ONCOCYTIC INTRATHYROID PARATHYROID ADENOMA MASQUERADING AS HURTHLE CELL NEOPLASM: FINE NEEDLE ASPIRATION CYTOLOGY OF TWO CASES

2021 ◽  
pp. 57-58
Author(s):  
Mega Lahori ◽  
Hua Chen
Keyword(s):  
Parathyroid Adenoma ◽  
Thyroid Tissue ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Thyroid Lobe ◽  
Cell Adenoma ◽  
Hürthle Cell ◽  
Hypoechoic Nodule ◽  
Left Thyroid Lobe ◽  
Pth Level

Ectopic parathyroid adenomas in thyroid tissue are uncommon (0.7 - 6%), and their oncocytic variants are exceedingly rare. We report two cases of intrathyroid parathyroid adenoma which were diagnosed as Hurthle cell adenoma on cytology. Case 1 is a 49-year-old female with a 2.4 cm hypoechoic nodule in the left lateral neck. Electrochemiluminescent immunoassay of the aspirate revealed PTH level of 422 pg/ml, conrming the presence of hyperfunctional parathyroid tissue. Subsequent resection of the left thyroid lobe revealed an enlarged intrathyroidal parathyroid. Case 2 is a 58-year-old female with a 2.1 cm hypoechoic nodule in the posterior-mid left thyroid lobe. Strong overexpression of parathyroid hormone and Chromogranin A genes and low expression of thyrocyte-related genes suggested parathyroid origin of the cells sampled. MEN1 mutation and multiple copy number alterations indicated the neoplastic nature of the nodule. Parathyroid oxyphil cells and oncocytic thyrocytes share cytomorphological ndings and distinguishing them by cytology alone is challenging, especially when the targeted lesion is intrathyroidal. Distinguishing intrathyroid oncocytic parathyroid adenoma from oncocytic thyroid follicular lesions has signicant clinical implications as Bethesda-IV category lesions have 20%–30% risk of malignancy. While stippled chromatin or intracytoplasmic fat vacuoles may be suggestive of parathyroid origin, these are not specic. Classifying the origin of a nodule as parathyroid vs thyroid rests upon the detection of PTH in aspirate material by ECL, immunocytochemistry or next-generation sequencing. In parathyroid aspirates, PTH level 100 pg/mL is suggestive of the presence of PTH-secre ≥ ting tissue at the site biopsied or along the needle track.

scholarly journals Primary Hyperparathyroidism due to Parathyroid adenoma presenting as recurrent acute pancreatitis

2017 ◽  
Vol 8 (1) ◽  
pp. 98-100
Author(s):  
Tarun J George ◽  
Pughazhendhi Thangavelu ◽  
S Zahir Hussain ◽  
MP Kumaran ◽  
Kini Ratnakar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Elevated Serum ◽  
Surgical Excision ◽  
Medical Sciences ◽  
Thyroid Lobe ◽  
Recurrent Acute Pancreatitis ◽  
Hypoechoic Nodule ◽  
Left Thyroid Lobe

Primary hyperparathyroidism (PHPT) due to parathyroid adenoma presenting as recurrent acute pancreatitis is a rare entity. A 17-year-old male presented with recurrent attacks of pancreatitis and was found to have elevated serum calcium and Parathyroid hormone levels, 11.9mg/dL (8.5-10.2 mg/dL) and 396 pg/ml (10-65pg/ml) respectively. USG neck showed a 1.1 x 0.9 cm hypoechoic nodule in the superior aspect of left thyroid lobe. Parathyroid scintigraphy findings were consistent with parathyroid adenoma. After recovery of pancreatitis, surgical excision of the adenoma was done and the histopathological findings confirmed parathyroid adenoma. There were no further recurrence of pancreatitis following the excision.Asian Journal of Medical Sciences Vol.8(1) 2017 98-100

scholarly journals Bilateral Hurthle cell adenoma of thyroid: a rare case report

2017 ◽  
Vol 3 (2) ◽  
pp. 462
Author(s):  
Rahul Kumar Singh ◽  
Amit Goyal ◽  
Poonam Elhence ◽  
Amit Kumar
Keyword(s):  
Cell Carcinoma ◽  
Needle Aspiration ◽  
Thyroid Lobe ◽  
Aspiration Cytology ◽  
Cell Adenoma ◽  
Fine Needle ◽  
Hürthle Cell ◽  
Hürthle Cell Carcinoma ◽  
Hurthle Cell Carcinoma ◽  
Needle Aspiration Cytology

