A Case of Multiple Endocrine Neoplasia Type 2B associated with a M918T Mutation in RET Proto-Oncogene.

Kim, Tae Yong; Hwang, Jae Kyung; Moon, Min Kyong; Park, Young Joo; Park, Do Joon; Kim, Seong Yeon; Lee, Hong Kyu; Yoon, Yo Kyu; Cho, Bo Youn

Case Report

Journal of Korean Endocrine Society 2003;18(1):85-93.
Published online February 1, 2003.

A Case of Multiple Endocrine Neoplasia Type 2B associated with a M918T Mutation in RET Proto-Oncogene.

Tae Yong Kim, Jae Kyung Hwang, Min Kyong Moon, Young Joo Park, Do Joon Park, Seong Yeon Kim, Hong Kyu Lee, Yo Kyu Yoon, Bo Youn Cho

¹Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
²Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Abstract

A multiple endocrine neoplasia type 2B(MEN2B) is the most distinct and aggressive form of the MEN type 2 variants. We report a case of a 24-years-old woman with MEN2B. The patient had previously undergone a Duhamel's operation due to a megacolon at 6 years old, minor surgery to remove small tumors on the lip at 8 years old, and a bilateral osteotomy of the femur, due to coxa valga, at 15 years old. She underwent a total thyroidectomy and neck dissection, due to a growing thyroid nodule, despite thyroxine treatment, at 19 years old. The pathology revealed a medullary thyroid carcinoma. There was no history of MEN 2B in her family. She had prominent lips, multiple oral mucosal masses, and marfanoid habitus. During the subsequent follow-up, a positron emission tomogram was taken due to a persistently high level of serum calcitonin, despite repeated neck dissections, which revealed a mass in the right adrenal gland. Adrenomedullary function tests showed high levels of urinary catecholamine metabolites, and a genetic analysis of the peripheral leukocyte showed a codon 918 mutation (Met918Thr) at exon 16 of the RET proto-oncogene. The patient underwent a right adrenalectomy and the pathology revealed a pheoch-romocytoma.

Key Words: Multiple endocrine neoplasia type 2B, Medullary thyroid carcinoma, Pheochromocytoma, Mucosal neuroma, RET proto-oncogene