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Original Article
- Fine Needle Aspiration Cytology of Parathyroid Lesions
- Ilyeong Heo, Sunhoo Park, Chang Won Jung, Jae Soo Koh, Seung-Sook Lee, Hyesil Seol, Hee Seung Choi, Soo Youn Cho
- Korean J Pathol. 2013;47(5):466-471. Published online October 25, 2013
- DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.466
- 8,693 View
- 77 Download
- 32 Crossref
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Abstract
PDF Background There has been an increase in the use of fine needle aspiration cytology (FNAC) for the diagnosis of parathyroid lesions (PLs). Differentiation between a thyroid lesion and a PL is not easy because of their similar features. We reviewed parathyroid aspirates in our institution and aimed to uncover trends in diagnostic criteria.
Methods We selected 25 parathyroid aspirates (from 6 men and 19 women) confirmed surgically or immunohistochemically from 2006 to 2011.
Results Major architectural findings of PLs include scattered naked nuclei, loose clusters, a papillary pattern with a fibrovascular core, tight clusters, and a follicular pattern. These architectures were commonly admixed with one another. Cytological features included anisokaryosis, stippled chromatin, a well-defined cell border, and oxyphilic cytoplasm. Eighteen of the 25 patients were diagnosed with PL using FNAC. Seven patients had been misdiagnosed with atypical cells (n=2), benign follicular cells (n=2), adenomatous goiter (n=2) and metastatic carcinoma (n=1) in FNAC. Using clinicoradiologic data, the sensitivity of the cytological diagnosis was 86.7%. The cytological sensitivity decreased to 50% without this information.
Conclusions FNAC of PL is easily confused with thyroid lesions. A combination of cytological parameters and clinical data will be required to improve the diagnostic sensitivity of PLs.
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Citations
Citations to this article as recorded by
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Case Reports
- Parathyromatosis: Critical Diagnosis Regarding Surgery and Pathologic Evaluation
- Ayşegül Aksoy-Altinboga, Ayşegül Akder Sari, Türkan Rezanko, Mehmet Haciyanli, Aylin Orgen Calli
- Korean J Pathol. 2012;46(2):197-200. Published online April 25, 2012
- DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.2.197
- 7,042 View
- 40 Download
- 12 Crossref
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Abstract
PDF
Parathyromatosis, in which several nodules of hyperfunctioning parathyroid tissue form in the neck and mediastinum, is a rare cause of recurrent hyperparathyroidism. However, there are some theories regarding the origin of parathyromatosis, and seeding after rupture of the parathyroid gland capsule during surgical removal of a parathyroid lesions is the most regarded one. Herein, we report a 41-year-old man who presented with multiple parathyroid nodules in and around the left thyroid lobe 5 years after parathyroid surgery for secondary hyperparathyroidism that was finally diagnosed as parathyromatosis. We discuss the differential diagnosis of parathyromatosis from other parathyroid tumors, particularly from parathyroid carcinoma, which is important in the management of a suspected lesion.
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Citations
Citations to this article as recorded by- Intractable Parathyromatosis despite extensive surgical interventions: A case report with literature review
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Florentino Carral, Ana Isabel Jiménez, Mariana Tomé, Javier Alvarez, Ana Díez, Concepción García, Vicente Vega, Carmen Ayala
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Abraham E. Wei, Matthew R. Garrett, Ankur Gupta
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M Haciyanli, S Karaisli, S Gucek Haciyanli, A Atasever, D Arikan Etit, EO Gur, T Acar
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I. Achour, S. Charfi, M.A. Chaabouni, A. Chakroun, F. Guermazi, B. Hammami, A. Ghorbel
La Revue de Médecine Interne.2017; 38(1): 61. CrossRef - Recurrent primary hyperparathyroidism due to Type 1 parathyromatosis
Monica Jain, David L. Krasne, Frederick R. Singer, Armando E. Giuliano
Endocrine.2017; 55(2): 643. CrossRef
- Intractable Parathyromatosis despite extensive surgical interventions: A case report with literature review
- Functioning Parathyroid Carcinoma: A case report.
- Kyoung Chan Choi, Won Hee Choi
- Korean J Pathol. 1996;30(2):169-172.
- 1,382 View
- 12 Download
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Abstract
PDF
- Parathyroid carcinoma is a relatively rare endocrine tumor, accounting for approximately 1 to 5% of patients with primary hyperparathyroidism. Patients with parathyroid carcinomas are often symptomatic, have markedly elevated calcium levels, and have a palpable cervical mass. They are equally distributed between the sexes and usually present 10 years before their benign counterparts. The diagnosis is suspected when the tumor is large, parathyroid hormone levels are high, and a palpable mass is present in the neck. Parathyroid carcinoma is often misdiagnosed preoperatively, suspected intraoperatively, and only confirmed postoperatively. We experienced a case of hyperfunctioning parathyroid carcinoma in a 36 year old man, which was confirmed microscopically. The tumor showed: 1) capsular and blood vessel invasion; 2) frequent mitotic figures in the parenchymal cells; 3) a trabecular pattern, and 4) intervening thick fibrous bands. Immunohistochemical stain of p53 may be one of the useful methods in identifying malignancy of parathyroid gland.
