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Ben Nacef I, Khelifi D, Kalthoum M, Rojbi I, Riahi I, Mekni S, Ben Salah M, Mchirgui N, Khiari K. Synchronous parathyroid carcinoma and papillary thyroid carcinoma. Clin Case Rep 2022; 10:e06369. [PMID: 36188029 PMCID: PMC9508800 DOI: 10.1002/ccr3.6369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 12/04/2022] Open
Abstract
The simultaneous occurrence of parathyroid carcinoma and nonmedullary thyroid carcinoma is unusual. We report the case of 60‐year‐old woman who was found to have concurrent parathyroid carcinoma with severe clinical manifestations of primary hyperparthyroidism in addition to an incidental papillary thyroid carcinoma. Parathyroid hormone level was 569 pg/ml (normal range 10–65), and the serum calcium concentration was 13.83 mg/dl (normal range, 8.8–10.4). Preoperative investigation found a large 3 cm anterior cervical nodule suggestive of parathyroid adenoma. Total thyroidectomy and left parathyroidectomy were performed, and the final anatomopathological examination of the operative specimen concluded the coexistence of papillary microcarcinoma and parathyroid carcinoma. Although parathyroid carcinoma is an uncommon cause of hypercalcemia, it should be considered when severe hypercalcemia is observed, and in case of coexistence of thyroid nodules. The possibility of both malignancies must also be considered since parathyroid and nonmedullary thyroid carcinoma rare cases have previously been reported.
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Affiliation(s)
- Ibtissem Ben Nacef
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Dayssem Khelifi
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Mehdi Kalthoum
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Imen Rojbi
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Ines Riahi
- Department of Otorhinolaryngology‐Head and Neck Surgery University Hospital of Charles Nicolle Tunis Tunisia
| | - Sabrine Mekni
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Mamia Ben Salah
- Department of Otorhinolaryngology‐Head and Neck Surgery University Hospital of Charles Nicolle Tunis Tunisia
| | - Nadia Mchirgui
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Karima Khiari
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
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De Falco N, Santangelo G, Chirico F, Cangiano A, Sommella MG, Cosenza A, Ronchi A, Accardo M, Pellino G, Parmeggiani D, Canonico S, De Falco M. Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature. BMC Endocr Disord 2021; 21:60. [PMID: 33827539 PMCID: PMC8028146 DOI: 10.1186/s12902-021-00724-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Parathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. The intrathyroidal localization of a parathyroid gland is not frequent with a reported prevalence of 0.2%. Carcinoma of parathyroids with intrathyroidal localization represents an even rarer finding, reported in only 16 cases described in literature. The rare constellation of synchronous parathyroid and thyroid carcinomas has prompted us to report our experience and perform literature review. CASE PRESENTATION We herein report a case of a 63-years-old man with multinodular goiter and biochemical diagnosis of hyperparathyroidism. Total thyroidectomy with radio-guide technique using gamma probe after intraoperative sesta-MIBI administration and intraoperative PTH level was performed. The high radiation levels in the posterior thyroid lobe discovered an intrathyroidal parathyroid. Microscopic examination revealed a parathyroid main cell carcinoma at the posterior thyroidal left basal lobe, a classic papillary carcinoma at the same lobe and follicular variant of papillary carcinoma at the thyroidal right lobe. To the best of our knowledge, this is the first case documenting a synchronous multicentric non medullary thyroid carcinomas and intrathyroidal parathyroid carcinoma. CONCLUSIONS Our experience was reported and literature review underlining challenging difficulties in diagnostic workup and surgical management was carried out.
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Affiliation(s)
- Nadia De Falco
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Giuseppe Santangelo
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Fabrizio Chirico
- Maxillofacial Surgery Unit, Federico II University, Naples, Italy
| | - Angelo Cangiano
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Maria Giulia Sommella
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Angelo Cosenza
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Andrea Ronchi
- Division of Morphopathology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marina Accardo
- Division of Morphopathology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianluca Pellino
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Domenico Parmeggiani
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Silvestro Canonico
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Massimo De Falco
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy.
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Thaduri A, Bansal A, Anthony ML, Narayan ML, Chug A, Garg PK. Brown tumor, parathyroid adenoma, and papillary thyroid cancer: A triple whammy. Oral Oncol 2021; 116:105159. [PMID: 33526354 DOI: 10.1016/j.oraloncology.2020.105159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Abhinav Thaduri
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Adity Bansal
- Department of Dentistry and Cranio-Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Manishi L Narayan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Ashi Chug
- Department of Dentistry and Cranio-Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Pankaj Kumar Garg
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India.
