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Xu T, Zheng X, Wei T. Incidental synchronous intrathyroidal parathyroid carcinomas and papillary thyroid microcarcinoma with compressive neck mass and primary hyperparathyroidism: case report and literature review. BMC Endocr Disord 2024; 24:125. [PMID: 39054438 PMCID: PMC11270972 DOI: 10.1186/s12902-024-01656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is a rare malignancy, often diagnosed incidentally through postoperative pathological examination. The occurrence of nodular goiter, intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma (PA), and papillary thyroid microcarcinoma (PTMC) is extremely uncommon, which prompted us to report our case experience. CASE PRESENTATION We describe a 67-year-old male who presented with a cervical mass causing tracheal compression, which prompted him to seek medical advice. Based on preoperative auxiliary examination results from color Doppler ultrasound, SPECT parathyroid imaging, and blood tests, he was initially diagnosed with a suspected parathyroid adenoma and nodular goiter. Excision of the right lobe and isthmus of the thyroid, and left superior parathyroid gland was conducted, which were sent to intraoperative frozen pathological examination. During intraoperative observation, adhesion around the right thyroid lobe was discovered. Consequently, right central area lymph node dissection was performed due to suspicion of an aggressive malignant tumor. Histology and immunohistochemistry analysis revealed incidental intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma, classical papillary thyroid microcarcinoma, and nodular goiter. CONCLUSION Parathyroid carcinoma should be highly suspected when extremely high levels of PTH and severe hypercalcemia are present, which cannot be simply explained by a preoperatively localized parathyroid adenoma, especially when suspicious malignant adhesion is found during intraoperative exploration. In cases where multifocal thyroid nodules are associated with increased uptake of 99Tc-sestamibi, the possibility of coexisting carcinomas should be considered, not only for thyroid malignancy but also for the potential presence of intrathyroidal parathyroid carcinoma.
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MESH Headings
- Humans
- Male
- Parathyroid Neoplasms/surgery
- Parathyroid Neoplasms/pathology
- Parathyroid Neoplasms/diagnostic imaging
- Parathyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Neoplasms/diagnosis
- Aged
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/diagnostic imaging
- Hyperparathyroidism, Primary/surgery
- Hyperparathyroidism, Primary/etiology
- Hyperparathyroidism, Primary/pathology
- Hyperparathyroidism, Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Neoplasms, Multiple Primary/diagnosis
- Incidental Findings
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Affiliation(s)
- Tianfeng Xu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan Province, China
| | - Xun Zheng
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan Province, China
| | - Tao Wei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan Province, China.
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Abdullah AM, Qaradakhy AJ, Saeed YA, Salih AM, Karim S, Ali OA, Hassan SH, Nasraldeen SA, Mohammed SH, Kakamad FH. Papillary thyroid carcinoma associated with non‑functioning parathyroid carcinoma with Warthin's tumor of the parotid gland: A case report and brief literature review. MEDICINE INTERNATIONAL 2023; 3:26. [PMID: 37304572 PMCID: PMC10251473 DOI: 10.3892/mi.2023.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023]
Abstract
Multiple neck pathologies occurring simultaneously are a rare condition. The present study describes an extremely rare case of papillary thyroid carcinoma, non-functioning parathyroid carcinoma (PC) and Warthin's tumor of the parotid gland. A 59-year-old male presented with a 3-month history of anterior neck swelling. The neck ultrasound revealed a left-sided thyroid nodule associated with pathological lymph nodes. There was a parotid gland mass. A fine-needle aspiration of the left parotid mass was not diagnostic, although the left thyroid nodule revealed a malignancy with metastasis to the left cervical group lymph nodes. The patient underwent total thyroidectomy, left central and left lateral cervical lymph node dissection. A superficial parotidectomy was also performed. A histopathological examination revealed three different pathologies: Papillary thyroid microcarcinoma, PC and Warthin's tumor. The simultaneous occurrence of a Warthin's tumor, papillary thyroid microcarcinoma and PC is an unusual condition. The concurrent findings of these three pathologies have not yet been reported in the literature, at least to the best of our knowledge. The synchronous findings of PTC, non-functioning PC and Warthin's tumor are extremely rare, yet possible. Surgical intervention remains the most appropriate treatment strategy.
