{"id":5982,"date":"2023-03-17T08:42:45","date_gmt":"2023-03-17T08:42:45","guid":{"rendered":"https:\/\/www.eurocytology.eu\/course\/carcinoma-medular\/"},"modified":"2023-04-26T09:26:24","modified_gmt":"2023-04-26T09:26:24","slug":"carcinoma-medular","status":"publish","type":"course","link":"https:\/\/www.eurocytology.eu\/es\/course\/citologia-de-tiroides\/tumores-malignos\/carcinoma-medular\/","title":{"rendered":"Carcinoma medular"},"content":{"rendered":"<div data-object_id=\"5982\" class=\"cbxwpbkmarkwrap cbxwpbkmarkwrap_guest cbxwpbkmarkwrap_user_cat cbxwpbkmarkwrap-course \"><a  data-redirect-url=\"https:\/\/www.eurocytology.eu\/es\/wp-json\/wp\/v2\/course\/5982\/\"  data-display-label=\"1\" data-show-count=\"1\" data-bookmark-label=\"Bookmark\"  data-bookmarked-label=\"Bookmarked\"  data-loggedin=\"0\" data-type=\"course\" data-object_id=\"5982\" class=\"cbxwpbkmarktrig  cbxwpbkmarktrig-button-addto\" title=\"Bookmark This\" href=\"#\"><span class=\"cbxwpbkmarktrig-label\" >Bookmark (<i class=\"cbxwpbkmarktrig-count\">0<\/i>)<\/span><\/a> <div  data-type=\"course\" data-object_id=\"5982\" class=\"cbxwpbkmarkguestwrap\" id=\"cbxwpbkmarkguestwrap-5982\"><div class=\"cbxwpbkmarkguest-message\"><a href=\"#\" class=\"cbxwpbkmarkguesttrig_close\"><\/a><h3 class=\"cbxwpbookmark-title cbxwpbookmark-title-login\">Please login to bookmark<\/h3><form name=\"loginform\" id=\"loginform\" action=\"https:\/\/www.eurocytology.eu\/wp-login.php\" method=\"post\"><p class=\"login-username\">\n\t\t\t\t<label for=\"user_login\">Nombre de usuario o correo electr\u00f3nico<\/label>\n\t\t\t\t<input type=\"text\" name=\"log\" id=\"user_login\" autocomplete=\"username\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-password\">\n\t\t\t\t<label for=\"user_pass\">Contrase\u00f1a<\/label>\n\t\t\t\t<input type=\"password\" name=\"pwd\" id=\"user_pass\" autocomplete=\"current-password\" spellcheck=\"false\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-remember\"><label><input name=\"rememberme\" type=\"checkbox\" id=\"rememberme\" value=\"forever\" \/> Recu\u00e9rdame<\/label><\/p><p class=\"login-submit\">\n\t\t\t\t<input type=\"submit\" name=\"wp-submit\" id=\"wp-submit\" class=\"button button-primary\" value=\"Acceder\" \/>\n\t\t\t\t<input type=\"hidden\" name=\"redirect_to\" value=\"https:\/\/www.eurocytology.eu\/es\/wp-json\/wp\/v2\/course\/5982\/\" \/>\n\t\t\t<\/p><\/form><p class=\"cbxwpbookmark-guest-register\">No account yet? <a href=\"https:\/\/www.eurocytology.eu\/es\/register\/?redirect_to=https%3A%2F%2Fwww.eurocytology.eu%2Fes%2Fwp-json%2Fwp%2Fv2%2Fcourse%2F5982%2F\">Register<\/a><\/p><\/div><\/div><\/div><p align=\"justify\">El carcinoma medular (CMT) representa cerca del 5% de los c\u00e1nceres de tiroides. A diferencia de los otros carcinomas que se originan de las c\u00e9lulas foliculares, el carcinoma medular se origina de las c\u00e9lulas parafoliculares (c\u00e9lulas C) de la tiroides, que sintetiza calcitonina. Cerca del 80% a 90% son espor\u00e1dicos y ocurren en adultos, el resto ocurre en ni\u00f1os con s\u00edndromes gen\u00e9ticos llamados neoplasia endocrina m\u00faltiple (NEM). Los pacientes con NEM 2\u00aa (S\u00edndrome de Sipple) desarrollan esta neoplasia junto con feocromocitoma y algunas veces con la hiperplasia o el adenoma de la paratiroides. Los pacientes con NEM 2b (S\u00edndrome mucoso-neuroma) tienen carcinoma medular, feocromocitoma, m\u00faltiples neuromas mucosos y habitus marfanoide. Cerca del 90% de estos tumores secreta calcitonina y el plasma de los pacientes puede ser usado para screening.