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Shen J, Wu Q, Wang Y. The role of ultrasound in the diagnosis of the coexistence of primary hyperparathyroidism and non-medullary thyroid carcinoma. BMC Med Imaging 2019; 19:7. [PMID: 30658569 PMCID: PMC6339388 DOI: 10.1186/s12880-019-0306-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The coexistence of primary hyperparathyroidism(PHPT) and papillary thyroid cancer(PTC) is a known entity; it is a rare and complicated setting for diagnostic imaging. METHODS After reviewing clinical data of 112 patients who had been treated for PHPT in our facility between January 2015 and December 2017, we identified 7 non-medullary thyroid carcinoma (NMTC) (6.25%). All of them had taken an ultrasound scan and undergone operation. In addition, we have also reviewed relevant reports from other facilities addressing PHPT and NMTC (Mainly PTC). RESULTS The 7 NMTCs were all pathologically confirmed PTC in our study, and they consisted of 6 parathyroid adenomas and 1 parathyroid carcinoma. 1 of the 7 patients had 2 malignant PTC nodules with neck lymph node metastasis, the rest 6 had single-focal PTC. Processing previous report data supported an association between PHPT and PTC, although the coexistence of PHPT and PTC is rare, but it does happen. Ultrasound, as an effective examination, would help screen the simultaneous lesions before operation, thus to avoid second surgery if not observed for both diseases at initial stage. CONCLUSIONS Ultrasound is a necessary choice for preoperative localization, because it has the ability to simultaneously examine the thyroid and parathyroid lesions.
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Affiliation(s)
- Jian Shen
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Qiong Wu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Yan Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, Shanghai, 200233, China.
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Guo R, Wang J, Zhang M, Zhang M, Meng H, Zhang Y, Li B. Value of 99mTc-MIBI SPECT/CT parathyroid imaging and ultrasonography for concomitant thyroid carcinoma. Nucl Med Commun 2018; 38:676-682. [PMID: 28614134 DOI: 10.1097/mnm.0000000000000692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to assess the frequency of carcinoma in cases with suspected parathyroid adenoma and test the value of Tc-methoxyisobutylisonitrile (Tc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) parathyroid imaging and neck ultrasonography in detecting concomitant thyroid carcinoma. PATIENTS AND METHODS We enrolled 741 patients with clinically suspected parathyroid adenoma who underwent Tc-MIBI planer scans and SPECT/CT of the skull base, neck, and thorax; patients also underwent ultrasonography within 1 month before SPECT/CT. Each case with suspected lesion was analyzed and correlated with pathology. We estimated the frequency of carcinoma detection on SPECT/CT performed for suspected parathyroid adenoma. The sensitivity, specificity, and accuracy of detecting thyroid carcinoma were estimated for both SPECT/CT and ultrasonography. RESULTS In total, 222 patients with 250 pathology results were assessed. Of these, 54 patients showed carcinoma. With respect to the anatomical distribution of the incidental findings, 19 (35.19%) had parathyroid carcinoma, 20 (37.04%) had papillary thyroid carcinoma, three (5.56%) had follicular thyroid carcinoma, six (11.11%) had medullary thyroid carcinoma, and six (11.11%) had other carcinomas. For thyroid carcinoma detection, the sensitivity, specificity, and accuracy were 35.71, 88.16, and 80.49% for SPECT/CT and 73.81, 95.10, and 91.99% for ultrasonography, respectively. CONCLUSION The frequency of carcinoma is high on Tc-MIBI SPECT/CT performed for suspected parathyroid adenoma. Although Tc-MIBI SPECT/CT plays an important role in the diagnosis and location of parathyroid adenoma, ultrasonography appears to be more suitable for identifying a concomitant thyroid carcinoma. This may vitally influence the choice of therapeutic regimen in patients with primary hyperparathyroidism.
