A nonfunctioning parathyroid carcinoma misdiagnosed as a follicular thyroid nodule

World Journal of Surgical Oncology

Claudio Marcocci¹  Paolo Miccoli³  Alberto Campomori²  Fulvio Basolo³  Silvia Magno¹  Liborio Torregrossa³  Gianluca Frustaci³  Filomena Cetani² 

[1] Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy;Endocrine Unit 2, University Hospital of Pisa, Via Paradisa 2, Pisa, 56124, Italy;Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy

关键词: Parathyroid tumorigenesis;    PTH;    Chromogranin A;    Calcium metabolism;    Primary hyperparathyroidism;   

Others  :  1225045
DOI  :  10.1186/s12957-015-0672-9

 received in 2015-06-15, accepted in 2015-08-03,  发布年份 2015

【 摘 要 】

Parathyroid carcinoma (PC) is a rare endocrine malignancy. The tumor is mostly functioning, causing severe primary hyperparathyroidism, with high serum calcium and parathyroid hormone (PTH) levels. Nonfunctioning PC is extremely rare. We report a 50-year-old male patient who was referred to our Department for a right thyroid nodule, incidentally detected on carotid Doppler ultrasound scan, with a fine-needle aspiration cytology showing a follicular lesion. At the time of our evaluation, neck ultrasound showed a 1.3 cm right hypoechoic thyroid nodule with irregular margins and the absence of enlarged bilateral cervical lymph nodes. Thyroid function tests were normal. Serum calcium was normal and plasma PTH slightly above the upper limit of the normal range. The patients underwent right lobectomy. The intraoperative frozen-section pathological examination raised the suspicion of a PC. Definitive histology showed a markedly irregular infiltrative growth of the tumor with invasion of the thyroid tissue and cervical soft tissues. Immunostaining for thyroglobulin was negative, whereas staining for chromogranin A and PTH showed a strong reactivity. Based on the microscopic findings and the immunohistochemical profile, the tumor was diagnosed as a PC. Postoperative serum calcium and phosphate levels were in the normal range. One month after surgery, serum calcium and PTH were normal. Neck ultrasound and total body computed tomography scan were negative for local and metastatic disease. Eight months later, serum calcium was normal and plasma PTH level remained around the upper limit of normal range. Neck ultrasound did not show any pathological lesions. This is the first case of a nonfunctioning sporadic PC misdiagnosed prior of surgery as a follicular thyroid nodule. The parathyroid nature of the neck lesion could not be suspected before surgery. Fine-needle aspiration cytology (FNAC) may fail to distinguish a parathyroid tumor from a benign thyroid nodule because at FNAC, parathyroid and thyroid lesions have some morphological similarities. Histological criteria are not always sufficient for the differential diagnosis, which can definitely be established using immunohistochemistry.

【 授权许可】

   
2015 Cetani et al.

【 图 表 】

Fig. 1.

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