<\/p>\n<h3>Caracter\u00edsticas citol\u00f3gicas diagn\u00f3sticas<\/h3>\n<ul>\n<li>Predominio de c\u00e9lulas aisladas<\/li>\n<li>Grupos sueltos, trab\u00e9culas, rosetas<\/li>\n<li>C\u00e9lulas plasmacitoides, epitelioides y\/o en forma de huso<\/li>\n<li>N\u00facleos redondos, con cromatina en \u201csal y pimienta\u201d o granular gruesa<\/li>\n<li>Gr\u00e1nulos citopl\u00e1smicos<\/li>\n<li>Amiloide<\/li>\n<\/ul>\n<p>El patr\u00f3n citol\u00f3gico es variable, las c\u00e9lulas son usualmente uniformes en tama\u00f1o y forma, pero en muchos casos se observan c\u00e9lulas de gran tama\u00f1o. La mayor\u00eda de las c\u00e9lulas tienen abundante citoplasma bas\u00f3filo, que t\u00edpicamente contiene peque\u00f1os gr\u00e1nulos neurosecretores que se ti\u00f1en de rojo con las tinciones de tipo Romanowski y son metacrom\u00e1ticos con May-Grunwald-Giemsa. El citoplasma puede ser exc\u00e9ntrico, dando una apariencia \u201cplasmocitoide\u201d, o puede ser elongado. Algunas c\u00e9lulas pueden ser binucleadas o multinucleadas. Se encuentra amiloide en algunos casos. Este es similar al coloide, pero frecuentemente contiene n\u00facleos de fibroblastos alargados y distorsionados. Su presencia puede confirmarse con la tinci\u00f3n de Rojo Congo.<\/p>\n<p align=\"justify\">Las c\u00e9lulas neopl\u00e1sicas muestran positividad en la inmunocitoqu\u00edmica para calcitonina y para el ant\u00edgeno carcinoembrionario (ACE).<\/p>\n<h3>Diagn\u00f3stico diferencial<\/h3>\n<ul>\n<li>Carcinoma anapl\u00e1sico<\/li>\n<li>Tumor metast\u00e1sico<\/li>\n<li>Tumor de c\u00e9lulas de Hurthle<\/li>\n<li>Neoplasia folicular<\/li>\n<li>Carcinoma insular<\/li>\n<li>Carcinoma papilar<\/li>\n<\/ul>\n<p align=\"justify\">No se observan nucleolos prominentes, como en los tumores de c\u00e9lulas de Hurthle en el carcinoma medular, que tiene n\u00facleos mas hipercrom\u00e1ticos con cromatina granular gruesa. Los carcinomas medulares pueden tener c\u00e9lulas en forma de huso, pero no c\u00e9lulas gigantes o marcada atipia nuclear como en el carcinoma anapl\u00e1sico. En casos dudosos, inmunocitoqu\u00edmica positiva para calcitonina o un nivel de calcitonina elevado en el suero ayuda a confirmar el diagn\u00f3stico.<\/p>\n<p align=\"justify\">La mayor\u00eda de los carcinoma medulares se diagnostican correctamente con el aspirado de aguja fina, cerca del 25% se diagnostican err\u00f3neamente como otras neoplasias.<\/p>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img fetchpriority=\"high\" decoding=\"async\" alt=\"\" height=\"1031\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture2_9.jpg\" width=\"1375\" \/><\/a><figcaption>Discohesive elongated and &#8216;plasmacytoid&#8217; cells (Pap).&nbsp;<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img decoding=\"async\" alt=\"\" height=\"1125\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture3_6.jpg\" width=\"1500\" \/><\/a><figcaption>The nuclei have a coarsely granular chromatin and nucleoli are incospicuous (Pap).&nbsp;Note elongated cells and cells with eccentric nucleus.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img decoding=\"async\" alt=\"\" height=\"1125\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture4_5.jpg\" width=\"1500\" \/><\/a><figcaption>Discohesive tumour cells with dense, granular cytoplasm (MGG).&nbsp;Few nuclei however appear bare but the chromatin pattern is the same.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1125\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture5_3.jpg\" width=\"1500\" \/><\/a><figcaption>&#8216;Plasmacytoid&#8217; cells with &#8216;salt and pepper&#8217; chromatin and finely granular cytoplasm (MGG).&nbsp;These granules are neuroendocrine and are best identified on this stain.