Question:
Which of the following statements about medullary thyroid carcinoma (MTC) is false?
Which of the following statements about medullary thyroid carcinoma (MTC) is false?
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FNAC of Medullary Thyroid Carcinoma is often misdiagnosed due to variable cellular morphology.
If MTC is suspected clinically, always draw serum Calcitonin and CEA levels before planning any surgical intervention.
If MTC is suspected clinically, always draw serum Calcitonin and CEA levels before planning any surgical intervention.
Updated On: Sep 3, 2026
- Prophylactic lateral neck dissection is done if the primary tumor is >1.5 cm
- MTC arises from parafollicular C cells
- MTC secretes calcitonin and sometimes CEA
- Fine needle aspiration cytology is highly sensitive and always diagnostic
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The Correct Option is D
Solution and Explanation
Concept:
The question asks the clinician to evaluate four distinct statements regarding the pathophysiology, surgical management, and diagnostic features of Medullary Thyroid Carcinoma (MTC) and identify the incorrect (false) statement.
Explanation:
• Let us evaluate each statement based on standard endocrine oncology literature.
• Statement A: MTC has a very high propensity for early lymphatic metastasis. Prophylactic ipsilateral or bilateral lateral neck dissection is frequently considered and performed if the primary tumor is large (typically $>1$ to 1.5 cm) or if central compartment nodes are grossly positive. This statement is considered generally true in surgical practice.
• Statement B: MTC unequivocally arises from the neuroendocrine parafollicular C cells of the thyroid gland, which are of neural crest origin. This is a universally true physiological fact.
• Statement C: Parafollicular C cells synthesize and secrete calcitonin, making it the primary, highly sensitive biomarker for MTC. Carcinoembryonic antigen (CEA) is also frequently co-secreted and acts as an important secondary prognostic marker. This statement is true.
• Statement D: Fine Needle Aspiration Cytology (FNAC) is the standard initial test for all thyroid nodules. However, the cytological appearance of MTC is notoriously heterogeneous and deceptive.
• MTC cells on FNAC can appear as spindle-shaped, plasmacytoid, or round cells, frequently mimicking other thyroid neoplasms such as Hürthle cell tumors, anaplastic carcinoma, or even benign lesions.
• Because of this extreme morphological variability, standard H&E staining on FNAC is absolutely NOT "always diagnostic."
• To definitively confirm MTC on cytology, the pathologist must suspect the diagnosis and perform specific immunohistochemical staining for Calcitonin, Chromogranin, or CEA.
• Therefore, the claim that FNAC is highly sensitive and always diagnostic for MTC is factually false.
Final Answer:
Statement D is false because the cytological diagnosis of MTC can be very challenging and requires immunohistochemistry to be definitive.
The question asks the clinician to evaluate four distinct statements regarding the pathophysiology, surgical management, and diagnostic features of Medullary Thyroid Carcinoma (MTC) and identify the incorrect (false) statement.
Explanation:
• Let us evaluate each statement based on standard endocrine oncology literature.
• Statement A: MTC has a very high propensity for early lymphatic metastasis. Prophylactic ipsilateral or bilateral lateral neck dissection is frequently considered and performed if the primary tumor is large (typically $>1$ to 1.5 cm) or if central compartment nodes are grossly positive. This statement is considered generally true in surgical practice.
• Statement B: MTC unequivocally arises from the neuroendocrine parafollicular C cells of the thyroid gland, which are of neural crest origin. This is a universally true physiological fact.
• Statement C: Parafollicular C cells synthesize and secrete calcitonin, making it the primary, highly sensitive biomarker for MTC. Carcinoembryonic antigen (CEA) is also frequently co-secreted and acts as an important secondary prognostic marker. This statement is true.
• Statement D: Fine Needle Aspiration Cytology (FNAC) is the standard initial test for all thyroid nodules. However, the cytological appearance of MTC is notoriously heterogeneous and deceptive.
• MTC cells on FNAC can appear as spindle-shaped, plasmacytoid, or round cells, frequently mimicking other thyroid neoplasms such as Hürthle cell tumors, anaplastic carcinoma, or even benign lesions.
• Because of this extreme morphological variability, standard H&E staining on FNAC is absolutely NOT "always diagnostic."
• To definitively confirm MTC on cytology, the pathologist must suspect the diagnosis and perform specific immunohistochemical staining for Calcitonin, Chromogranin, or CEA.
• Therefore, the claim that FNAC is highly sensitive and always diagnostic for MTC is factually false.
Final Answer:
Statement D is false because the cytological diagnosis of MTC can be very challenging and requires immunohistochemistry to be definitive.
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