• 대한두경부종양학회지
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• 제38권1호
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• pp.25-29
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• 2022

Parathyroid carcinoma is very rare malignant neoplasm, accounting for less than 0.005% of all cancers. Most parathyroid carcinoma is a functioning tumor that causes hyperparathyroidism, leading to hypercalcemia. We report a parathyroid carcinoma case that was suspicious for spontaneous infarction of cancer, leading to resolution of hypercalcemia. A 29-year-old male visited our hospital presenting with right neck swelling and pain. He has been experiencing frequent urolithiasis for four years but laboratory tests showed normal serum calcium level. Right vocal cord paresis was identified with laryngoscopy. Ultrasonography revealed a 3.7 × 3.5 cm mass in the right thyroid containing a focal cystic portion. Computed tomography confirmed the presence of a low-density right thyroid mass. Right thyroid lobectomy was performed and pathological evaluation revealed parathyroid carcinoma with central necrosis. We report this very rare case with a literature review.

• 대한세포병리학회지
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• 제14권1호
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• pp.1-6
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• 2003

Parathyroid carcinoma is a rare disorder accounting for 0.5% to 5% of parathyroid neoplasia. Diagnosis of parathyroid carcinoma in fine needle aspiration cytology (FNAC) is difficult because ail characteristic features of parathyroid carcinoma can be recognized in parathyroid adenoma or hyperplasia. Cellular atypism cannot be used for the diagnostic criteria of parathyroid carcinoma as malignancies of most other organs. We experienced two cases of cytologic features of parathyroid carcinoma confirmed by histologic examination. The majority of tumor cells formed large cohesive clusters, although individual tumor cells were also present. The tumor cells displayed rather pleomorphic round to oval nuclei, occasional prominent nucleoli, and distinct cytoplasmic margin. Occasionally karyolysis, anuclear cells, and nonepithelial cell clusters were noted. The histologic findings showed a partially lobulated architecture, with admixture of sheets of chief cells, oxyphil cells, and occasional water clear cells. The tumor infiltrated into the thyroid parenchyme and perithyroidal soft tissue. The electron microscopic study of case 1 disclosed typical findings of parathyroid neoplasm; clusters of secretory chief cells with centrally located round to ovoid nuclei, moderately clumped heterochromatins and one or two nucleoli. The tumor cells showed conspicous interdigitation of contiguous ceil membrane and intercellular microvilli.

• 대한두경부종양학회지
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• 제17권2호
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• pp.205-209
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• 2001

Purpose: Most cases of primary hyperparathyroidism are due to parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We under-took a retrospective study in 6 patients with parathyroid carcinoma, with the aim of conveying experience from management for this rare cause of hyperparathyroidism. Methods: Clinical symptoms, biochemical laboratory, radiologic, and intraoperative findings, local recurrence and distant metastasis were analyzed in 6 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 2001. Results: Mean age was 50.2 years (33.0-60.0 years) and male to female ratio was 1:1. Neck mass was found in 5 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidism in all cases, mean serum calcium level was 11.2mg/dl(10.5-12.1mg/dl), slightly elevated. Laboratory values after surgery were within the normal range in 5 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 3 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than unilateral thyroid lobectomy and central compartment neck node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During follow-up period, any local or systemic recurrence were not evident in all the cases. Conclusion: Although parathyroid carcinoma is a rare disease and its preoperative diagnosis, in our experience, could not easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important for the management of the parathyroid cancer.

• 대한두경부종양학회지
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• 제15권2호
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• pp.235-238
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• 1999

Parathyroid carcinoma is rare, occurring in less than 2-3% of the patients with primary hyperparathyroidism. In the patients with chronic renal failure, the incidence is extremely low. Only 13 cases of parathyroid carcinoma with chronic renal failure have been described in the world literature. We report a case of parathyroid carcinoma in a 43-year-old man who has been suffered from chronic renal failure for 19 years. To our knowledge, this is the first case of parathyroid carcinoma occurring in the thyroid gland associated with secondary hyperparathyroidism.

