Master Medullary Carcinoma with Picmonic for Medicine

With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing.

Medullary Carcinoma

Medullary-medusa and Car-gnome
Picmonic
There are four main types of thyroid cancer, listed in descending order of prevalence are papillary, follicular, medullary, and anaplastic. Medullary thyroid carcinoma, the third most common type of thyroid cancer is divided into sporadic and familial types. This cancer arises from parafollicular C cells, may produce calcitonin and manifest with hypocalcemia or produce ACTH and manifest with Cushing syndrome. It is characterized histologically by amyloid-staining sheets of cells and will exhibit calcitonin release with pentagastrin administration. Two major risk factors for medullary carcinoma are a history of head and neck radiation and family history of MEN 2A and 2B.
8 KEY FACTS
Sporadic and Familial Types
Sporadic-spear and Familial-family

The majority of medullary carcinomas are sporadic and have no association with other genetic factors or syndromes.  The other remaining cases are due to an autosomal dominantly inherited RET gene mutation that can lead to familial medullary thyroid cancer or to either MEN 2A or MEN 2B syndromes, in which medullary thyroid cancer is commonly present.  Familial cases generally carry a better prognosis than sporadic.

Arises from Parafollicular C cells
Pair-of-folliciles C-cat

These neuroendocrine cells within the thyroid gland produce and secrete calcitonin.

Produces Calcitonin
Cow-throne

Calcitonin is a peptide hormone that has antagonistic effects to parathyroid hormone (PTH); it is secreted in response to high blood calcium levels and its primary function is to lower calcium levels by decreasing absorption in the GI tract, modifying bone resorption, and increasing excretion by the kidneys.  By measuring serum levels of calcitonin, it can be used as a tumor marker for medullary carcinoma. 

Hypocalcemia
Hippo-calcified-cow

Since calcitonin downregulates calcium in the blood, an excessive amount of calcitonin may produce hypocalcemia, which can manifest as tetany, paresthesias, seizures, and EKG abnormalities.

May Produce ACTH
Air-conditioning

Adrenocorticotropic hormone is a peptide hormone normally produced by the anterior pituitary gland.  Like many other cancers, medullary thyroid carcinomas can produce ectopic ACTH and therefore patients can present with signs and symptoms of Cushing syndrome such as weight gain, hypertension, abdominal striae, etc. 

DIAGNOSIS
Sheets of Cells With Amyloid Deposition
Bed-sheets of Cells and Armadillo

Medullary carcinoma cells arrange themselves into sheets; the cells that form these sheets contain excess calcitonin that is eventually converted into amyloid protein.  These amyloid deposits can be stained with Congo Red dye and will exhibit the pathognomonic apple-green birefringence when viewed under polarized light.

Increased calcitonin with Pentagastrin Infusion
Up-arrow Cow-throne with Pentagram-gas

As a diagnostic test, a synthetic peptide hormone called Pentagastrin can be administered to a patient in order to stimulate the release of calcitonin from C cells, which can then be measured and compared to baseline levels.  Patients with medullary thyroid cancer will have levels markedly above normal or baseline after pentagastrin infusion.

RISK FACTORS
MEN 2A and 2B
2 MEN with (A) Apple and (B) Bee

These two subsets of the multiple endocrine neoplasia (MEN) syndromes both involve medullary thyroid cancer and pheochromocytomas.  MEN 2A also classically includes parathyroid hyperplasia, while MEN 2B also manifests with mucosal neuromas, or more specifically oral ganglioneuromatosis.  Both of these syndromes are inherited in an autosomal dominant fashion via the RET oncogene on chromosome 10.

Unlock all 8 facts & definitions with Picmonic Free!

JOIN FREE

Take the Medullary Carcinoma Quiz

Picmonic's rapid review multiple-choice quiz allows you to assess your knowledge.

START QUIZ NOW

It's worth every penny

Our Story Mnemonics Increase Mastery and Retention

Memorize facts with phonetic mnemonics

Unforgettable characters with concise but impactful videos (2-4 min each)

Ace Your Medical (MD/DO) Classes & Exams with Picmonic:

Over 870,000 students use Picmonic’s picture mnemonics to improve knowledge, retention, and exam performance.

Choose the #1 Medical (MD/DO) student study app.

Picmonic for Medicine (MD/DO) covers information that is relevant to your entire Medical (MD/DO) education. Whether you’re studying for your classes or getting ready to conquer the USMLE Step 1, USMLE Step 2 CK, COMLEX Level 1, or COMLEX Level 2, we’re here to help.

Works better than traditional Medical (MD/DO) flashcards.

Research shows that students who use Picmonic see a 331% improvement in memory retention and a 50% improvement in test scores.