Multiple endocrine neoplasia type IIB

Managers: David P. Girvan, MD, FRCSC and Nis Schmidt, MD, FRCSC

Canadian Journal of Surgery 1996; 39: 96-97

Submitted by Nis Schmidt, MD, FRCSC, Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver

Submissions to "Surgical Images" should be sent to Dr. David P. Girvan, Victoria Hospital Corporation, PO Box 5375, Station B, London ON N6A 5A5 or to Dr. Nis Schmidt, Department of Surgery, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC V6Z 1Y6 with a copy of the submitting letter to Dr. Jonathan L. Meakins, Rm. S10.34, Royal Victoria Hospital, 687 Pine Ave. W, Montreal QC H3A 1A1.

A 25-year-old man presented to his ophthalmologist, complaining of an irritating tag at the edge of his left eyelid (Fig. 1). Tissue biopsy revealed a small neuroma, which prompted further investigation. This revealed elevated urinary vanillylmandelic acid and urinary catecholamine levels. Magnetic resonance imaging of the adrenal glands (Fig. 2) disclosed multiple tumours bilaterally, compatible with pheochromocytomas. Ultrasonography of the thyroid gland (Fig. 3) confirmed microcalcification and heterogeneous thickening in the right lobe. The serum calcitonin level was grossly elevated. Bilateral adrenalectomy was performed (Fig. 4). The gross and microscopic appearances of the left adrenal tumour are shown in Figs. 5 and 6 respectively. Adrenalectomy was followed soon after by radical thyroidectomy for medullary carcinoma.

| CJS: Apr. 1996 | Surgery and orthopedics |

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