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Affiliation(s)
- Ari M. Abdullah
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
- Department of Pathology, Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Aras J. Qaradakhy
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
- Department of Radiology, Shorsh Teaching Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Yadgar A. Saeed
- Department of Pathology, Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Abdulwahid M. Salih
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
| | - Seema Karim
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Osama A. Ali
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Shko H. Hassan
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Shalaw A. Nasraldeen
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Shvan H. Mohammed
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46000, Iraq
| | - Fahmi H. Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46000, Iraq
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Simescu R, Pop M, Piciu A, Muntean V, Piciu D. Association of Parathyroid and Differentiated Thyroid Carcinomas: A Narrative Up-To-Date Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1184. [PMID: 36143862 PMCID: PMC9503363 DOI: 10.3390/medicina58091184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022]
Abstract
Aim: Parathyroid carcinoma (PC) is a rare endocrine malignancy that represents 0.005% of all malignant tumors. Associated PC and differentiated thyroid carcinoma (DTC) is an exceptionally rare condition, and the preoperative diagnostics and proper treatment are challenging. Almost all PCs and the majority of DTCs are diagnosed postoperatively, making correct surgical treatment questionable. Specific guidelines for parathyroid and thyroid carcinomas association treatment are lacking. The purposes of our study were to identify the association between parathyroid and thyroid carcinomas, to analyze the available published data, and to evaluate the possible relationship between preoperative diagnostic and surgical decision-making, and outcome-related issues. Material and methods: We performed a literature review of several databases from the earliest records to March 2022, using controlled vocabulary and keywords to search for records on the topic of PC and WDTC pathological association. The reference lists from the initially identified articles were analyzed to obtain more references. Results: We identified 25 cases of PC and DTC association, 14 more than the latest review from 2021. The mean age of patients was 55, with a female to male ratio of about 3:1. Exposure to external radiation was identified in only one patient, although it is considered a risk factor the development of both PC and DTC. The preoperative suspicion of PC was stated by the authors in only 25% of cases, but suspicion based on clinical, laboratory, ultrasound (US), and fine needle aspiration (FNA) criteria could have been justified in more than 50% of them. With neck ultrasound, 40% of patients presented suspicious features both for PC and thyroid carcinoma. Intra-operatory descriptions of the lesions revealed the highest suspicion (83.3%) of PC, but en bloc resection was recommended and probably performed in only about 50% of the cases. Histopathological examinations of the thyroid revealed different forms of papillary thyroid carcinoma (PTC) in most cases. Postoperative normocalcemia was achieved in 72% of patients, but follow-up data was missing in about 25% of cases. Conclusion: Associated PC and DTC is an exceptionally rare condition, and the preoperative diagnostic and treatment of the patients is a challenge. However, in most cases pre- and intraoperative suspicious features are present for identification by a highly specialized multidisciplinary endocrine team, who can thus perform the optimal treatment to achieve curability.
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Affiliation(s)
- Razvan Simescu
- Humanitas Hospital Cluj-Napoca, 400664 Cluj-Napoca, Romania
- Department of Surgery, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Miana Pop
- Humanitas Hospital Cluj-Napoca, 400664 Cluj-Napoca, Romania
- Department of Surgery, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Andra Piciu
- Department of Medical Oncology, University of Medicine and Pharmacy Iuliu Hatieganu Cluj–Napoca, 400347 Cluj-Napoca, Romania
- Institute of Oncology Prof. Dr. I. Chiricuta Cluj-Napoca, 400015 Cluj-Napoca, Romania
| | - Valentin Muntean
- Humanitas Hospital Cluj-Napoca, 400664 Cluj-Napoca, Romania
- Department of Surgery, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Doina Piciu
- Institute of Oncology Prof. Dr. I. Chiricuta Cluj-Napoca, 400015 Cluj-Napoca, Romania
- Doctoral School, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, 400347 Cluj-Napoca, Romania
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