<p class="abstract">Hurthle cell of adenoma of thyroid gland is rare neoplasms of the thyroid.  Size more than 4 cm is rare finding and moreover the occurrence of a multifocal Hurthle cell adenoma is not supported by antecedents in literature. Sonography fails to identify its potentials for malignancy while fine needle aspiration cytology couldn’t differentiate it from Hurthle cell carcinoma of thyroid. The management of Hurthle cell adenoma and Hurthle cell carcinoma is quite different and hence diagnostic dilemma should be sorted out early. A 26 year old female presented with bilateral thyroid swelling. Ultrasonography of thyroid gland showed complex solid cystic nodules in bilateral thyroid lobes with right thyroid lobe measuring 4.1×3.4×2.5 cm and left thyroid lobe measure 3.1×1.7×1.6 cm. Fine needle aspiration cytology (FNAC) was suggestive of papillary malignancy with extensive Hurthle cell changes (Class V, Bethesda classification). The patient underwent total thyroidectomy with bilateral parathyroid gland preservation. Histopathology revealed it as Hurthle cell adenoma (HCA) involving bilateral lobe and multifocal in nature. The treatment of choice for Hurthle cell carcinoma is total thyroidectomy with neck dissection depending on the nature of the lesions. However the treatment of Hurthle cell adenoma is only hemithyroidectomy or lobectomy as it is a benign condition. Differentiation of these two entirely different conditions warrants more studies<span lang="EN-IN">.</span></p>

scholarly journals An Unusual Case of Primary Hyperparathyroidism: Case Report of a Bifocal Intrathyroidal Parathyroid Carcinoma

2020 ◽  
pp. 014556132097746
Author(s):  
Maxime Damien ◽  
Alexandra Rodriguez ◽  
Pierre Kleynen ◽  
Didier Dequanter ◽  
Cyril Bouland
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Photon Emission ◽  
Parathyroid Tissue ◽  
Emission Computed Tomography ◽  
Thyroid Lobe ◽  
Imaging Results ◽  
Pet Ct ◽  
Left Thyroid Lobe

Intrathyroidal parathyroid carcinoma is an extremely rare cause of primary hyperparathyroidism. We reported a 51-year old woman who presented symptoms of hypercalcemia. 99mTc sestamibi single-photon emission computed tomography/computed tomography (CT) revealed a large hypermetabolic nodule in the left thyroid lobe suggestive of hyperfunctioning parathyroid tissue. 11C-methionine positron emission tomography/computed tomography (PET/CT) and 18F-fluorocholine PET/CT confirmed the nodule in the left thyroid lobe and also revealed a hypermetabolic activity on the posterior surface of the lower left pole. The patient underwent a total thyroidectomy and parathyroidectomy, and a diagnosis of bifocal intrathyroidal parathyroid carcinoma was confirmed. We present the first reported case of bifocal intrathyroidal carcinoma and discuss the discordant imaging results.

scholarly journals Intrathyroidal Parathyroid Carcinoma: Report of an Unusual Case and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Lizette Vila Duckworth ◽  
William E. Winter ◽  
Mikhail Vaysberg ◽  
César A. Moran ◽  
Samer Z. Al-Quran
Keyword(s):  
Thyroid Gland ◽  
Parathyroid Carcinoma ◽  
Unusual Case ◽  
Thyroid Tissue ◽  
Parathyroid Tissue ◽  
African American Female ◽  
Thyroid Lobe ◽  
Local Infiltration ◽  
Sestamibi Scan ◽  
The Right

Intrathyroidal parathyroid carcinoma is an exceedingly rare cause of primary hyperparathyroidism. A 51-year-old African American female presented with goiter, hyperparathyroidism, and symptomatic hypercalcemia. Sestamibi scan revealed diffuse activity within an enlarged thyroid gland with uptake in the right thyroid lobe suggestive of hyperfunctioning parathyroid tissue. The patient underwent thyroidectomy and parathyroidectomy. At exploration, a 2.0 cm nodule in the usual location of the right inferior parathyroid was sent for intraoperative frozen consultation, which revealed only ectopic thyroid tissue. No parathyroid glands were identified grossly on the external aspect of the thyroid. Interestingly, postoperative parathyroid hormone levels normalized after removal of the thyroid gland. Examination of the thyroidectomy specimen revealed a 1.4 cm parathyroid nodule located within the parenchyma of the right superior thyroid, with capsular and vascular invasion and local infiltration into surrounding thyroid tissue. We present only the eighth reported case of intrathyroidal parathyroid carcinoma and review the literature.

scholarly journals Appearance of Hürthle cell carcinoma soon after surgical extirpation of Hürthle cell adenoma and follicular adenoma of the thyroid gland

2015 ◽  
Vol 49 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Nevena Ristevska ◽  
Sinisa Stojanoski ◽  
Daniela Pop Gjorceva
Keyword(s):  
Thyroid Gland ◽  
Cell Carcinoma ◽  
Tumour Size ◽  
Follicular Adenoma ◽  
Needle Aspiration ◽  
Cell Adenoma ◽  
Rare Tumour ◽  
Hürthle Cell ◽  
Hürthle Cell Carcinoma ◽  
Hurthle Cell Carcinoma

