Two cases synchronous atypical parathyroid adenomas and papillary thyroid carcinoma
Iya A. Voronkova,
Anastasiya M. Lapshina,
Larisa E. Gurevich,
Ludmila Ya. Rozhinskaya,
Timur A. Britvin,
Alexey V. Krivosheev,
Ilya V. Kim,
Sergey N. Kuznetsov,
Natalia G. Mokrysheva 
Abstract
Most clinicians are well aware of the coexistence of medullary thyroid cancer and hyperparathyroidism in hereditary and sporadic multiple endocrine neoplasia syndromes. Тhe reported incidence of nonmedullary thyroid carcinoma in patients with primary hyperparathyroidism (pHPT) is only approximately 3%. Papillary thyroid carcinomas (PTC) is a malignant epithelial tumour. PTC represent up to 87% of all thyroid carcinomas. Atypical parathyroid adenoma (APA) are a subset of parathyroid neoplasms that exhibit some of the features of parathyroid carcinoma but lack unequivocal invasive growth. APA represents about 0.5–4% of cases of PHPT. As a group, they may be considered tumors of uncertain malignant potential. The clinical importance, and long-term outcomes as well as appropriate operative management and surveillance are not well defined for APA probably due to the overall low prevalence as well as the lack of a standard definition of APA.
We report two cases of a 63-year-old woman and 57-year-old man with a synchronous atypical parathyroid adenoma and papillary thyroid carcinoma. One of this patients had a classic symptoms of pHPT, including severe metabolic bone disease and renal disease, but another didn’t have. The mean preoperative calcium was 3,48 and 4,1 (range 2.12–2.6) mmol/l and a mean parathyroid hormone (PTH) of 1300 and 1533 (range 15–65) pg/ml, respectively. Thyroid ultrasound didn’t show a nodule with features of the thyroid carcinoma in both cases. The thyroid cancer was suspected after intraoperative revision. The patients underwent a total thyroidectomy and surgical excision of the parathyroid adenoma. Surgical pathology showed papillary microcarcinoma in both cases (in the first – unilateral, in the second – bilateral) and APA.
Awareness of this condition will enable clinicians to evaluate for possible thyroid pathology in patients with primary hyperparathyroidism. Both of these endocrine conditions could then be managed with a single surgery involving concomitant resection of the thyroid and parathyroid glands.
About the Authors
Iya A. VoronkovaEndocrinology Research Centre; Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
MD, PhD
Anastasiya M. Lapshina
Endocrinology Research Centre
Russian Federation
MD, PhD
Larisa E. Gurevich
Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
PhD, Professor
Ludmila Ya. Rozhinskaya
Endocrinology Research Centre
Russian Federation
MD, PhD, Professor
Timur A. Britvin
Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
MD, PhD
Alexey V. Krivosheev
Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
MD
Ilya V. Kim
Endocrinology Research Centre
Russian Federation
MD, PhD
Sergey N. Kuznetsov
Endocrinology Research Centre
Russian Federation
MD
Natalia G. Mokrysheva
Endocrinology Research Centre
Russian Federation
MD, PhD, Professor
References
1. Vysetti S, Sridhar P, Theckedath B, et al. Synchronous papillary thyroid carcinoma and primary hyperparathyroidism: diagnosis and management issues. Hosp Pract (1995). 2012;40(4):16-19. doi: 10.3810/hp.2012.10.998.
2. Rosai J, Albores Saavedra J, Asioli S, et al. Papillary thyroid carcinoma. In: Lloyd RV, Osamura RY, Kloppel G, Rosai J, editors. WHO classification of tumours of endocrine organs. Lyon: IARC; 2017. р. 81-91.
3. McCoy KL, Seethala RR, Armstrong MJ, et al. The clinical importance of parathyroid atypia: is long-term surveillance necessary? Surgery. 2015;158(4):929-935; discussion 935-926. doi: 10.1016/j.surg.2015.06.022.
4. Christakis I, Busaidy NL, Cote GJ, et al. Parathyroid carcinoma and atypical parathyroid neoplasms in MEN1 patients; A clinico-pathologic challenge. The MD Anderson case series and review of the literature. Int J Surg. 2016;31:10-16. doi: 10.1016/j.ijsu.2016.05.035.
5. Dobrinja C, Santandrea G, Giacca M, et al. Effectiveness of Intraoperative Parathyroid Monitoring (ioPTH) in predicting a multiglandular or malignant parathyroid disease. Int J Surg. 2017; 41 Suppl 1:S26-S33. doi: 10.1016/j.ijsu.2017.02.063.
6. DeLellis RA, Arnold A, Eng C, et al. Parathyroid adenoma. In: Lloyd RV, Osamura RY, Kloppel G, Rosai J, editors. WHO classification of tumours of endocrine organs. Lyon: IARC; 2017. р. 153-158.
7. Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122-1129. doi: 10.1210/jc.2012-4022.
8. Yu N, Donnan PT, Murphy MJ, Leese GP. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol (Oxf). 2009;71(4):485-493. doi: 10.1111/j.1365-2265.2008.03520.x.
