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Review
. 2021 Apr 7;21(1):60.
doi: 10.1186/s12902-021-00724-7.

Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature

Nadia De Falco  1 , Giuseppe Santangelo  1 , Fabrizio Chirico  2 , Angelo Cangiano  1 , Maria Giulia Sommella  1 , Angelo Cosenza  1 , Andrea Ronchi  3 , Marina Accardo  3 , Gianluca Pellino  1 , Domenico Parmeggiani  1 , Silvestro Canonico  1 , Massimo De Falco  4
Affiliations
Review

Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature

Nadia De Falco et al. BMC Endocr Disord. .

Abstract

Background: Parathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. The intrathyroidal localization of a parathyroid gland is not frequent with a reported prevalence of 0.2%. Carcinoma of parathyroids with intrathyroidal localization represents an even rarer finding, reported in only 16 cases described in literature. The rare constellation of synchronous parathyroid and thyroid carcinomas has prompted us to report our experience and perform literature review.

Case presentation: We herein report a case of a 63-years-old man with multinodular goiter and biochemical diagnosis of hyperparathyroidism. Total thyroidectomy with radio-guide technique using gamma probe after intraoperative sesta-MIBI administration and intraoperative PTH level was performed. The high radiation levels in the posterior thyroid lobe discovered an intrathyroidal parathyroid. Microscopic examination revealed a parathyroid main cell carcinoma at the posterior thyroidal left basal lobe, a classic papillary carcinoma at the same lobe and follicular variant of papillary carcinoma at the thyroidal right lobe. To the best of our knowledge, this is the first case documenting a synchronous multicentric non medullary thyroid carcinomas and intrathyroidal parathyroid carcinoma.

Conclusions: Our experience was reported and literature review underlining challenging difficulties in diagnostic workup and surgical management was carried out.

Keywords: Hyperparathyroidism; Intrathyroidal parathyroid; Parathyroid cancer; Surgical approach; Thyroid cancer.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Scintigraphy with 99mtechnetium: Late hypercaptation at lower left pole of the thyroid, no mediastinal uptake
Fig. 2
Fig. 2
Posterior view of the operative specimen, node of the lower left pole of the thyroid subcapsular seat, reddish-yellow in color
Fig. 3
Fig. 3
Histopathological finding. a Conventional papillary carcinoma. Histological evaluation showing a neoplasm with a papillary architectural pattern (H&E, original magnification 200x). b Follicular variant of a papillary carcinoma. Histological evaluation showing a neoplastic proliferation with a follicular architectural pattern and cytological atypia including ground-glass nuclei and nuclear grooves (H&E, original magnification 200x). c-d Parathyroid carcinoma. Histological evaluation showing neoplastic islets separated by thick bands of connective tissue (yellow star). The neoplasm shows an infiltrative growth in the adjacent soft tissue (blue arrows). Thyroid tissue is present in the lower right (C, H&E, original magnification 40x). The neoplasm is constituted by main cells (D, H&E, original magnification 200x). Abbreviation: H&E: hematoxylin and eosin
Fig. 4
Fig. 4
Nests of main cells (yellow star) associated with thyroid follicles (blue star) (H&E, original magnification 200x). Abbreviation: H&E: hematoxylin and eosin
See this image and copyright information in PMC

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