和 MTC。此外，这种碰撞淋巴结转移的生长速度可能很慢。在肿瘤标志物倍增时间和定期结构成像的指导下，经过一段时间的主动监测后进行的手术抢救仍可能导致生化和结构缓解。
欧洲甲状腺杂志