-Original-

An Extended Family with Familial Medullary Thyroid Carcinoma and Hirschsprung's Disease

Takehito Igarashi¹, Ritsuko Okamura¹, Tomoo Jikuzono¹, Shinya Uchino², Iwao Sugitani¹ and Kazuo Shimizu¹

¹Division of Endocrine Surgery, Department of Surgery, Nippon Medical School
²Department of Surgery, Noguchi Hospital

Familial medullary thyroid carcinoma (FMTC) is an autosomal dominant inherited disease that has highly characteristic clinical features, including medullary thyroid carcinoma (MTC). Mutation of the RET proto-oncogene is known to be responsible for development of FMTC and for multiple endocrine neoplasia types 2A and 2B. Hirschsprung's disease is the most common form of structural intestinal obstructive disease in human newborns. Hirschsprung's disease is defined by the absence of neural crest-derived enteric ganglia along a variable length of the bowel that invariably involves the rectoanal junction. Co-segregation of FMTC and Hirschsprung's disease is uncommon; nevertheless, in 3 generations of 1 family, we observed 5 patients with FMTC, 2 patients with Hirschsprung's disease, and 1 patient with characteristics of both FMTC and Hirschsprung's disease. Moreover, a Cys620Ser mutation in RET was identified in 4 of the 8 patients. This mutation had both activating and inactivating effects on the RET (REarranged during Transfection) protein. There were individual differences in the penetrance of Hirschsprung's disease due to the RET mutation, but the penetrance of MTC was uniform and high. Genetic testing is important for making decisions about treatment and follow-up in families of this kind.

J Nippon Med Sch 2014; 81: 64-69

Keywords
familial medullary thyroid carcinoma, Hirschsprung's disease, RET

Correspondence to
Takehito Igarashi, MD, PhD, Division of Endocrine Surgery, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
takehito@nms.ac.jp

Received, June 14, 2013
Accepted, July 17, 2013