Abstract
The chance of an intrathyroidal occurrence of a parathyroid gland is about 1–3%. Among the causes of hyperparathyroidism, parathyroid cases occur in less than 1% of patients. Here we present the case of a 63 year old Saudi female suffering from an intrathryroidal parathyroid carcinoma. The suspicion coming from the clinical investigations that the removed tumor tissue may be a parathyroid carcinoma could be confirmed by histology. Additionally non-radioactive in situ hybridization to localize mRNA transcripts for Cyclin D1 and immunohistochemical localization of Cyclin D1 was performed. Although parathyroid adenoma and carcinoma have disparate natural history, it can be difficult to differentiate between the two entities. Clinical presentation, operative findings may raise suspicion, but may not be conclusive especially if there is no evidence of invasion or metastasis, especially if the gland was intrathyroidal.
Highlights
Parathyroid adenomas account for 85% of primary hyperparathyroidism [1]
Mitotic activity, trabecular growth pattern and capsular, vascular, and adjacent soft tissue invasion have been considered characteristic of parathyroid carcinoma, but some of these morphological features have been identified in parathyroid adenomas as well [4]
Clarification of the molecular pathogenesis of parathyroid carcinoma can aid in diagnostically difficult cases and may provide important clues for a more effective therapy
Summary
Parathyroid adenomas account for 85% of primary hyperparathyroidism [1]. On the other hand, parathyroid carcinoma is a rare disease that accounts only for 1% to 3% of cases of primary hyperparathyroidism [2,3] and to the best of our knowledge, intrathyroidal parathyroid carcinoma have been reported only three times [3]. Diagnostic Pathology 2008, 3:46 http://www.diagnosticpathology.org/content/3/1/46 athyroid tumors They think that over expressed cyclin D1 plays a role in the pathogenesis of a much larger proportion of parathyroid adenomas than previously assumed. The fine needle aspiration (FNA) of the cervical mass was performed to evaluate left thyroid pathology and showed findings consistent with parathyroid neoplasm. Using in situ hybridization we found a weak to distinct signal for CD1 in the cytoplasm of glandular cells of the parathyroid adenoma tissue (Figure 3). Parathyroid carcinoma cells showed a variable staining with the probe used: Cells strongly positive from CD1 mRNA varied with only weakly stained tumor cells. Parathyroid carcinoma cells showed a variable staining for CD1 and carcinoma cells strongly positive from CD1 mRNA varied with only weakly stained tumor cells (Figure 5). The patient is two years from surgery, disease free and her serum calcium and parathormone level remained in the normal range
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