Abstract
Introduction
Non functional parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our case is an exception, because it was detected in early stage, with no local invasion present. We present a case of the smallest non-functional PC yet reported and review of the literature.
Case presentation
A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1.
Conclusion
Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on.
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Data availability
Data available on request from the authors.
References
Piciu D, Irimie A, Kontogeorgos G, Piciu A, Buiga R (2013) Highly aggressive pathology of non-functional parathyroid carcinoma. Orphanet J Rare Dis 8(1):1–4. https://doi.org/10.1186/1750-1172-8-115
Sawhney S et al (2022) Parathyroid Carcinoma: a review. Indian J Surg Oncol 13(1):133–142. https://doi.org/10.1007/S13193-021-01343-3
Owen RP et al (2011) Parathyroid carcinoma: a review. Head Neck 33(3):429–436. https://doi.org/10.1002/HED.21376
Apaydın T, Yavuz DG (2020) Seven cases of parathyroid carcinoma and review of the literature. Hormones 20(1):189–195. https://doi.org/10.1007/S42000-020-00220-Y
Zheng Y, Wen J, Lin W, Lin L, Chen G (2020) Approach to parathyroid carcinoma (PC): seven cases and a review of the literature. Transl Cancer Res 9(8):4982. https://doi.org/10.21037/TCR-19-2368
Wilkins BJ, Lewis JS Non-functional parathyroid carcinoma: a review of the literature and report of a case requiring extensive surgery. https://doi.org/10.1007/s12105-009-0115-4
Wang L et al (2015) Non-functional parathyroid carcinoma: a case report and review of the literature. Cancer Biol Ther 16(11):1569. https://doi.org/10.1080/15384047.2015.1070989
Mohebati A, Shaha A, Shah J (2012) Parathyroid carcinoma: challenges in diagnosis and treatment. Hematol Oncol Clin N Am 26(6):1221–1238. https://doi.org/10.1016/J.HOC.2012.08.009
Campennì A et al (2012) Parathyroid carcinoma presenting as normocalcemic hyperparathyroidism. J Bone Mineral Metab 30(3):367–372. https://doi.org/10.1007/S00774-011-0344-Y
Asare EA et al (2015) Parathyroid Carcinoma: An Update on Treatment Outcomes and Prognostic Factors from the National Cancer Data Base (NCDB). Ann Surg Oncol 22(12):3990–3995. https://doi.org/10.1245/s10434-015-4672-3
Guy CC (1929) Tumors of the parathyroid glands. Surg Gynecol Obstet 149(6):522–527
Price LW, Mowat GT (2005) A case of rapidly-growing carcinoma in the neck, arising in a parathyroid rest. Br J Surg 19(76):645–650. https://doi.org/10.1002/BJS.1800197615
Armstrong H (1938) Primary carcinoma of the parathyroid gland with report of a case. Bull Acad Med Tor 11:105–110
McQuillan AS (1938) PARATHYROID TUMOR REPORT OF TWO CASES. Ann Surg 108(3):464–467
Sieracki JC, Horn RC Nonfunctional carcinoma of t h e parathyroid. https://doi.org/10.1002/1097-0142.
Pachter MR, Lattes R (1963) Uncommon Mediastinal Tumors: Report of two parathyroid adenomas, one nonfunctional parathyroid carcinoma and one ‘bronchial-type-adenoma.’ Dis Chest 43(5):519–528. https://doi.org/10.1378/CHEST.43.5.519
Altenähr E, Saeger W (1973) Light and electron microscopy of parathyroid carcinoma. Report of three cases. Virchows Arch A Pathol Pathol Anat 360(2):107–122. https://doi.org/10.1007/BF00543222
Dhom G, Hohbach C (1980) The value of electron microscopy in diagnostic pathology. Case 12. Ultrastruct Pathol 1(1):141–150. https://doi.org/10.3109/01913128009141410
Chahinian AP, Holland JF, Nieburgs HE, Marinescu A, Geller SA, Kirschner PA (1981) Case report metastatic nonfunctioning parathyroid carcinoma: ultrastructural evidence of secretory granules and response to chemotherapy. Am J Med Sci 282(2):80–84. https://doi.org/10.1097/00000441-198109000-00005
Aldinger KA, Hickey RC, Ibanez ML, Samaan NA ,Parathyroid carcinoma: a clinical study of seven cases of functioning and two cases of non functioning parathyroid cancer. https://doi.org/10.1002/1097-0142.