• 대한두경부종양학회지
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• 제9권1호
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• pp.56-62
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• 1993

The parathyroid carcinoma is a rare cause of primary hyperparathyroidism. There was approximately 170 reports in the would literature. and only two documented cases in Korean literature. It is still difficult to distinguish. histologically, benign from malignant parathyroid tumors. However, if diagnotic criteria are that strict, it can be suscessfully cured by initial operation. The initial operation should be an en bloc resection of the tumor, avoiding rupture of the tumor capsule and spillage of tumor cells. This report details the management of a 51 year old female with functioning parathyroid carcinoma who underwent an en bloc resection of the tumor at the time of initial operation.

• Radiation Oncology Journal
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• 제28권2호
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• pp.111-116
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• 2010

부갑상선암은 매우 드문 내분비악성 종양으로 부갑상선기능 항진증의 0.5~4%를 차지하며 흔히 고칼슘 혈증과 부갑상선호르몬의 증가를 보인다. 비기능성 부갑상선암은 부갑상선기능 항진증으로 나타나는 증상이 없으며 병리조직학적 진단기준이 분명하지 않아 늦게 진단이 되는 질환이다. 근치적 절제술이 가장 표준적인 치료이지만 수술 후 국소재발이 흔하기 때문에 불완전 절제가 시행되었거나 미세 잔류 종양이 있는 경우 외부 방사선치료를 시행하여 국소 조절률 향상을 얻을 수 있다고 보고되고 있다. 저자는 부갑상선에 발생한 비기능성 악성종양으로 근치적 절제술 후 외부 방사선치료를 시행한 1예를 경험하였기에 문헌 고찰과 함께 이를 보고하고자 한다.

• 대한두경부종양학회지
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• 제13권2호
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• pp.241-246
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• 1997

It has become evident in recent years that parathyroid adenoma and well differentiated thyroid cancer occur together more than would be expected by chance alone. However, the association between them is not well understood. We have experienced 4 cases of coexistent parathyroid adenoma and well-differentiated thyroid cancer during the past 16 years. None of them had a familial incidence or a history of radiation exposure. Three cases showed symptomatic hypercalcemia(including renal stones, bone pain, joint pain) and in two of them(patient 1 and patient 2), thyroid abnormalities were detected preoperatively by neck ultrasonography or neck CT for evaluation of parathyroid lesions. However, in patient 3, a parathyoid humor was identified and removed incidentally during the course of thyroidectomy. In 3 cases, surgeries for thyroid carcinoma and parathyroid adenoma were performed during the same exploration of the neck, but in patient 4, thyroidectomy preceded parathyroidectomy; The interval between thyroidectomy and subsequent parathyroidectomy was 11 yeras. The thyroid tumors in 3 cases were papillary carcinoma, the sizes of which ranged from 1.0 cm to 1.5 cm in greatest diameter. The remaining case(patient 4) was minimal invasive follicular carcinoma. Total or near-total thyroidectomy with various types of cervical lymphnode dissection and bilateral neck exploration for the parathyroid lesion was performed in 3 cases with papillary carcinoma. Ipsilateral lobectomy and contralateral partial thyroidectomy with consequent unilateral neck exploration for the parathyroid tumor was performed in the case of follicular cancer. In our experience, parathyroid adenoma and well-differentiated thyroid carcinomas can be coexistent and we felt that the attention to the hypercalcemic patients would be needed for detection of this rare condition.

• 대한세포병리학회지
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• 제18권1호
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• pp.74-80
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• 2007

Parathyroid tumors may be difficult to distinguish from thyroid follicular lesions, especially when a tumor is nonfunctioning. We report here two cases of asymptomatic parathyroid carcinoma preoperatively misdiagnosed as thyroid follicular lesions, and one case of parathyroid adenoma showing hyperparathyroidism, and review the cytologic features favoring the diagnosis of parathyroid neoplasm. The cytologic findings that are characterized by clean background, monomorphic small cells, cohesive three-dimensional papillary clusters, small tight clusters with scattered naked nuclei, and well-defined clear cytoplasm favor a diagnosis for the parathyroid lesions. Cytologic findings such as macrofollicular structure, presence of colloid and macrophages, and presence of perivacuolar cytoplasmic granules on May-Grunwald-Giemsa stain support a diagnosis of a thyroid follicular lesion. The cytomorphology of parathyroid tumors is so variable that the distinction from a thyroid lesion cannot be based on the presence or absence of a single feature only but on the cytologic features as a whole.