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture7_1.jpg\" width=\"1600\" \/><\/a><figcaption>Nuclei are round and cytoplasm well stained; only a few cells show cytoplasmic granularity (MGG).&nbsp;On this stain as well the irregular granularity of chromatin distribution can be identified although it is better seen on Papanicolaou.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/421_1425469869.jpg\" width=\"1600\" \/><\/a><figcaption>Few discohesive tumour cells adjacent to a cell cluster (MGG).&nbsp;<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"675\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture1_12.jpg\" width=\"491\" \/><\/a><figcaption><strong>Typical appearance of neuroendocrine granules on MGG.<\/strong> They are fine and uniform, as opposed to the coarser and bluish stain of the colloid-filled fagosomes of thyrocytes in goitre or follicular neoplasms.&nbsp;<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"800\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture6_2.jpg\" width=\"538\" \/><\/a><figcaption>A calcitonin stain on archival FNA material.&nbsp;<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/424_1425478565.jpg\" width=\"1600\" \/><\/a><figcaption>Discohesive &#8220;plasmacytoid&#8221; cells with dense cytoplasm and typical chromatin pattern (MGG).&nbsp;<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/425_1425393498.jpg\" width=\"1600\" \/><\/a><figcaption>Cells from a MTC mimicking oncocytic changes (Pap).<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/429_1425395136.jpg\" width=\"1600\" \/><\/a><figcaption>At higher power the typical chromatin pattern is apparent (Pap).&nbsp;<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/426_1425395692.jpg\" width=\"1600\" \/><\/a><figcaption><strong>Calcitonin positive cells.<\/strong> Note the eccentric nucleus.&nbsp;<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture13_0.jpg\" width=\"1600\" \/><\/a><figcaption><strong>Calcitonin positive cells.<\/strong><\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/2007_1425396329.jpg\" width=\"1600\" \/><\/a><figcaption><strong>Calcitonin positive cells.<\/strong><\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"1200\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/415_1425398637.jpg\" width=\"1600\" \/><\/a><figcaption><strong>Calcitonin positive cells.<\/strong> At low power it is hard to identify cells in this blood-stained sample.<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"491\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture16.jpg\" width=\"614\" \/><\/a><figcaption><strong>Nuclear pseudoinclusions may be seen (MGG).<\/strong> In some centres serum calcitonin is measured at the same time as the FNA is obtained, therefore making interpretation of such findings easier. Immunocytochemistry for calcitonin and absence of thyroglobulin will establish the diagnosis.&nbsp;<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"501\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture17.jpg\" width=\"626\" \/><\/a><figcaption><strong>A cluster of atypical spindle cells (MGG).<\/strong>This finding is rather useful in suggesting MTC.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"685\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture18_0.jpg\" width=\"856\" \/><\/a><figcaption>A large fragment of elongated atypical cells (MGG) with the typical chromatin pattern. Nuclei are pleomorphic and the occasional &#8216;pseudoinclusion&#8217; can be identified.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"960\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/images\/Picture19_0.jpg\" width=\"1200\" \/><\/a><figcaption><strong>An histological section (H&amp;E).