We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Picture of the Month FREE

Yann-Jinn Lee, MD; Hsi-Che Liu, MD; Hung-Chang Lee, MD; Chi-Yuan Tzen, MD; Chi-Yu Huang, MD; Tsen-Long Yang, MD
[+] Author Affiliations

Section Editor: Walter W. Tunnessen, MD

Arch Pediatr Adolesc Med. 2001;155(7):845-846. doi:10.1001/archpedi.155.7.845.
Text Size: A A A
Published online

A 10-YEAR-OLD GIRL underwent reduction cheiloplasty and excision of tongue nodules. The development of progressively patulous lips and thickening of the tongue began at age 6 years. Following surgery, a right neck mass was discovered. Thyroid scan revealed an enlarged gland with a cold area in the upper two thirds of the right lobe. A right thyroidectomy was performed. Her medical history included abdominal distension and the onset of severe constipation at age 4 years, which responded to medical treatment. On physical examination thick lips and an enlarged, nodular tongue were present (Figure 1 and Figure 2). A firm, visibly enlarged goiter was palpable in the left thyroid gland. An ultrasound study demonstrated an enlarged left lobe of the thyroid with 2 hypoechoic nodules and bilateral, enlarged cervical lymph nodes. Her serum calcitonin level was 299 pmol/L (reference, <26.6 pmol/L). A total thyroidectomy was performed with modified radical neck dissection. Pathologic interpretation of the removed tissue revealed medullary thyroid carcinoma (MTC) with metastases to the cervical lymph nodes. A review of the tongue biopsy specimen was consistent with mucosal neuromas. DNA sequencing analysis of exon 16 of the RET proto-oncogene from peripheral blood cells showed a germline M918T mutation (Figure 3).




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

NYSORA Textbook of Regional Anesthesia and Acute Pain Management
Fig. 43-10

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have Abdominal Aortic Aneurysm?