Large Parathyroid Tumor 8 Years after Thyroid Surgery: A Case Report

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Abstract

This report represents an unusually large parathyroid carcinoma (PC) mimicking thyroid nodule recurrence after hemithyroidectomy. PC is a rare endocrine malignancy accounting for less
than 1% of hyperparathyroidism cases. This is the first case report where contrast-enhanced
ultrasound (CEUS) was performed on a PC. A 63-year-old female presented with an enlarged
mass on the left side of the neck. In 2012, left-side hemithyroidectomy was done due to a benign goiter. In 2020, laboratory analysis showed markedly elevated parathyroid hormone and
calcium. Multiparametric neck ultrasonography was performed including B-mode, color
Doppler, shear wave elastography, and CEUS. Computed tomography revealed an irregular
mass in proximity to the trachea, esophagus, and dislocation of the common carotid artery.
Perifocal fatty tissue appeared normal. Scintigraphy displayed a suspected parathyroid tumor
or a suspected left lobe nodule of thyroid. Based on the biochemical diagnosis of primary
hyperparathyroidism and radiological examinations, a suspected parathyroid tumor was considered. Intraoperative findings demonstrated an unusually large 9 × 6 cm tumor (84 g) adjacent to the common carotid artery anterolaterally and the recurrent laryngeal nerve medially.
Pathohistological examination revealed a tumor solid in structure, with focal necrosis penetrating the capsule. Immunohistochemical analysis was positive for chromogranin, CD56, and
Ki-67 (8–10%) and negative for CK20 and CK7. The morphological and immunohistochemical
results correspond to PC. PC is a challenging diagnosis requiring a multidisciplinary approach, especially in the case of previous neck surgery. The only curative treatment for PC is radical
surgery. Lifelong monitoring of PCs is mandatory due to the high recurrence rate.
Original languageEnglish
Pages (from-to)528-534
JournalCase Reports in Oncology
Volume15
Issue number2
DOIs
Publication statusPublished - 16 May 2022

Keywords*

  • Parathyroid surgery
  • Parathyroid carcinoma
  • Hyperparathyroidism
  • Parathyroid hormone
  • Contrast-enhanced ultrasound

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.3. Anonymously reviewed scientific article published in a journal with an international editorial board and is available in another indexed database

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