Ordonez NG, Ibanez ML, Samaan NA, Hickey RC (1983) Immunoperoxidase study of uncommon parathyroid tumors. Report of two cases of nonfunctioning parathyroid carcinoma and one intrathyroid parathyroid tumor-producing amyloid. Am J Surg Pathol 7(6):535–542. https://doi.org/10.1097/00000478-198309000-00004
Yamashita H et al (1984) Light and electron microscopic study of nonfunctioning parathyroid carcinoma. Report of a case with a review of the literature
Merlano M et al (1985) Non-functioning parathyroid carcinoma: a case report. Tumori 71(2):193–196. https://doi.org/10.1177/030089168507100216
Murphy MN, Glennon PG, Diocee MS, Wick MR, Cavers DJ Nonsecretory parathyroid carcinoma of the mediastinum
Collins FD, Warren MC, Palmer FJ, Rankin DR (1986) Nonfunctioning parathyroid carcinoma: a case history. J Surg Oncol 31(1):60–61. https://doi.org/10.1002/JSO.2930310114
Yamashita H, Noguchi S, Murakami N, Toda M, Adachi M, Daa T (1992) Immunohistological study of nonfunctional parathyroid carcinoma. Report of a case. Acta Pathol Jpn 42(4):279–285. https://doi.org/10.1111/J.1440-1827.1992.TB02542.X
Eurelings M, Frijns CJM, Jeurissen FJF (2002) Painful ophthalmoplegia from metastatic nonproducing parathyroid carcinoma: Case study and review of the literature. Neuro Oncol 4:44–48
Kirkby-Bott J, Lewis P, Harmer CL, Smellie WJB (2005) One stage treatment of parathyroid cancer. Eur J Surg Oncol 31(1):78–83. https://doi.org/10.1016/j.ejso.2004.06.014
Fernandez-Ranvier GG et al (2007) Nonfunctioning parathyroid carcinoma: case report and review of literature. Endocr Pract 13(7):750–757. https://doi.org/10.4158/EP.13.7.750
Grodski S, Gill A, Robinson BG, Sidhu S (2008) Nonfunctioning parathyroid cancer presenting as a cervical mass. Thyroid 18(4):473–474. https://doi.org/10.1089/THY.2006.0323
Mazeh H, Prus D, Freund HR (2008) “Incidental non-functional parathyroid carcinoma identified during thyroidectomy. Isr Med Assoc J 10(8–9):659 (PMID:18847176)
Gao WC et al (2010) Nonfunctional parathyroid carcinoma. J Cancer Res Clin Oncol 136(7):969–974. https://doi.org/10.1007/S00432-009-0740-Z
Nakamura Y, Kataoka H, Sakoda T, Horie Y, Kitano H (2010) Nonfunctional parathyroid carcinoma. Int J Clin Oncol 15(5):500–503. https://doi.org/10.1007/S10147-010-0062-9/FIGURES/5
Krvavica A, Kovačić M, Baraka I, Rudić M (2011) Non-functioning parathyroid gland carcinoma: case report. Acta Clin Croat 50(2)
Kotromanovic Z et al (2012) Non-functional parathyroid gland carcinoma, a rare malignant tumor of the head and neck. Coll Antropol 36:23–25
Suganuma N et al (2017) Non-functioning parathyroid carcinoma: a case report. Surg Case Rep 3(1):1–6. https://doi.org/10.1186/S40792-017-0357-4
Sen M et al (2021) Non-functioning oxyphilic parathyroid carcinoma: a case report. Surg Case Rep. https://doi.org/10.1186/S40792-021-01201-Y
Khalil M, Zafereo M, Gule-Monroe M, Sherman SI, Bell D (2021) Non-functional water clear cell parathyroid carcinoma masquerading as medullary thyroid carcinoma. Ann Diagn Pathol. https://doi.org/10.1016/J.ANNDIAGPATH.2021.151791
De Quervain F (1909) Parastruma maligna aberrata. Langenbecks Arch Surg 100(1):334–353