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Affiliation(s)
- Rui Guo
- Departments of aNuclear Medicine bEndocrine and Metabolic Diseases, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Taywade SK, Damle NA, Tripathi M, Agarwal S, Aggarwal S. Synchronous parathyroid adenoma and papillary thyroid cancer detected on 99mTc-sestamibi scintigraphy. Indian J Endocrinol Metab 2016; 20:878-879. [PMID: 27867896 PMCID: PMC5105577 DOI: 10.4103/2230-8210.192915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Nishikant A. Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Aggarwal
- Department of Medicine, Endocrinology Unit, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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An unusual presentation of primary hyperparathyroidism: multiple brown tumors and coexisting thyroid carcinoma. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Basaran Y, Ince S, Alagoz E, Meric C, Taslipinar A. An unusual presentation of primary hyperparathyroidism: multiple brown tumors and coexisting thyroid carcinoma. Rev Esp Med Nucl Imagen Mol 2016; 35:321-4. [PMID: 27036887 DOI: 10.1016/j.remn.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/15/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
We present a patient with a complex clinical picture of primary hyperparathyroidism with multiple destructive skeletal lesions suspicious of bone metastases and concomitant multifocal papillary thyroid carcinoma with a metastatic central lymph node. He presented with progressively worsening right hip pain and restricted motion. Magnetic resonance imaging revealed multiple lytic lesions involving predominantly the right trochanter minor and the left inferior and posterior pubic rami. Biochemical tests were consistent with primary hyperparathyroidism. Neck ultrasound and parathyroid scintigraphy revealed a single parathyroid adenoma and a thyroid nodule, preoperative cytology of which confirmed papillary thyroid carcinoma, as did the final surgical specimen. Biochemical results, regarding hyperparathyroidism, declined to normal levels and his complaints gradually decreased after surgery. Postoperative whole body bone scintigraphy showed increased tracer uptakes at multiple sites, but they were proved to be metabolically inactive by fluorodeoxyglucose positron emission tomography/computed tomography.
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Affiliation(s)
- Y Basaran
- Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey
| | - S Ince
- Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine, Etlik, Ankara, Turkey
| | - E Alagoz
- Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine, Etlik, Ankara, Turkey.
| | - C Meric
- Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey
| | - A Taslipinar
- Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey
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Phillips DJ, Kutler DI, Kuhel WI. Incidental thyroid nodules in patients with primary hyperparathyroidism. Head Neck 2015; 36:1763-5. [PMID: 25548812 DOI: 10.1002/hed.23533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND It is desirable to detect neoplastic thyroid disease before proceeding with surgical therapy for hyperparathyroidism so that both conditions can be treated with a single operation. METHODS Between March 1998 and June 2009, 227 patients with primary hyperparathyroidism were treated with surgical therapy. Of these, 217 were evaluated preoperatively with a modified 4-dimensional CT and ultrasonography. The medical records of these patients were reviewed in order to document the incidence and significance of thyroid pathology in this cohort of patients. RESULTS Thyroid nodules were identified in 159 of the 217 patients (73.3%). Nine of 217 patients (4.1%) were treated with either a partial or a total thyroidectomy at the time of parathyroidectomy. Three of these patients had papillary thyroid carcinoma, 1 had a Hurthle cell carcinoma, and 1 had an incidental micropapillary thyroid carcinoma. CONCLUSION The rate of clinically significant thyroid malignancy in patients undergoing surgical treatment of primary hyperparathyroidism was 1.8%.
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Abstract
Undescended parathyroid adenomas are rare, representing 0.08% of all parathyroid adenomas; however, they make up 7% of the underlying cause of failed cervical exploration in patients with persistent primary hyperparathyroidism. A 43-year-old woman with no significant medical or family history presented with fatigue and was diagnosed with primary hyperparathyroidism; however, preoperative imaging including sestamibi scan and ultrasound was unable to identify the hyperfunctioning gland. She underwent a neck exploration and hemithyroidectomy and partial parathyroidectomy with failure of resolution of her disease. Subsequent work up including a CT of the neck demonstrated a 1.9 cm mass adjacent to the left submandibular gland. This was removed with postoperative normalisation of the patient's serum calcium and parathyroid hormone levels.
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Affiliation(s)
| | - Ali A Maawy
- University of California San Diego, La Jolla, California, USA
| | - Deborah K Oh
- University of California San Diego, La Jolla, California, USA
| | - Michael Bouvet
- University of California San Diego, La Jolla, California, USA
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Association of synchronous medullary and papillary thyroid carcinomas with primary hyperparathyroidism: first case report and literature review. The Journal of Laryngology & Otology 2014; 128:565-8. [PMID: 24877696 DOI: 10.1017/s002221511400108x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We report a case of a patient with symptomatic primary hyperparathyroidism who was found, through a thorough radiological investigation, to also have papillary and medullary thyroid carcinomas. CASE REPORT A 59-year-old female was diagnosed with primary hyperparathyroidism. A further radiological investigation found suspicious areas within both thyroid lobes that were later diagnosed as foci of papillary and medullary thyroid carcinomas. Appropriate treatment was commenced. Reports of similar occurrences of synchronous thyroid and parathyroid pathologies are discussed. CONCLUSION To our knowledge, this is the first reported case of two synchronous thyroid cancers occurring in the context of primary hyperparathyroidism. We strongly recommend a thorough radiological investigation of all patients with primary hyperparathyroidism to prevent missing concurrent thyroid cancers.
