J Korean Endocr Soc.  2010 Mar;25(1):61-67. 10.3803/jkes.2010.25.1.61.

A Case of Coexistence of Parathyroid and Papillary Thyroid Carcinoma

• Yom YS
• Lee MJ
• Lim HW
• Park JH
• Kim ST
• Lee YM
• Yang DJ
• Cho YZ
• Park MI
• Lee KW
• Park KY
• Lim DM
• Kim BJ

• KMID: 2177863
• DOI: http://doi.org/10.3803/jkes.2010.25.1.61

Abstract

Primary hyperparathyroidism is usually caused by a parathyroid adenoma, occasionally by primary parathyroid hyperplasia and rarely by parathyroid carcinoma. Coincidental occurrence of thyroid carcinoma in parathyroid adenoma is not uncommon, but synchronous parathyroid and thyroid carcinoma is extremely rare. Here, we describe a case of synchronous parathyroid carcinoma and papillary thyroid carcinoma.

Keyword

Papillary thyroid carcinoma; Parathyroid carcinoma; Synchronous

MeSH Terms

Carcinoma
Hyperparathyroidism, Primary
Hyperplasia
Parathyroid Neoplasms
Thyroid Gland
Thyroid Neoplasms
Carcinoma
Thyroid Neoplasms

Figure

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  Fig. 1 Radiologic findings of hyperparathyroidism. A. Skull X-ray shows heterogeneous salt and pepper appearance of skull. B. Digit X-ray shows resorption of the phalangeal tufts (subperiosteal resorption). C. The DEXA of the spine shows the T-score for L1 is -3.7. The DEXA of the hip shows femoral neck T-score of -2.6 and total score of -2.6. The higher values for L2, L3 and L4 are related to the degenerative change. These findings would be consistent with that of severe osteoporosis.

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  Fig. 2 A, B. A preoperative neck ultrasonography. Ultrasonographic findings of the neck shows about 2.43 cm sized mass lesion is seen in right lower perithyroid area (A), about 1 cm sized cystic lesion is seen in left. thyroid lower pole (B). C, D. A preoperative axial neck CT scan. C. The calcified right parathyroid mass (thick arrow, 2.4 × 1.5 cm) has heterogeneous density and irregular margin from the thyroid gland. And left thyroid lobe nodule (thin arrow, 1.3 × 1.2 cm) was diagnosed as follicular adenoma. D. The right thyroid lobe nodule (thick arrow, 1.3 × 1.2 cm) which was finally revealed as a papillary carcinoma with ossification are seen. E. MIBI scan. Focal abnormal uptake persistently in right lower thyroid area in early and 2-hour delayed imaging. Cell survival curves measured by cell counting kit-8 after 48 hours of treatment with re-differentiation agents in FTC-133 cells. U0126, selective inhibitor of MEK1/2; LY294002, selective inhibitor of PI3K; TSA, trichostatin A.

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  Fig. 3 A, B. Microscopic examination of the right lobe of the thyroid gland after decalcification shows a nodular tumor with ossification in a low-power view (A, ×12.5) and many nuclear pseudoinclusions in a high-power view (B, ×400). C, D. A scan view of the parathyroid gland shows broad intratumoral fibrous bands separating expansile tumor nodules (C). Microscopic examination shows vascular invasion in a medium-power view (C, ×100), and severe nuclear pleomorphism in a high-power view (D, ×200).

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  Fig. 4 Serum intact-PTH, total serum calcium, serum phosphorus, albumin and ionized calcium levels of patient.

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