<\/strong> Amyloid deposits are readily identifiable. Amyloid in cytological samples is more difficult to separate from collagen or colloid.&nbsp;<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<div data-object_id=\"5982\" class=\"cbxwpbkmarkwrap cbxwpbkmarkwrap_guest cbxwpbkmarkwrap_user_cat cbxwpbkmarkwrap-course \"><a  data-redirect-url=\"https:\/\/www.eurocytology.eu\/es\/wp-json\/wp\/v2\/course\/5982\/\"  data-display-label=\"1\" data-show-count=\"1\" data-bookmark-label=\"Bookmark\"  data-bookmarked-label=\"Bookmarked\"  data-loggedin=\"0\" data-type=\"course\" data-object_id=\"5982\" class=\"cbxwpbkmarktrig  cbxwpbkmarktrig-button-addto\" title=\"Bookmark This\" href=\"#\"><span class=\"cbxwpbkmarktrig-label\" >Bookmark (<i class=\"cbxwpbkmarktrig-count\">0<\/i>)<\/span><\/a> <div  data-type=\"course\" data-object_id=\"5982\" class=\"cbxwpbkmarkguestwrap\" id=\"cbxwpbkmarkguestwrap-5982\"><div class=\"cbxwpbkmarkguest-message\"><a href=\"#\" class=\"cbxwpbkmarkguesttrig_close\"><\/a><h3 class=\"cbxwpbookmark-title cbxwpbookmark-title-login\">Please login to bookmark<\/h3><form name=\"loginform\" id=\"loginform\" action=\"https:\/\/www.eurocytology.eu\/wp-login.php\" method=\"post\"><p class=\"login-username\">\n\t\t\t\t<label for=\"user_login\">Nombre de usuario o correo electr\u00f3nico<\/label>\n\t\t\t\t<input type=\"text\" name=\"log\" id=\"user_login\" autocomplete=\"username\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-password\">\n\t\t\t\t<label for=\"user_pass\">Contrase\u00f1a<\/label>\n\t\t\t\t<input type=\"password\" name=\"pwd\" id=\"user_pass\" autocomplete=\"current-password\" spellcheck=\"false\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-remember\"><label><input name=\"rememberme\" type=\"checkbox\" id=\"rememberme\" value=\"forever\" \/> Recu\u00e9rdame<\/label><\/p><p class=\"login-submit\">\n\t\t\t\t<input type=\"submit\" name=\"wp-submit\" id=\"wp-submit\" class=\"button button-primary\" value=\"Acceder\" \/>\n\t\t\t\t<input type=\"hidden\" name=\"redirect_to\" value=\"https:\/\/www.eurocytology.eu\/es\/wp-json\/wp\/v2\/course\/5982\/\" \/>\n\t\t\t<\/p><\/form><p class=\"cbxwpbookmark-guest-register\">No account yet? <a href=\"https:\/\/www.eurocytology.eu\/es\/register\/?redirect_to=https%3A%2F%2Fwww.eurocytology.eu%2Fes%2Fwp-json%2Fwp%2Fv2%2Fcourse%2F5982%2F\">Register<\/a><\/p><\/div><\/div><\/div><p>El carcinoma medular (CMT) representa cerca del 5% de los c\u00e1nceres de tiroides. A diferencia de los otros carcinomas que se originan de las c\u00e9lulas foliculares, el carcinoma medular se origina de las c\u00e9lulas parafoliculares (c\u00e9lulas C) de la tiroides, que sintetiza calcitonina. Cerca del 80% a 90% son espor\u00e1dicos y ocurren en adultos, el [&hellip;]<\/p>\n","protected":false},"featured_media":0,"parent":5970,"menu_order":3,"template":"","meta":[],"tags":[],"course_area":[17],"authors":[],"class_list":["post-5982","course","type-course","status-publish","hentry","course_area-thyroid"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Carcinoma medular - Eurocytology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.eurocytology.eu\/es\/course\/citologia-de-mama\/carcinoma-de-mama\/carcinoma-medular\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Carcinoma medular - Eurocytology\" \/>\n<meta property=\"og:description\" content=\"El carcinoma medular (CMT) representa cerca del 5% de los c\u00e1nceres de tiroides. A diferencia de los otros carcinomas que se originan de las c\u00e9lulas foliculares, el carcinoma medular se origina de las c\u00e9lulas parafoliculares (c\u00e9lulas C) de la tiroides, que sintetiza calcitonina. 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