9. Мокрышева Н.Г., Рожинская Л.Я., Перетокина Е.В., и др. Анализ основных эпидемиологических характеристик первичного гиперпаратиреоза в России (по данным регистра). // Проблемы эндокринологии. – 2012. – T. 58. – №5. – С. 16–20 [Mokrysheva NG, Rozhinskaia LY, Peretokina EV, et al. The results of analysis of the major epidemiological characteristics of primary hyperparathyroidism in Russia based on the registry data. Problems of endocrinology. 2012;58(5):16-20. (In Russ.)] doi: 10.14341/probl201258516-20.
10. DeLellis RA. Parathyroid tumors and related disorders. Mod Pathol. 2011;24 Suppl 2:S78-93. doi: 10.1038/modpathol.2010.132.
11. Elgoweini M, Chetty R. Hyalinizing parathyroid adenoma and hyperplasia: report of 3 cases of an unusual histologic variant. Ann Diagn Pathol. 2011;15(5):329-332. doi: 10.1016/j.anndiagpath.2011.03.001.
12. Alwaheeb S, Rambaldini G, Boerner S, et al. Worrisome histologic alterations following fine-needle aspiration of the parathyroid. J Clin Pathol. 2006;59(10):1094-1096. doi: 10.1136/jcp.2005.029017.
13. Shane E. Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab. 2001;86(2):485-493. doi: 10.1210/jcem.86.2.7207.
14. Duan K, Mete O. Parathyroid carcinoma: diagnosis and clinical implications. Turk Patoloji Derg. 2015;31 Suppl 1:80-97. doi: 10.5146/tjpath.2015.01316.
15. DeLellis RA. Parathyroid tumors and related disorders. Mod Pathol. 2011;24 Suppl 2:S78-93. doi: 10.1038/modpathol.2010.132.
16. Fernandez-Ranvier GG, Khanafshar E, Jensen K, et al. Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis? Cancer. 2007;110(2):255-264. doi: 10.1002/cncr.22790.
17. Landry CS, Wang TS, Asare EA, et al. Parathyroid. In: AJCC Cancer Staging Manual. Springer; 2017. p. 903-910. doi: 10.1007/978-3-319-40618-3_75.
18. Ryhanen EM, Leijon H, Metso S, et al. A nationwide study on parathyroid carcinoma. Acta Oncol. 2017;56(7):991-1003. doi: 10.1080/0284186X.2017.1306103.
19. Kruijff S, Sidhu SB, Sywak MS, et al. Negative parafibromin staining predicts malignant behavior in atypical parathyroid adenomas. Ann Surg Oncol. 2014;21(2):426-433. doi: 10.1245/s10434-013-3288-8.
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4. Рис. 1. Гистологические особенности новообразований пациента А.: а – неинкапсулированная папиллярная микрокарцинома, фолликулярный вариант (Г-Э, ×100); б – атипическая аденома ОЩЖ из главных клеток с наличием полос фиброза (Г-Э, ×100); в – очаг клеточного и ядерного полиморфизма (1) в атипической аденоме ОЩЖ (Г-Э, ×200); г – экспрессия ПТГ в клетках атипической аденомы ОЩЖ: очаговая в клетках с выраженным полиморфизмом (1) и диффузная – в главных паратиреоцитах (2) (×100); д – экспрессия парафибромина в клетках атипической аденомы ОЩЖ: выраженная в главных паратиреоцитах (1) и отсутствие ядерной экспрессии в клетках с выраженным ядерным полиморфизмом (2) (×200). | |
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5. Рис. 2. Макропрепарат операционного материала пациентки Б.: а – атипическая аденома ОЩЖ на разрезе серо- коричневого цвета с фокусом фиброза в центре; б – фокус папиллярной микрокарциномы ЩЖ с фиброзом и кальцификацией стромы. | |
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6. Рис. 3. Гистологические особенности новообразований пациентки Б.: а – неинкапсулированная папиллярная микро- карцинома, фолликулярный вариант, с фиброзом и кальцификацией стромы (Г-Э, ×200); б – атипическая аденома ОЩЖ из оксифильных клеток (1), остаток ткани ОЩЖ из главных клеток оттеснен к периферии (2) (Г-Э, ×100); в) очаг фиброза в атипической аденоме ОЩЖ (Г-Э, ×50); г – экспрессия ПТГ в клетках атипической аденомы ОЩЖ (×100); д – диффузная экспрессия парафибромина в ядрах клеток атипической аденомы (1) и в остатке неизмененной ткани ОЩЖ (2) (×200). | |
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For citations:
Voronkova I.A., Lapshina A.M., Gurevich L.E., Rozhinskaya L.Ya., Britvin T.A., Krivosheev A.V., Kim I.V., Kuznetsov S.N., Mokrysheva N.G. Two cases synchronous atypical parathyroid adenomas and papillary thyroid carcinoma. Clinical and experimental thyroidology. 2017;13(4):40-48. (In Russ.)
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