MOCK27 MENII
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Stem
A young female with thyroid nodule and Elevated calcitonin levelsWhat is the single best investigation to be done?
FNAC
What is the type of cancer you suspect? and why?
Medullary thyroid cancer due to elevation of calcitonin levels.
Report of FNAC, positive for calcitonin and antithyroid your comment?
Medullary thyroid cancer
As this case is familiar, what will you think?
MEN2a
Mode of inheritance of MEN
Autosomal dominant. (RET chrom. 10)
What is the source of this type of cancer?
Parafollicular C cells
What is IHC in simple words?
It is a method of localizing specific antigens in tissues or cells based on antigen antibody recognition
How does it work?
The antibodies are usually linked to an enzyme or a fluorescent dye.
When the antibodies bind to the antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope.What is the type of the AG-AB reaction in IHC?
?Complement fixation/ reporter molecule
TNM classification of Thyroid cancer?
(In the exam, you will be given size 3 cm and some regional LN and no mets then ask to do TNM)T2N1M0
What if size is 4 cm & regional LNs, what is TNM?
T3N1M0
If the patient developed hypertension, what will you suspect she might have?
Pheochromocytoma
What are the other adrenal gland swelling you know?
Infection: abscess
Trauma: haematoma
Neuroblastoma
LymphangiomaHow can you diagnose Pheochromocytoma?
PlasmaCatecholamines
Free metanephrine
Catecholamines stimulation testUrine
Catecholamines
VMA
Fractionated metanephrine
Total metanephrineImaging
Ultrasound
CT, PET CT
MRI
MIBG scintigraphyThe condition is familial what other pathology will you suspect?
Parathyroid hyperplasia
What are the types of MEN? And gene mutation of each?
MEN type I: Mutation in MENIN gene
MEN type 2a: Mutation in RET oncogene
MEN type 2b: Mutation in RET oncogeneWhat is the treatment plan of medullary thyroid cancer?
After doing full examination and investigation and staging I will discuss with a MDT, for total thyroidectomy with block neck dissection if +ve nodes.
Types of neck dissection?
Radical
Modified radical (spare IJV, SCM, & CN 11)
SelectiveClassify MEN
MEN 1Parathyroid hyperplasia
Pituitary Adenoma
Pancreatic tumourMEN 2A
Parathyroid hyperplasia
Medullary thyroid ca
PheochromocytomaMEN 2B
Same as MEN2a with addition of
Marfanoid
Mucosal neuroma -
A admin moved this topic from Pathology
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