Abstract Background. Hürthle cell neoplasms could be benign (Hürthle cell adenoma) or malignant (Hürthle cell carcinoma). Hürthle cell carcinoma is a rare tumour, representing 5% of all differentiated thyroid carcinomas. The cytological evaluation of Hürthle cell neoplasms by fine needle aspiration biopsy (FNAB) is complicated because of the presence of Hürthle cells in both Hürthle cell adenoma and Hürthle cell carcinoma. Thus, the preoperative distinction between these two entities is very difficult and possible only with pathohistological findings of the removed tumour. Case report. A 57-year old female patient was admitted at our Department, for investigation of nodular thyroid gland. She was euthyroid and FNAB of the nodules in both thyroid lobes were consistent of Hürthle cell adenoma with cellular atypias. After thyroidectomy the histopathology revealed Hürthle cell adenoma with high cellular content and discrete cellular atypias in the left lobe and follicular thyroid adenoma without cellular atypias in the right lobe. One year after substitution therapy, a palpable tumour on the left side of the remnant tissue was found, significantly growing with time, presented as hot nodule on 99mTc-sestamibi scan and conclusive with Hürthle cell adenoma with marked cellularity on FNAB. Tumorectomy was performed and well-differentiated Hürthle cell carcinoma detected. The patient received ablative dose of 100 mCi 131I. No signs of metastatic disease are present up to date. Conclusions. The differences between Hürthle cell adenomas and Hürthle cell carcinomas could be clearly made only by histopathological evaluation. Patients with cytological diagnosis of Hürthle cell neoplasms should proceed to total thyroidectomy, especially if tumour size is > 1cm, FNAB findings comprise cellular atypias and/or multiple bilateral nodules are detected in the thyroid gland.

A rare case of hurthle cell adenoma and parathyroid adenoma

2018 ◽  
Author(s):  
Fulden Sarac ◽  
Sumru Savas ◽  
Pelin Tutuncuoglu
Keyword(s):  
Parathyroid Adenoma ◽  
Rare Case ◽  
Cell Adenoma ◽  
Hürthle Cell

scholarly journals A Parathyroid Adenoma: Benign Disease Presenting with Hyperparathyroid Crisis

2010 ◽  
Vol 2010 ◽  
pp. 1-4
Author(s):  
A. S. Tahim ◽  
J. Saunders ◽  
P. Sinha
Keyword(s):  
Parathyroid Adenoma ◽  
Epigastric Pain ◽  
Cystic Mass ◽  
Benign Disease ◽  
Thyroid Lobe ◽  
Ultrasound Studies ◽  
Rare Manifestation ◽  
Parathyroid Disease ◽  
Endocrine Surgeon ◽  
Pth Level

Hyperparathyroid crisis is a rare manifestation of parathyroid disease. We present the case of a 53-year-old gentleman with a review of the current literature. He presented in acute renal failure with epigastric pain and vomiting. His serum-corrected calcium (CCa2+) was raised at 5.2 mmol/L, in addition to a massively raised parathyroid hormone (PTH) level (3957 ng/L). Ultrasound studies of the neck revealed a 2 cm well-defined mass inferoposterior to right thyroid lobe. CT scans of the neck showed a normal mediastinum and confirmed no associated lymphadenopathy. Having undergone medical resuscitation for 9 days, a neck exploration revealed a cystic mass, which was excised. Histological investigations revealed a 9.25 g, cystic parathyroid adenoma with no features of malignancy. His PTH and CCa2+returned to normal postoperatively. This suspicious presentation of benign disease, including a marked elevation in PTH, highlights the challenges facing the endocrine surgeon in dealing with parathyroid disease.

scholarly journals SAT-388 Dry Cough as Only Sign of a Parathyroid Adenoma Producer of PTH

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Antonio Selman-Geara ◽  
Antonio Benitez-Camporro ◽  
Guillermo Defillo-Guerrero ◽  
Ammar Ibrahim ◽  
Yasmin Redondo, Cytopathologist ◽  
...  
Keyword(s):  
Parathyroid Adenoma ◽  
Clinical Manifestations ◽  
Clinical Importance ◽  
Clinical Findings ◽  
Left Lobe ◽  
Productive Cough ◽  
Thyroid Lobe ◽  
Free T4 ◽  
Free T3 ◽  
Left Thyroid Lobe