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12
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Association of parathyroid pathology with well-differentiated thyroid carcinoma. Presse Med 2012; 41:e265-71. [PMID: 22459989 DOI: 10.1016/j.lpm.2011.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 11/28/2011] [Accepted: 12/12/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objective was to evaluate the association of well-differentiated thyroid carcinoma and parathyroid pathology. METHODS The medical records of 14 patients with concomitant pathologies were retrospectively reviewed. RESULTS Parathyroidectomies (1.3%) and thyroidectomies (3.5%) performed for well-differentiated thyroid carcinoma resulted in the diagnosis of concomitant pathologies. Five patients had a primary hyperparathyroidism (PHPT) and nine were operated for thyroidectomy with intraoperative finding of an enlarged parathyroid gland. Patients (64%) were normocalcemic preoperatively. Thirteen had papillary carcinoma. Fifty percent of patients had multiple foci of papillary microcarcinoma. Twenty-nine percent of patients had parathyroid hyperplasia. All patients with preoperative hypercalcemia normalized their serum calcium. During follow-up, thyroglobuline, calcium serum values and cervical ultrasound showed no evidence of recurrence of the diseases. CONCLUSIONS These observations stress the importance of pre and intraoperative evaluation to detect overt thyroid and parathyroid pathology before performing a parathyroidectomy for hyperparathyroidism or a thyroidectomy for a well-differentiated thyroid carcinoma.
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Arciero CA, Shiue ZS, Gates JD, Peoples GE, Dackiw APB, Tufano RP, Libutti SK, Zeiger MA, Stojadinovic A. Preoperative thyroid ultrasound is indicated in patients undergoing parathyroidectomy for primary hyperparathyroidism. J Cancer 2011; 3:1-6. [PMID: 22211139 PMCID: PMC3245602 DOI: 10.7150/jca.3.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/18/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Primary hyperaparathyroidism (pHPT) is often accompanied by underlying thyroid pathology that can confound preoperative parathyroid localization studies and complicate intra-operative decision making. The aim of this study was to examine the utility of preoperative thyroid ultrasonography (US) in patients prior to undergoing parathyroidectomy for pHPT. METHODS An Institutional Review Board approved prospective study was undertaken from January 2005 through July 2008. All patients with pHPT meeting inclusion criteria (n=94) underwent preoperative thyroid ultrasound in addition to standard (99m)Tc-sestamibi scintigraphy for parathyroid localization. Demographics, operative management and final pathology were examined in all cases. RESULTS Fifty-four of the 94 patients (57%) were noted to have a thyroid nodule on preoperative US, of which 30 (56%) underwent further examination with fine needle aspiration biopsy. Alteration of the operative plan attributable to underlying thyroid pathology occurred in 16 patients (17%), with patients undergoing either total thyroidectomy (n=9) or thyroid lobectomy (n=7). Thyroid cancer was noted in 33% of patients undergoing thyroid resection, and 6% of all patients with HPT. CONCLUSIONS The routine utilization of preoperative thyroid ultrasound in patients prior to undergoing parathyroid surgery for pHPT is indicated. The added information from this non-invasive modality facilitates timely management of co-incidental, and sometimes malignant, thyroid pathology.
