Abstract
Clinical examples of amyloid deposition in parathyroid glands are exceedingly rare and usually present as an incidental finding in a patient with amyloid goiter. Here, we present the first histologically documented case of parathyroid amyloid deposition that presented as a mass. The patient did not have hyperparathyroidism. The parathyroid gland was submitted for intra-operative frozen section and concern for medullary thyroid carcinoma was raised. An important histologic clue arguing against medullary thyroid carcinoma was the evenly dispersed nature of the amyloid. Histologic perinuclear clearing and parathyroid hormone immunohistochemistry confirmed parathyroid origin on permanent sections. The patient was also found to have associated amyloid goiter. Mass spectrometry of the amyloid showed it to be composed of kappa light chains. On further work-up, the patient was diagnosed with multiple myeloma. Awareness of parathyroid amyloid deposition is important as it is a histologic mimic of medullary thyroid carcinoma, especially on frozen section. Amyloid typing with evaluation for multiple myeloma in any patient with kappa or lambda light chain restriction is also important.
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References
Hazard JB. The C cells (parafollicular cells) of the thyroid gland and medullary thyroid carcinoma. A review. Am J Pathol. 1977;88:213–50.
Franc B, Rosenberg-Bourgin M, Caillou B, Dutrieux-Berger N, Floquet J, Houcke-Lecomte M, et al. Medullary thyroid carcinoma: search for histological predictors of survival (109 proband cases analysis). Hum Pathol. 1998;29:1078–84.
Ozdemir D, Dagdelen S, Erbas T. Endocrine involvement in systemic amyloidosis. Endocr Pract. 2010;16:1056–63.
Hamed G, Heffess CS, Shmookler BM, Wenig BM. Amyloid goiter. A clinicopathologic study of 14 cases and review of the literature. Am J Clin Pathol. 1995;104:306–12.
Siddiqui MA, Gertz M, Dean D. Amyloid goiter as a manifestation of primary systemic amyloidosis. Thyroid Assoc. 2007;17:77–80.
Kazdaghli Lagha E, M’sakni I, Bougrine F, Laabidi B, Ben Ghachem D, Bouziani A. Amyloid goiter: first manifestation of systemic amyloidosis. Eur Ann Otorhinolaryngol Head Neck Dis. 2010;127:108–10.
Febrero B, Ríos A, Rodríguez JM, Ferri B, Polo L, Parrilla P. Giant amyloid goiter in Crohn’s disease. Endocr Pathol. 2012;23:260–3.
Aydin B, Koca YS, Koca T, Yildiz I, Gerek Celikden S, Ciris M. Amyloid Goiter secondary to ulcerative colitis. Case Rep Endocrinol. 2016;2016:3240585.
Vanguri VK, Nosé V. Transthyretin amyloid goiter in a renal allograft recipient. Endocr Pathol. 2008;19:66–73.
Anderson TJ, Ewen SW. Amyloid in normal and pathological parathyroid glands. J Clin Pathol. 1974;27:656–63.
Leedham PW, Pollock DJ. Intrafollicular amyloid in primary hyperparathyroidism. J Clin Pathol. 1970;23:811–7.
Koelmeyer TD. Generalised amyloidosis with involvement of the parathyroids: case report. N Z Med J. 1977;85:372–3.
Villamil CF, Massimi G, D’Avella J, Cole SR. Amyloid goiter with parathyroid involvement: a case report and review of the literature. Arch Pathol Lab Med. 2000;124:281–3.
Abdou AG, Kandil MA. A case of amyloid goiter associated with intrathyroid parathyroid and lymphoepithelial cyst. Endocr Pathol. 2009;20:243–8.
Ordoñez NG, Ibañez ML, Samaan NA, Hickey RC. 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. 1983;7:535–42.
Ellis HA, Mawhinney WH. Parathyroid amyloidosis. Arch Pathol Lab Med. 1984;108:689–90.
Ori Y, Halpern M, Sadov R, Feinmesser R, Ramadan R, Korzets A. Familial Mediterranean fever, an amyloid thyroid goiter and an enlarged parathyroid gland. Isr Med Assoc J. 2012;14:232–3.
Williams ED, Brown CL, Doniach I. Pathological and clinical findings in a series of 67 cases of medullary carcinoma of the thyroid. J Clin Pathol. 1966;19:103–13.
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Hill, K., Diaz, J., Hagemann, I.S. et al. Multiple Myeloma Presenting as Massive Amyloid Deposition in a Parathyroid Gland Associated with Amyloid Goiter: A Medullary Thyroid Carcinoma Mimic on Intra-operative Frozen Section. Head and Neck Pathol 12, 269–273 (2018). https://doi.org/10.1007/s12105-017-0853-7
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DOI: https://doi.org/10.1007/s12105-017-0853-7