Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls
Intrathyroidal parathyroid carcinoma is extremely rare clinical entity with potentially multiple diagnostic pitfalls. We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone le...
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| Veröffentlicht in: | Japanese journal of clinical oncology 2011-09, Vol.41 (9), p.1142-1146 |
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| container_title | Japanese journal of clinical oncology |
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| creator | Kruljac, Ivan Pavic, Ivana Matesa, Neven Mirosevic, Gorana Maric, Andreja Becejac, Branko Ivkic, Mirko Zadravec, Dijana Katinic, Krizo Vrkljan, Milan |
| description | Intrathyroidal parathyroid carcinoma is extremely rare clinical entity with potentially multiple diagnostic pitfalls. We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone level. Neck ultrasonography demonstrated multinodular goiter with predominant 34 mm nodule in left thyroid lobe. Additional 16 mm nodule was found beneath the left lobe. Routine percutaneous fine-needle aspiration of predominant nodule indicated follicular thyroid carcinoma, while left inferior nodule was confirmed to be of parathyroid origin. The patient underwent surgery, during which frozen sections identified medullary thyroid carcinoma with metastasis to upper mediastinal lymph node. Permanent sections of the predominant left lobe nodule revealed intrathyroidal parathyroid carcinoma surrounded with multiple microscopic metastases. Left inferior nodule was metastatic lymph node. Additional 10 mm intrathyroidal metastasis of primary parathyroid carcinoma was found within right thyroid lobe. This case indicates that fine-needle-aspiration and intraoperative biopsy are of limited value in diagnosing parathyroid carcinoma, especially if localized intrathyroidally. Oncological en-block resection is treatment of choice, implying ipsilateral lobectomy in case of thyroid invasion. This firstly described case of intrathyroidal parathyroid carcinoma causing intrathyroidal dissemination may influence future treatment strategies. |
| doi_str_mv | 10.1093/jjco/hyr094 |
| format | Article |
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We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone level. Neck ultrasonography demonstrated multinodular goiter with predominant 34 mm nodule in left thyroid lobe. Additional 16 mm nodule was found beneath the left lobe. Routine percutaneous fine-needle aspiration of predominant nodule indicated follicular thyroid carcinoma, while left inferior nodule was confirmed to be of parathyroid origin. The patient underwent surgery, during which frozen sections identified medullary thyroid carcinoma with metastasis to upper mediastinal lymph node. Permanent sections of the predominant left lobe nodule revealed intrathyroidal parathyroid carcinoma surrounded with multiple microscopic metastases. Left inferior nodule was metastatic lymph node. Additional 10 mm intrathyroidal metastasis of primary parathyroid carcinoma was found within right thyroid lobe. This case indicates that fine-needle-aspiration and intraoperative biopsy are of limited value in diagnosing parathyroid carcinoma, especially if localized intrathyroidally. Oncological en-block resection is treatment of choice, implying ipsilateral lobectomy in case of thyroid invasion. This firstly described case of intrathyroidal parathyroid carcinoma causing intrathyroidal dissemination may influence future treatment strategies.</description><identifier>ISSN: 0368-2811</identifier><identifier>EISSN: 1465-3621</identifier><identifier>DOI: 10.1093/jjco/hyr094</identifier><identifier>PMID: 21742652</identifier><language>eng</language><publisher>England</publisher><subject>Adult ; Biopsy, Fine-Needle ; Carcinoma - secondary ; Carcinoma - surgery ; Diagnostic Errors ; Frozen Sections ; Goiter, Nodular - etiology ; Humans ; Hypercalcemia - etiology ; Lymphatic Metastasis - diagnosis ; Male ; Neck Dissection ; Parathyroid Hormone - blood ; Parathyroid Neoplasms - blood ; Parathyroid Neoplasms - complications ; Parathyroid Neoplasms - pathology ; Parathyroid Neoplasms - surgery ; Parathyroidectomy ; Thyroid Neoplasms - secondary ; Thyroid Neoplasms - surgery ; Thyroidectomy</subject><ispartof>Japanese journal of clinical oncology, 2011-09, Vol.41 (9), p.1142-1146</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c349t-6e427222aee0c24ff0aadc30b8ad00130b872b27a18f53dc1ed73b5061d447f3</citedby><cites>FETCH-LOGICAL-c349t-6e427222aee0c24ff0aadc30b8ad00130b872b27a18f53dc1ed73b5061d447f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21742652$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kruljac, Ivan</creatorcontrib><creatorcontrib>Pavic, Ivana</creatorcontrib><creatorcontrib>Matesa, Neven</creatorcontrib><creatorcontrib>Mirosevic, Gorana</creatorcontrib><creatorcontrib>Maric, Andreja</creatorcontrib><creatorcontrib>Becejac, Branko</creatorcontrib><creatorcontrib>Ivkic, Mirko</creatorcontrib><creatorcontrib>Zadravec, Dijana</creatorcontrib><creatorcontrib>Katinic, Krizo</creatorcontrib><creatorcontrib>Vrkljan, Milan</creatorcontrib><title>Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls</title><title>Japanese journal of clinical oncology</title><addtitle>Jpn J Clin Oncol</addtitle><description>Intrathyroidal parathyroid carcinoma is extremely rare clinical entity with potentially multiple diagnostic pitfalls. We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone level. Neck ultrasonography demonstrated multinodular goiter with predominant 34 mm nodule in left thyroid lobe. Additional 16 mm nodule was found beneath the left lobe. Routine percutaneous fine-needle aspiration of predominant nodule indicated follicular thyroid carcinoma, while left inferior nodule was confirmed to be of parathyroid origin. The patient underwent surgery, during which frozen sections identified medullary thyroid carcinoma with metastasis to upper mediastinal lymph node. Permanent sections of the predominant left lobe nodule revealed intrathyroidal parathyroid carcinoma surrounded with multiple microscopic metastases. Left inferior nodule was metastatic lymph node. Additional 10 mm intrathyroidal metastasis of primary parathyroid carcinoma was found within right thyroid lobe. This case indicates that fine-needle-aspiration and intraoperative biopsy are of limited value in diagnosing parathyroid carcinoma, especially if localized intrathyroidally. Oncological en-block resection is treatment of choice, implying ipsilateral lobectomy in case of thyroid invasion. This firstly described case of intrathyroidal parathyroid carcinoma causing intrathyroidal dissemination may influence future treatment strategies.</description><subject>Adult</subject><subject>Biopsy, Fine-Needle</subject><subject>Carcinoma - secondary</subject><subject>Carcinoma - surgery</subject><subject>Diagnostic Errors</subject><subject>Frozen Sections</subject><subject>Goiter, Nodular - etiology</subject><subject>Humans</subject><subject>Hypercalcemia - etiology</subject><subject>Lymphatic Metastasis - diagnosis</subject><subject>Male</subject><subject>Neck Dissection</subject><subject>Parathyroid Hormone - blood</subject><subject>Parathyroid Neoplasms - blood</subject><subject>Parathyroid Neoplasms - complications</subject><subject>Parathyroid Neoplasms - pathology</subject><subject>Parathyroid Neoplasms - surgery</subject><subject>Parathyroidectomy</subject><subject>Thyroid Neoplasms - secondary</subject><subject>Thyroid Neoplasms - surgery</subject><subject>Thyroidectomy</subject><issn>0368-2811</issn><issn>1465-3621</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkMtOwzAQRS0EoqWwYo-8Y4FC_cqj7FDFo1IlNt1HE3tCXSVxsR2h_gGfTaqWhzSaexdnZnEIuebsnrOZnG422k3XO89m6oSMucrSRGaCn5Ixk1mRiILzEbkIYcMYSwuVn5OR4LkSWSrG5GvRRQ9xOHfW0C38dQ1e2861QD9tXFP7j4OGthghDGMDjY7GNVLt9kQDEYdNG1fhAw2u9xqpq6mx8N65EK2m0BkaPUJssYt0a2MNTRMuydmQAa-OOSGr56fV_DVZvr0s5o_LREs1i0mGSuRCCEBkWqi6ZgBGS1YVYBjj-5KLSuTAizqVRnM0uaxSlnGjVF7LCbk9vN1699FjiGVrg8amgQ5dH8qiyNJZypkayLsDqb0LwWNdbr1twe9Kzsq9-HIvvjyIH-ib49--atH8sj-m5TfCfIR7</recordid><startdate>201109</startdate><enddate>201109</enddate><creator>Kruljac, Ivan</creator><creator>Pavic, Ivana</creator><creator>Matesa, Neven</creator><creator>Mirosevic, Gorana</creator><creator>Maric, Andreja</creator><creator>Becejac, Branko</creator><creator>Ivkic, Mirko</creator><creator>Zadravec, Dijana</creator><creator>Katinic, Krizo</creator><creator>Vrkljan, Milan</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201109</creationdate><title>Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls</title><author>Kruljac, Ivan ; Pavic, Ivana ; Matesa, Neven ; Mirosevic, Gorana ; Maric, Andreja ; Becejac, Branko ; Ivkic, Mirko ; Zadravec, Dijana ; Katinic, Krizo ; Vrkljan, Milan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c349t-6e427222aee0c24ff0aadc30b8ad00130b872b27a18f53dc1ed73b5061d447f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Biopsy, Fine-Needle</topic><topic>Carcinoma - secondary</topic><topic>Carcinoma - surgery</topic><topic>Diagnostic Errors</topic><topic>Frozen Sections</topic><topic>Goiter, Nodular - etiology</topic><topic>Humans</topic><topic>Hypercalcemia - etiology</topic><topic>Lymphatic Metastasis - diagnosis</topic><topic>Male</topic><topic>Neck Dissection</topic><topic>Parathyroid Hormone - blood</topic><topic>Parathyroid Neoplasms - blood</topic><topic>Parathyroid Neoplasms - complications</topic><topic>Parathyroid Neoplasms - pathology</topic><topic>Parathyroid Neoplasms - surgery</topic><topic>Parathyroidectomy</topic><topic>Thyroid Neoplasms - secondary</topic><topic>Thyroid Neoplasms - surgery</topic><topic>Thyroidectomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kruljac, Ivan</creatorcontrib><creatorcontrib>Pavic, Ivana</creatorcontrib><creatorcontrib>Matesa, Neven</creatorcontrib><creatorcontrib>Mirosevic, Gorana</creatorcontrib><creatorcontrib>Maric, Andreja</creatorcontrib><creatorcontrib>Becejac, Branko</creatorcontrib><creatorcontrib>Ivkic, Mirko</creatorcontrib><creatorcontrib>Zadravec, Dijana</creatorcontrib><creatorcontrib>Katinic, Krizo</creatorcontrib><creatorcontrib>Vrkljan, Milan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Japanese journal of clinical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kruljac, Ivan</au><au>Pavic, Ivana</au><au>Matesa, Neven</au><au>Mirosevic, Gorana</au><au>Maric, Andreja</au><au>Becejac, Branko</au><au>Ivkic, Mirko</au><au>Zadravec, Dijana</au><au>Katinic, Krizo</au><au>Vrkljan, Milan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls</atitle><jtitle>Japanese journal of clinical oncology</jtitle><addtitle>Jpn J Clin Oncol</addtitle><date>2011-09</date><risdate>2011</risdate><volume>41</volume><issue>9</issue><spage>1142</spage><epage>1146</epage><pages>1142-1146</pages><issn>0368-2811</issn><eissn>1465-3621</eissn><abstract>Intrathyroidal parathyroid carcinoma is extremely rare clinical entity with potentially multiple diagnostic pitfalls. We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone level. Neck ultrasonography demonstrated multinodular goiter with predominant 34 mm nodule in left thyroid lobe. Additional 16 mm nodule was found beneath the left lobe. Routine percutaneous fine-needle aspiration of predominant nodule indicated follicular thyroid carcinoma, while left inferior nodule was confirmed to be of parathyroid origin. The patient underwent surgery, during which frozen sections identified medullary thyroid carcinoma with metastasis to upper mediastinal lymph node. Permanent sections of the predominant left lobe nodule revealed intrathyroidal parathyroid carcinoma surrounded with multiple microscopic metastases. Left inferior nodule was metastatic lymph node. Additional 10 mm intrathyroidal metastasis of primary parathyroid carcinoma was found within right thyroid lobe. This case indicates that fine-needle-aspiration and intraoperative biopsy are of limited value in diagnosing parathyroid carcinoma, especially if localized intrathyroidally. Oncological en-block resection is treatment of choice, implying ipsilateral lobectomy in case of thyroid invasion. This firstly described case of intrathyroidal parathyroid carcinoma causing intrathyroidal dissemination may influence future treatment strategies.</abstract><cop>England</cop><pmid>21742652</pmid><doi>10.1093/jjco/hyr094</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Japanese journal of clinical oncology, 2011-09, Vol.41 (9), p.1142-1146 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Biopsy, Fine-Needle Carcinoma - secondary Carcinoma - surgery Diagnostic Errors Frozen Sections Goiter, Nodular - etiology Humans Hypercalcemia - etiology Lymphatic Metastasis - diagnosis Male Neck Dissection Parathyroid Hormone - blood Parathyroid Neoplasms - blood Parathyroid Neoplasms - complications Parathyroid Neoplasms - pathology Parathyroid Neoplasms - surgery Parathyroidectomy Thyroid Neoplasms - secondary Thyroid Neoplasms - surgery Thyroidectomy |
| title | Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls |
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