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Affiliation(s)
| | | | | | - George E. Peoples
- 4. Brooke Army Medical Center, Fort Sam Houston, TX, USA
- 5. United States Military Cancer Institute, Washington, D.C. , USA
- 6. Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Ralph P. Tufano
- 7. Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven K. Libutti
- 8. Albert Einstein College of Medicine / Montefiore Medical Center, New York City, NY, USA
- 9. Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Martha A. Zeiger
- 7. Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Stojadinovic
- 5. United States Military Cancer Institute, Washington, D.C. , USA
- 6. Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- 9. Walter Reed National Military Medical Center, Bethesda, MD, USA
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Vulpio C, Bossola M, De Gaetano A, Maresca G, Bruno I, Fadda G, Morassi F, Magalini SC, Giordano A, Castagneto M. Usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism. Head Neck 2010; 32:1226-35. [DOI: 10.1002/hed.21320] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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15
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Gates JD, Benavides LC, Shriver CD, Peoples GE, Stojadinovic A. Preoperative Thyroid Ultrasound In All Patients Undergoing Parathyroidectomy? J Surg Res 2009; 155:254-60. [DOI: 10.1016/j.jss.2008.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 09/04/2008] [Accepted: 09/11/2008] [Indexed: 12/17/2022]
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Parathyroid adenomas seen in the clinical follow-up of patients with differentiated thyroid carcinoma: a diagnostic dilemma. Clin Nucl Med 2009; 34:70-1. [PMID: 19352252 DOI: 10.1097/rlu.0b013e318192c525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The coexistence of nonmedullary thyroid carcinoma and parathyroid adenoma is an uncommon clinical entity. In most of the previously published studies, thyroid carcinomas are diagnosed incidentally during or after the treatment of parathyroid disease, mostly in the pathology specimens. Here, we report 2 cases of parathyroid adenoma who presented years after the treatment of differentiated thyroid carcinoma. Neither of the patients had symptoms of hypercalcemia and hyperparathyroidism, and parathyroid adenomas were diagnosed on routine physical examination of the neck and on routine monitoring of serum calcium levels.
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Dual-Phase 99MTc-MIBI Parathyroid Imaging Reveals Synchronous Parathyroid Adenoma and Papillary Thyroid Carcinoma: A Case Report. Kaohsiung J Med Sci 2008; 24:542-7. [DOI: 10.1016/s1607-551x(09)70014-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Hsu HC, Chi CH, Tsai MC, Lin CH. An Unusual Cause of Abdominal Pain: Thiazide-Related Hypercalcemia in a Patient with Veiled Hyperparathyroidism and Thyroid Papillary Carcinoma. J Emerg Med 2008; 34:151-3. [DOI: 10.1016/j.jemermed.2007.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Revised: 05/12/2007] [Accepted: 05/25/2007] [Indexed: 11/29/2022]
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Lee JK, Obrzut SL, Yi ES, Deftos LJ, Bouvet M. Incidental Finding of Metastatic Papillary Thyroid Carcinoma in a Patient with Primary Hyperparathyroidism. Endocr Pract 2007; 13:380-3. [PMID: 17669714 DOI: 10.4158/ep.13.4.380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report on the management of a patient with the rare concurrence of primary hyperparathyroidism and incidentally found metastatic papillary thyroid carcinoma in an adjacent lymph node. METHODS We present a case report, including scintigraphic and histologic documentation, and a summary of the related literature. RESULTS Primary hyperparathyroidism with concomitant occurrence of nonmedullary thyroid carcinoma is rare, occurring in less than 4% of patients. We report a case of a 53-year-old woman with no prior history of endocrine disease with primary hyperparathyroidism and an incidental finding of a concurrent thyroid carcinoma. In this patient, technetium 99m scintigraphy revealed a parathyroid adenoma beneath the inferior pole of the left thyroid bed. Parathyroidectomy was performed successfully with no complications. The final pathology examination showed a large parathyroid adenoma with an incidental finding of a small adjacent lymph node containing metastatic papillary thyroid carcinoma. The patient subsequently underwent total thyroidectomy, and the pathology evaluation revealed papillary thyroid carcinoma, follicular variant. CONCLUSION To our knowledge, this case of concomitant primary hyperparathyroidism and papillary thyroid cancer is unique in the way in which the diagnosis of metastatic papillary thyroid cancer was made. The presence of parathyroid adenoma should not exclude the diagnosis of thyroid carcinoma; therefore, careful thyroid evaluation should be considered for all patients with primary hyperparathyroidism.
