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CASE REPORT

A Rare Collision Medullary and Papillary Thyroid Carcinoma in Autoimmune Thyroid Disease: Case Report

Tena Šimunjak1,*, Bernardica Jurić2, Andro Košec3,4, Vladimir Bedeković3,4
1 Department of Otorhinolaryngology & Head and Neck Surgery, University Hospital Sveti Duh, Zagreb, 10000, Croatia
2 Ljudevit Jurak Clinical Department of Pathology and Cytology, University Clinical Hospital Center Sestre Milosrdnice, Zagreb, 10000, Croatia
3 Department of Otorhinolaryngology & Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, 10000, Croatia
4 School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
* Corresponding Author: Tena Šimunjak. Email: email
(This article belongs to the Special Issue: Advances and Innovations in Head and Neck Cancer: Cutting-Edge Treatments and Future Directions)

Oncology Research https://doi.org/10.32604/or.2025.072100

Received 19 August 2025; Accepted 03 November 2025; Published online 08 December 2025

Abstract

Background: Collision medullary and papillary thyroid carcinoma (MTC/PTC) is a rare entity, constituting less than 1% of all thyroid malignancies. The concurrent presence of these malignancies in patients with autoimmune thyroid disease, such as Graves’ disease, is even more uncommon. Calcitonin (Ctn) is considered one of the key MTC biomarkers. Mixed tumors may alter this relationship. Case Description: We report the case of a 55-year-old female with a history of Graves’ disease, who underwent total thyroidectomy for persistent dysthyroid orbitopathy. Histopathological analysis revealed a 9-mm collision MTC/PTC tumor in the left thyroid lobe, confirmed through immunohistochemical staining. Postoperative evaluation demonstrated lymph node metastases, necessitating central and left lateral neck dissection. Postoperative serum markers (calcitonin, carcinoembryonic antigen, thyroglobulin) declined significantly following surgery and radioiodine therapy. Conclusion: Subcentimeter collision MTC–PTC tumors can be aggressive, challenging size-based management thresholds. Treatment should integrate MTC and PTC protocols, with Ctn, carcinoembryonic antigen (CEA), and thyroglobulin monitored in tandem. Larger datasets are needed to refine Ctn prognostic thresholds in mixed tumors.

Keywords

Medullary thyroid carcinoma; papillary thyroid carcinoma; collision tumor; calcitonin; graves’; disease; case report

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