ECE2023 Poster Presentations Thyroid (163 abstracts)
Coexistence of Atypic Parathyroid Tumor and Metastatic Thyroid Papillary Carcinoma
Hatice Kostek 1 , Feyza Yener Ozturk 1 , Begum Kuver 1 , Rabia Abul 1 , Fatma Doğan İpek 1 , M. Masum Canat 1 , Selvinaz Erol 1 , Esra Cil Sen 1 , Mehmet Kostek 2 , Mehmet Taner Unlu 2 , Gulcin Cihangiroglu 3 , Alper Ozel 4 & Yuksel Altuntas 1
1University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Endocrinology and Metabolism, Istanbul, Turkey; 2University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, General Surgery, Istanbul, Turkey; 3University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Pathology, Istanbul, Turkey; 4University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Radiology, Istanbul, Turkey
Introduction: Atypical parathyroid tumour (APT) is a rare cause of primary hyperparathyroidism (PHPT) with a frequency of 1.2-1.3%. APT is a lesion with suspicious clinical and histological features of malignancy which does not completely respect the World Health Organization (WHO) criteria for diagnosis of Parathyroid Carcinoma (PC). There is a well-known association with PHT and medullary thyroid carcinoma for multiple endocrine neoplasia. However, concurrence of thyroid papillary carcinoma and PHPT is rarely defined in the literature. Here we report a case of multifocal thyroid papillary carcinoma accompanying severe hypercalcemia caused by APT.
Case Report: 43-year-old female patient was admitted to hospital with the complaint of weakness. Laboratory analyses revealed high serum calcium (14.45 mg/dl) and parathyroid hormone (PTH) (1651 ng/dl) with suppressed phosphorus (2.45 mg/dl). 24 hour urinary calcium excretion was 121 mg/day. The diagnosis was symptomatic PHPT. Bone densitometry showed osteopenia and ultrasonography(USG) was negative for renal calculus. Neck USG revealed a well-circumscribed, 43x27x33 mm, hypoechoic nodular lesion with cystic component close to the left lobe inferior pole, with intense vascularization in the inner structure. Technetium-99m-sestamibi parathyroid imaging showed parathyroid adenoma in the same localization. Also, a 9x8.5x6 mm hypoechoic solid nodule at the right thyroid lobe, containing punctate echogenic foci(ACR-TIRADS-V) and multiple nodules with the size of 5x5 mm (ACR-TIRADS II) and 7x6 mm (ACR-TIRADS IV) were shown by neck USG. Fine needle aspiration biopsy(FNAB) was resulted as Bethesda I for the right thyroid nodule twice. Serum calcitonin level was negative. Parathyroidectomy for symptomatic PHPT and thyroidectomy with frozen examination were planned as surgical procedure. Left lower parathyroid gland was excised. Since frozen examination was suspicious for papillary carcinoma, the patient underwent total thyroidectomy and central neck lymph node dissection. Pathology revealed APT, parathyroid cyst and multifocal classic type papillary microcarcinoma with lymph node metastasis. Serum calcium, phosphorus and PTH levels returned to normal levels as was 8.6 mg/dl 3.94 mg/dl and 46ng/dl, respectively. The patient was discharged at first day postoperatively without any postoperative complication.
Discussion: Although rarely seen, APT may be the cause of severe hypercalcemia in patients with PHPT especially in those with high PTH and large tumour size. Patients with APT should be strictly followed up as outcome is not known exactly. Thyroid nodules in those undergoing parathyroid surgery should also be evaluated carefully for medullary and non-medullary thyroid carcinoma.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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