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Affiliation(s)
- Jeffrey K Lee
- Department of Surgery, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California 92093-0987, USA
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Rezende NLP, Dedivitis RA, Sauma BIFC, Hushi GG, Pfuetzenreiter Jr. EG. Associação de doença tireoideana ao adenoma de paratireóide. Rev Col Bras Cir 2007. [DOI: 10.1590/s0100-69912007000200005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: avaliar a prevalência de doença incidental de tireóide em tratamento cirúrgico por HPP. MÉTODO: De janeiro de 1998 a dezembro de 2004, 20 pacientes com evidência clínica e laboratorial de HPP foram submetidos à paratiroidectomia. A população de pacientes incluía 15 mulheres e cinco homens, com idade variando de 44 a 83 anos. Os dados utilizados para o diagnóstico de doença tireoidiana: clínico, laboratorial, ultra-sonografia com Doppler, exame citopatológico da punção aspirativa por agulha fina (PAAF) e exame durante a exploração intra-operatória. Todos os pacientes eram portadores de adenoma de paratireóide, sendo dois duplos. RESULTADOS: Ao exame clínico foi detectado alteração à palpação da tireóide em sete pacientes, com cinco indicações cirúrgicas; a avaliação laboratorial mostrou alteração da função tireoidiana em três pacientes; a ultra-sonografia mostrou doença nodular em 15 pacientes, mas não determinou indicação cirúrgica; a PAAF de nódulo tireoidiano foi indicada em nove pacientes, com três pacientes de carcinoma papilífero; a exploração intra-operatória não adicionou achado ao exame ultra-sonográfico. CONCLUSÃO: A associação patológica entre doenças da tireóide e da paratireóide é freqüente. A ultra-sonografia é o método mais sensível de detecção, porém, o exame clínico e a PAAF são os que revelaram impacto na indicação cirúrgica sobre a glândula tireóide no momento da paratireoidectomia.
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Ruf J, Seehofer D, Nadjari B, Amthauer H, Rayes N. Incidental Parathyroid Adenoma Mimicking Tumor Recurrence in a Patient With Follicular Thyroid Carcinoma. Clin Nucl Med 2006; 31:74-6. [PMID: 16424689 DOI: 10.1097/01.rlu.0000195918.76677.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a 59-year-old woman with a history of follicular thyroid cancer who had reoperation for suspected local tumor recurrence as laboratory (tumor marker), imaging findings (ultrasound, I-131 scintigraphy and Tc-99m-MIBI scintigraphy), and also fine needle aspiration (FNA) cytology were equivocal. However, postoperative histopathology revealed a parathyroid adenoma.
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Affiliation(s)
- Juri Ruf
- Klinik für Strahlenheilkunde, Campus Virchow Klinikum, Germany.
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Abstract
Concomitant thyroid disease is not unusual among patients with primary hyperparathyroidism. However, the simultaneous occurrence of parathyroid and thyroid carcinoma is extremely rare. We report a 38-year-old man with primary hyperparathyroidism who presented with osteitis fibrosa cystica complicated with pathologic femoral neck fracture. Preoperative investigation for exclusion of multiple endocrine neoplasia did not find evidence of medullary thyroid carcinoma or pheochromocytoma, but imaging studies revealed the presence of nodules in the right lobe and a parathyroid lesion over the left inferior pole of the thyroid gland. Total thyroidectomy, left parathyroidectomy, and bipolar hemiarthroplasty of the left hip were then performed simultaneously. The resected specimens were pathologically identified as papillary thyroid carcinoma and parathyroid carcinoma, respectively. After the operation, 131I ablation therapy was administered at a dose of 120 mCi. Additional doses of 30 mCi were given yearly as serum thyroglobulin level became elevated. Serum calcium level remained normal during yearly follow-up. Although parathyroid carcinoma is an uncommon cause of parathyroid hormone-dependent hypercalcemia, it should nonetheless be given due consideration because its surgical approach differs from that of parathyroid adenoma. As the coexistence of parathyroid and non-medullary thyroid carcinoma has previously been reported, the possibility of both malignancies must also be considered in the setting of primary hyperparathyroidism with thyroid nodules. If confirmed with preoperative parathyroid scintigraphic and other laboratory studies, an optimal outcome may be achieved with complete resection of both tumors at the time of initial operation, followed by adjunctive therapy.
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Affiliation(s)
- Shi-Dou Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
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Abstract
Nuclear medicine sestamibi parathyroid imaging is now a standard preoperative assessment for patients with hyperparathyroidism. Since the introduction of Technetium-99m (99mTc) sestamibi for parathyroid imaging in 1989 there has been a steady refinement in the imaging technique. The accuracy is determined by the scan technique employed, with the dual-isotope (123Iodine/99mTc sestamibi)scan providing better accuracy than the simpler sestamibi washout method. Now the pathologic parathyroid process can be localized preoperatively with great confidence, limiting the time and extent of the neck dissection and allowing a significant number of parathyroid surgeries to be performed as outpatient procedures.
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Affiliation(s)
- Brian P Mullan
- Section of Nuclear Medicine, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55095, USA.
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