• 대한핵의학회지
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• 제37권4호
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• pp.260-261
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• 2003

Tc-99m methoxyisobutylisonitrile (MIBI) and Tl-201/technetium subtraction scintigraphy have been used for localization of abnormal parathyroid gland. The uptake mechanism of tracers has been postulated to be increased cellular density and vascularity, or dependent on the presence of mitochondria-rich cells. However, the uptake of these tracers was not specific for abnormal parathyroid gland. The author report a case of thymic carcinoma that would have been mistaken for carcinoma of parathyroid because of Tc-99m MIBI and Tl-201 uptake.

• 핵의학기술
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• 제13권3호
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• pp.76-80
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• 2009

$^{99m}Tc$-MIBI는 adenoma뿐만 아니라, hyperplasia, carcinoma에서 방사능섭취가 증가된다. 이에 본 연구는 $^{99m}Tc$-MIBI로 국소화 된 병소를 정량화함으로써, 조직검사로 확진된 adenoma, hyperplasia 그리고 carcinoma를 후향적으로 분석 하였다. 2002년 4월부터 2009년 1월까지 부산대병원에서 조직검사결과 adenoma, hyperplasia, carcinoma로 확진된 환자 27명 (Male: 6, Female: 21, Mean age: 47.5)을 대상으로 Adac사의 Solus Epic 장비를 이용하여 Double-phase $^{99m}Tc$-MIBI parathyroid scan(조기 영상 15분, 지연영상 2시간)을 실시하였다. ADAC Laboratories, Ver. 4.20 software를 이용하여 지연영상에서 병변 부위와 비 병변(L/NL)부위에 각각 관심 영역을 설정하였고, 조기 영상에서도 같은 크기, 같은 위치에 관심영역을 설정하였다. 또한, 병변 부위에 종축을 설정하였다. 각각의 관심 영역에서 평균값(Mean value)으로 병변 대 비병변의 섭취율비(L/NL ratio)을 구하고, 배출률(%, washout rate)은 (조기영상방사능계수치-조기영상방사능계수치)/지연영상방사능계수치${\times}100$의 공식으로 구하였으며, count profile을 이용해 종축의 길이를 측정하였다. 조기 영상에서 병변 대 비병변의 섭취율비(L/NL ratio)는 adenoma가 $1.53{\pm}0.41$, hyperplasia가 $1.38{\pm}0.27$, carcinoma가 $1.45{\pm}0.64$로 유의한 차이가 없었다(p>0.05). 지연영상에서 병변 대 비병변의 섭취율비(L/NL ratio)는 adenoma가 $1.56{\pm}0.43$, hyperplasia가 $1.33{\pm}0.10$, carcinoma가 $1.83{\pm}0.79$로 유의한 차이가 없었다(p>0.05). 병소부위의 종축길이는 adenoma가 $2.11{\pm}0.67$, hyperplasia가 $2.23{\pm}0.75,$ carcinoma가 $2.20{\pm}0.97$로 유의한 차이가 없었다(p>0.05). 그리고, 배출률(%, washout rate)은 adenoma가 $31.59{\pm}13.97$, hyperplasia가 $37.8{\pm}5.69$, carcinoma가 $17.73{\pm}11.02$로 hyperplasia가 carcinoma 보다 의미있게 높았다(p<0.05, p=0.028 by Kruskal-willis statistic, Dunn's Multiple comparison test). 이는 hyperplasia와 carcinoma를 감별하는데 도움이 되었다.