Abstract BACKGROUND: The parathyroid adenoma producing an excess of PTH is characterized by hypercalcemia, asthenia, physical weakness and renal lithiasis. This clinical case is presented only with a dry (non-productive) cough sign of long duration.CASE: 51-year-old female born in Padre Las Casas, D.R. presenting with chief complain of dry cough for about four years. Clinical findings: (03/13/2019) Height 62”, Weight 142 lbs, Temperature 36.2 Celsius, BP 90/60 mmHg, RR 16 rpm, HR 60 bpm, on her neck no adenopathies or thyroid changes. Occasional coughing. A sonographic evaluation of the neck (04/09/2019) reveals a solid, heterogeneous nodular image of 0.7 cm x 0.5 cm in the left lobe of the Thyroid (Fig. 1) which by FNAB (04/10/2019) showed a benign adenomatoid node with cystic changes (Bethesda II) (Fig. 2). TEST: (03/20/2019) anti-TG 0.10 IU/mL (NV -115), anti-TPO 9.00 IU/mL (NV -34), TG 9.41 (NV -78 ng/mL), TSH 0.34 μIU/mL (VN 0.27-4.20), free T3 2.05 pg/mL (NV 2.04-4.40), total T3 0.74 ng/mL (NV 0.83-2.00), total T4 8.46 μg/dL (NV 5.1-14.1), free T4 1.61 ng/dL (NV 0.93-1.71) Calcium 10.4 mg/dL (NV 8.1-10.4), Phosphorus 2.6 mg/dL (NV 2.5-4.5), PTH-Intact 157 pg/mL (NV 14.5-87.1) Thyroid-Parathyroid scintigraphy (Sestamibi-Technetium 99mTc04: 15 mCi) (04/23/2019) shows lower left Parathyroid Adenoma (Fig. 3). She undergoes surgery (05/23/2019) removing the left thyroid lobe and left inferior parathyroid gland whose pathology shows chronic nodular colloid goiter, with areas of hemorrhage. Parathyroid adenoma of main cells (Fig. 4-5). Post-surgical TEST (06/24/2019) PTH-intact 69.0 pg/mL (NV 14.5-87.1), Calcium 8.6 mg/dL (NV 8.1-10.4), Phosphorus 2.7 mg/dL (NV 2.5-4.5), anti-TG 10.0 IU/mL (NV &lt;115), anti-TPO 9.00 IU/mL (NV &lt;34), TG 8.92 ng/mL (NV &lt;78), total T3 0.68 ng/mL (NV 0.83-2.00), free T3 1.95 pg/mL (NV 2.04-4.40), total T4 6.40 μg/dL (NV 5.1-14.1), free T4 1.02 ng/dL (NV 0.93-1.71). Post-surgical clinical evaluation (06/21/2019) Weight 142 lbs, Temperature 36.5 Celsius, BP 110/70 mmHg, RR 16 rpm, HR 60 bpm. Patient has not shown signs of coughing. Last TESTS (10/20/2019) Calcium 9.40 mg/dL, Phosphorus 3.10 mg/dL, PTH-intact 24.40 pg/mL, TG 11.90 ng/mL, total T4 6.80 μg/dL, free T4 1.23 ng/dL, total T3 0.88 ng/mL, free T3 2.66 pg/mL, anti-TPO 11.14 IU/mL, anti-TG 10 IU/mL. CONCLUSIONS: Lower left (benign) parathyroid adenoma whose clinical manifestations are not common. Dry (non-productive) cough is not known as a manifestation of elevated PTH-intact. Calcium and Phosphorus levels in normal values. In addition, histological alterations of the left thyroid lobe of benign character with few manifestations of hormonal alterations and normal antibodies. It is of crucial clinical importance to observe and document more cases with similar presentation in order to identify the possible causes of cough with an elevated PTH manifestation.

scholarly journals Intrathyroidal Parathyroid Cyst: An Unusual Neck Mass

2017 ◽  
Vol 10 ◽  
pp. 117955141769813 ◽  
Author(s):  
Maswood M Ahmad ◽  
Mohammed Almohaya ◽  
Mussa H Almalki ◽  
Naji Aljohani
Keyword(s):  
Thyroid Tissue ◽  
Parathyroid Tissue ◽  
Rare Condition ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Maximum Diameter ◽  
High Concentration ◽  
Clear Fluid ◽  
Parathyroid Cyst ◽  
Parathyroid Dysfunction

Parathyroid cyst (PC) is a very rare condition. A case of intrathyroidal PC is being reported here in a 53-year-old woman who presented to the endocrine clinic with slowly progressive painless left anterior neck swelling for 1 year with no symptoms of thyroid or parathyroid dysfunction and no compressive symptoms. Ultrasound of the thyroid showed a well-defined cystic lesion measuring 4.7 × 3.6 cm in maximum diameter with internal echoes within the cyst located in the left lobe of the thyroid gland. Fine needle aspiration revealed colorless clear fluid with a high concentration of parathyroid hormone. The patient underwent left hemithyroidectomy at her request. Histopathology revealed parathyroid tissue with unilocular cyst and thyroid tissue with goitrous changes. She was in remission, and there was no evidence of thyroid or parathyroid dysfunction after surgery.

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