What is the single best investigation to be done?

Spoiler

FNAC

What is the type of cancer you suspect? and why?

Spoiler

Medullary thyroid cancer due to elevation of calcitonin levels.

Report of FNAC, positive for calcitonin and antithyroid your comment?

Spoiler

Medullary thyroid cancer

As this case is familiar, what will you think?

Spoiler

MEN2a

Mode of inheritance of MEN

Spoiler

Autosomal dominant. (RET chrom. 10)

What is the source of this type of cancer?

Spoiler

Parafollicular C cells

What is IHC in simple words?

Spoiler

It is a method of localizing specific antigens in tissues or cells based on antigen antibody recognition

How does it work?

Spoiler

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?

Spoiler

?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)

Spoiler

T2N1M0

What if size is 4 cm & regional LNs, what is TNM?

Spoiler

T3N1M0

If the patient developed hypertension, what will you suspect she might have?

Spoiler

Pheochromocytoma

What are the other adrenal gland swelling you know?

Spoiler

Infection: abscess
Trauma: haematoma
Neuroblastoma
Lymphangioma

How can you diagnose Pheochromocytoma?
Plasma

Spoiler

Catecholamines
Free metanephrine
Catecholamines stimulation test

Urine

Spoiler

Catecholamines
VMA
Fractionated metanephrine
Total metanephrine

Imaging

Spoiler

Ultrasound
CT, PET CT
MRI
MIBG scintigraphy

The condition is familial what other pathology will you suspect?

Spoiler

Parathyroid hyperplasia

What are the types of MEN? And gene mutation of each?

Spoiler

MEN type I: Mutation in MENIN gene
MEN type 2a: Mutation in RET oncogene
MEN type 2b: Mutation in RET oncogene

What is the treatment plan of medullary thyroid cancer?

Spoiler

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?

Spoiler

Radical
Modified radical (spare IJV, SCM, & CN 11)
Selective

Classify MEN
MEN 1

Spoiler

Parathyroid hyperplasia
Pituitary Adenoma
Pancreatic tumour

MEN 2A

Spoiler

Parathyroid hyperplasia
Medullary thyroid ca
Pheochromocytoma

MEN 2B

Spoiler

Same as MEN2a with addition of
Marfanoid
Mucosal neuroma