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selpercatinib. Introduction Serum tumour markers are important tools in the management of patients with medullary thyroid carcinoma (MTC) ( 1 ). Serum calcitonin (CT) and carcinoembryonic antigen (CEA) are produced by neoplastic C-cells, and their
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a unique case of a 58-year-old woman with a large MTC, basal Ctn levels in excess of 5,000 pg/mL, and paraneoplastic diarrhea, but normal carcinoembryonic antigen (CEA) levels, and no lymph node involvement or distant metastases. The patient
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elevated serum calcitonin (Ct) or carcinoembryonic antigen (CEA) levels. In fact, serum markers remain detectable after initial treatment in a significant percentage of patients, and more frequently in those with large thyroid tumors, tumor extension beyond
Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
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-oncogene. Laboratory tests revealed a basal calcitonin level of 3,786 ng/L and carcinoembryonic antigen (CEA) level of 286.8 ng/mL. Parathyroid hormone, serum calcium, and 24-hour urinary catecholamines were within the normal range. Computed tomography (CT) of the neck
Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
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Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
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Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
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monitored after for serum levels of calcitonin and carcinoembryonic antigen (CEA) usually twice or three times a year. After 2015, CA19-9 serum levels were also routinely measured in these patients and were collected usually at each semester. Imaging tests
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The endocrine secretions of carcinomas can be life-threatening. Medullary thyroid carcinoma (MTC) is a rare cancer that is often associated with cortisol secretion, leading to paraneoplastic Cushing’s syndrome. Mutations of the proto-oncogene RET are driver molecular events in 70% of MTC cases. Here, we report a case of a woman, born in 1956, who was diagnosed with sporadic MTC in 2005, with subsequent relapses treated with focal treatments. In April 2019, she presented with severe and rapidly progressive paraneoplastic Cushing’s syndrome associated with lymph node, lung, liver and bone metastases. A supraclavicular lymph node biopsy revealed a somatic p.M918T (c.2753T>C) mutation in exon 16 of the RET proto-oncogene. The patient began treatment with selpercatinib in September 2019. Clinical efficacy was immediate. Chronic diarrhea disappeared within a few days. Clinical hypercorticism quickly disappeared, with quick improvements in muscle and skin conditions and fatigue. Two months after treatment initiation, urinary free cortisol normalized to 42 µg/24 h. Levels of the tumor markers carcinoembryonic antigen (CEA) and calcitonin also greatly decreased from baseline. After 34 months of treatment, selpercatinib elicits sustained clinical, biological and morphological responses. In summary, this case report illustrates the rapid and long-lasting antisecretory effect of selpercatinib associated with tumor control. As Cushing’s syndrome associated with medullary thyroid cancer is associated with poor prognosis, this case report is very encouraging. In addition, this suggests the potential benefit of molecular testing in all cases of medullary thyroid cancer.
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necessary if there is lateral lymph node compartment involvement ( 2 ). MTC follow-up is then based on a periodical neck ultrasound (US) and biochemical follow-up, based primarily on calcitonin (Ct) and carcinoembryonic antigen (CEA) measurement. Ct is
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years and 10 months, serum calcitonin was demonstrated to be slightly elevated (18.9 ng/L, normal range 0.0–13.0 ng/L). Carcinoembryonic antigen was normal (2.0 ng/mL, normal < 5.5 ng/mL), and serum calcium was normal as well, approaching a level of 10
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. ( 16 ). Serum tumoral markers of metastatic MTC are both calcitonin (CTN) and carcinoembryonic antigen (CEA). Their levels correlate with the tumor burden, and their doubling time is associated with the outcome of the disease ( 17 ). In this article
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/inflammatory disease were described in this CT scan. CTN and carcinoembryonic antigen (CEA) values were 4280 ng/L and 40 µg/L, respectively. The patient started systemic treatment with selpercatinib in April 2021 at the initial dose of 160 mg/BID. CTN and CEA values