Roffo AH, Landivar YAF (1914) Carcinoma of the parathyroid with metastasis simulating an aneurism of the arch of the aorta. Prensa Med Argent 2:177–181
Hall EM, Lawrence C (1935) Malignant tumors of the parathyroid glands. J Nerv Ment Dis 81(3):326–326
Mendiola R (1942) Parathyroid carcinoma. Rev Mex Cir 10:387–394
Klink BK, Karulf RE, Maimon WN, Peoples JB (1991) Nonfunctioning parathyroid carcinoma. Am Surg 57(7):463–467. https://doi.org/10.4172/2472-4971.1000119
Chao C, Hong C, Baorui L (2011) Nonfunctional parathyroid carcinoma. Chin Clin Oncol 16(10):959–960
Yitong X, Guanyu Z, Lili X (2012) Nonfunctional parathyroid carcinoma. A case report and review of the literature. Chin J Clinicians 6(10):2807–2808
Baba H et al (1986) Identification of parathyroid hormone messenger ribonucleic acid in an apparently nonfunctioning parathyroid carcinoma transformed from a parathyroid carcinoma with hyperparathyroidism. J Clin Endocrinol Metab 62(2):247–252. https://doi.org/10.1210/JCEM-62-2-247
Dikmen K et al (2017) Nonfunctional double parathyroid carcinoma with incidental thyroid micropapillary carcinoma: a rare case. Pan Afr Med J 27:1937–8688. https://doi.org/10.11604/PAMJ.2017.27.241.11503
Ashkenazi D, Elmalah I, Rakover Y, Luboshitzky R (2006) Concurrent nonfunctioning parathyroid carcinoma and parathyroid adenoma. Am J Otolaryngol 27(3):204–206. https://doi.org/10.1016/J.AMJOTO.2005.01.006
Cocorullo G et al (2017) Non-functioning parathyroid cystic tumour: malignant or not? Report of a case. G Chir 38(5):243. https://doi.org/10.11138/GCHIR/2017.38.5.243
Hara H et al (2001) Ultrasonographic features of parathyroid carcinoma. Endocr J 48(2):213–217. https://doi.org/10.1507/ENDOCRJ.48.213
Jovanovic MD et al (2016) Surgical treatment of concomitant thyroid and parathyroid disorders: analysis of 4882 cases. Eur Arch Oto-Rhino-Laryngol. https://doi.org/10.1007/s00405-016-4303-z
Heo I et al (2013) Fine needle aspiration cytology of parathyroid lesions. Korean J Pathol 47(5):466. https://doi.org/10.4132/KOREANJPATHOL.2013.47.5.466
Howell VM et al (2003) HRPT2 mutations are associated with malignancy in sporadic parathyroid tumours. J Med Genet 40(9):657. https://doi.org/10.1136/JMG.40.9.657
Sharretts JM, Kebebew E, Simonds WF (2010) Parathyroid cancer. Semin Oncol 37(6):580. https://doi.org/10.1053/J.SEMINONCOL.2010.10.013
Harari A et al (2011) Parathyroid carcinoma: a 43-year outcome and survival analysis. J Clin Endocrinol Metab 96(12):3679–3686. https://doi.org/10.1210/JC.2011-1571
Marcocci C, Cetani F, Rubin MR, Silverberg SJ, Pinchera A, Bilezikian JP (2008) Parathyroid carcinoma. J Bone Miner Res 23(12):1869. https://doi.org/10.1359/JBMR.081018
Ferraro V et al (2019) Current concepts in parathyroid carcinoma: a single Centre experience. BMC Endocr Disord 19(Suppl):1. https://doi.org/10.1186/S12902-019-0368-1
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Ivaniš, S., Jovanović, M., Dunđerović, D. et al. Case presentation of the smallest non-functional parathyroid carcinoma and review of the literature. Eur Arch Otorhinolaryngol 280, 5637–5647 (2023). https://doi.org/10.1007/s00405-023-08137-z
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DOI: https://doi.org/10.1007/s00405-023-08137-z