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Case report
Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma
  1. Suha Abdulla1,
  2. Eamon Shamil2,
  3. Mark Wilsher3 and
  4. Antony Jacob2
  1. 1 School of Medical Education, King’s College London, London, UK
  2. 2 Department of ENT Surgery, University Hospital Lewisham, London, UK
  3. 3 Department of Pathology, University Hospital Lewisham, London, UK
  1. Correspondence to Mr Eamon Shamil, Eamon.shamil{at}nhs.net

Abstract

Parathyroid carcinoma is the rarest endocrine malignancy. Definitive diagnosis is challenging as it is difficult to distinguish malignant from benign disease. A 71-year-old man presented with weight loss and hypercalcaemia. CT scans revealed multiple lung nodules and lytic bone lesions that were consistent with metastatic dissemination. Technetium-99m-sestamibi-single-photon emission computed tomography scan showed an abnormal uptake in the right thyroid lobe. Fine-needle aspiration (FNA) was performed on three occasions. The patient underwent parathyroidectomy with ipsilateral hemithyroidectomy without postoperative complications. Microscopic examination showed a parathyroid neoplasm with fibrosis and intravascular tumour on a background of unremarkable thyroid parenchyma. This resulted in an initial impression of parathyroid carcinoma. Further review by two independent pathologists provided a final diagnosis of oncocytic parathyroid adenoma. This case highlights the subjectivity and interobserver variation with endocrine histological examination. FNA can induce changes that mimic parathyroid carcinoma on histology. An index of suspicion for benign parathyroid adenomas should be maintained.

  • Parathyroid adenoma
  • carcinoma
  • metastasis
  • hyperparathyroidism
  • fine needle aspiration
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Footnotes

  • Contributors SA designed and co-wrote the manuscript. ES was responsible for idea conception and co-wrote the manuscript. MW contributed to the interpretation of the histopathology and critically revised the paper for important intellectual content. AJ is the consultant in charge of the patient’s clinical care and critically revised the paper for important intellectual content. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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