- Oncocytic Parathyroid Adenoma Associated with Primary Hyperparathyroidism: A Case Report.
- Jai Hyang Go
- Korean J Pathol. 2001;35(3):267-269.
- 1,630 View
- 37 Download
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Abstract
PDF
- A rare case of functioning oncocytic parathyroid adenoma associated with primary hyperparathyroidism was found in a 45-year-old woman. The preoperative serum calcium level was 13.1 mg/dL, the phosphate level was 2.44 mg/dL and the parathyroid hormone level was 153 pg/mL. Neck CT revealed a 2.5x1x1 cm, well enhanced mass behind the left thyroid gland, which was compatible with parathyroid adenoma. The removed parathyroid gland showed a well circumscribed, ovoid, brown colored, soft, solid mass. Histologically, this mass was composed of broad sheets of uniform cells having round dense nuclei and abundant eosinophilic granular cytoplasms. The adjacent rim of the normal parathyroid tissue was identified in the periphery of the mass. After operation, all hormone levels were normalized.
- Cytologic Findings of Parathyroid Carcinoma: Report of Two Cases.
- Yun Hee Jin, Yong Wook Park, Mi Sheon Jin, Seung Sam Paik, Se Jin Jang, Moon Hyang Park
- Korean J Cytopathol. 2003;14(1):1-6.
- 1,814 View
- 29 Download
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Abstract
PDF
- Parathyroid carcinoma is a rare disorder accounting for 0.5% to 5% of parathyroid neoplasia. Diagnosis of parathyroid carcinoma in fine needle aspiration cytology(FNAC) is difficult because all characteristic features of parathyroid carcinoma can be recognized in parathyroid adenoma or hyperplasia. Cellular atypism cannot be used for the diagnostic criteria of parathyroid carcinoma as malignancies of most other organs. We experienced two cases of cytologic features of parathyroid carcinoma confirmed by histologic examination. The majority of tumor cells formed large cohesive clusters, although individual tumor cells were also present. The tumor cells displayed rather pleomorphic round to oval nuclei, occasional prominent nucleoli, and distinct cytoplasmic margin. Occasionally karyolysis, anuclear cells, and nonepithelial cell clusters were noted. The histologic findings showed a partially lobulated architecture, with admixture of sheets of chief cells, oxyphil cells, and occasional water clear cells. The tumor infiltrated into the thyroid parenchyme and perithyroidal soft tissue. The electron microscopic study of case 1 disclosed typical findings of parathyroid neoplasm; clusters of secretory chief cells with centrally located round to ovoid nuclei, moderately clumped heterochromatins and one or two nucleoli. The tumor cells showed conspicous interdigitation of contiguous cell membrane and intercellular microvilli.
- Fine Needle Aspiration Cytology of Parathyroid Neoplasms: A Review of Three Cases.
- Lucia Kim, Jee Young Han, In Suh Park, Suk Jin Choi, Joon Mee Kim, Young Chae Chu
- Korean J Cytopathol. 2007;18(1):74-80.
- 1,777 View
- 25 Download
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Abstract
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- Parathyroid tumors may be difficult to distinguish from thyroid follicular lesions, especially when a tumor is nonfunctioning. We report here two cases of asymptomatic parathyroid carcinoma preoperatively misdiagnosed as thyroid follicular lesions, and one case of parathyroid adenoma showing hyperparathyroidism, and review the cytologic features favoring the diagnosis of parathyroid neoplasm. The cytologic findings that are characterized by clean background, monomorphic small cells, cohesive three-dimensional papillary clusters, small tight clusters with scattered naked nuclei, and well-defined clear cytoplasm favor a diagnosis for the parathyroid lesions. Cytologic findings such as macrofollicular structure, presence of colloid and macrophages, and presence of perivacuolar cytoplasmic granules on May-Grunwald-Giemsa stain support a diagnosis of a thyroid follicular lesion. The cytomorphology of parathyroid tumors is so variable that the distinction from a thyroid lesion cannot be based on the presence or absence of a single feature only but on the cytologic features as a whole.
- Mediastinal Parathyroid Cyst.
- Dong Hoon Kim, Gou Young Kim, Joung ho Han, Tae Seong Kim, Jhin gook Kim
- Korean J Pathol. 2003;37(4):296-297.
- 1,546 View
- 14 Download
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Abstract
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- The mediastinal parathyroid cyst is a very rare cause of space occupying lesions in the mediastinum.We report a case of a non-functioning mediastinal parathyroid cyst that occurred ina 42 year-old male. He suffered from foreign body sensation of the throat whenever he wasin the supine position. A chest computed tomography showed a round cyst with a narrowbase attached to trachea. It was white and tan, thin-walled semi-transparent cyst containingyellow and tan serous fluid. Microscopically it was characterized by a thin fibrous wall linedwith a single or double layer of uniform cells with clear cytoplasm and small nuclei. The liningcells were immunopositive for chromogranin A.
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