부갑상샘 종양의 세침흡인 세포소견 -3예 보고-

김루시아,한지영,박인서,최석진,김준미,주영채,Kim, Lucia,Han, Jee-Young,Park, In-Suh,Choi, Suk-Jin,Kim, Joon-Mee,Chu, Young-Chae 대한세포병리학회 2007 대한세포병리학회지 Vol.18 No.1

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.

반대측 부갑상선의 과증식증을 동반한 갑상선 내 부갑상선 암종 1예

구범모,문성규,이미지,김승우 대한이비인후과학회 2021 대한이비인후과학회지 두경부외과학 Vol.64 No.7

Parathyroid carcinoma accounts for about 0.5%-5% of all parathyroid neoplasms. Very rarely,but if the intrathyroidal parathyroid gland is present, the carcinoma can arise in that developmentalanomaly. It is very difficult to distinguish a thyroid nodule from an intrathyroidal parathyroidneoplasm with preoperative radiologic and cytologic evaluations. A 59-year-old malewas initially evaluated as presenting a follicular thyroid neoplasm accompanied by hyperparathyroidism. He received hemi-thyroidectomy with central neck dissection and subtotal parathyroidectomy. The final pathology evaluation revealed intrathyroidal parathyroid carcinomaand hyperplasia of contralateral parathyroid glands. We report this very rare and unique clinicalsituation with a literature review.

만성 콩팥병 3기 환자의 부갑상선암 1예

김진국 ( Jin Kuk Kim ),박무용 ( Moo Yong Park ),박정미 ( Jung Mi Park ),조윤희 ( Youn Hee Cho ),최수정 ( Soo Jeong Choi ),황승덕 ( Seung Duk Hwang ),곽정자 ( Jeong Ja Kwak ) 대한내과학회 2012 대한내과학회지 Vol.83 No.6

Parathyroid carcinoma is a rare disease in patients with primary hyperparathyroidism. We experienced a case of parathyroid carcinoma presenting with hyperparathyroidism. A 62-year-old male patient had hypercalcemia, chronic kidney disease, and an elevated parathyroid hormone level for at least 3 months. An ultrasonogram and parathyroid scan did not show parathyroid neoplasm. He underwent left hemithyroidectomy and parathyroidectomy. Biopsy revealed a parathyroid carcinoma. His azotemia and hypercalcemia improved after surgery. (Korean J Med 2012;83:796-801)

Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation

김호수,최봉희,박정랑,함종렬,정정화,김수경,김성수,김경영,정순일,정태식 대한내분비학회 2013 Endocrinology and metabolism Vol.28 No.3

Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A 99mtechnetium (99mTc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the procedure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL. Neck ultrasonography and 99mTc sestamibi scan detected a 5-cm parathyroid neoplasm in the left lower lobe of the patient’s thyroid; left parathyroidectomy was performed. This case indicated that thyroid ultrasonographers and pathologists need to be experienced enough to differentiate a parathyroid neoplasm from a thyroid nodule; 99mTc sestamibi scan, serum calcium, and iPTH levels can help to establish the diagnosis of parathyroid neoplasm.

만성신부전 환자에서 발생한 다발성 비기능성 부갑상선 암종 1예

임정혁,김대형,최상학,김영모 대한이비인후과학회 2003 대한이비인후과학회지 두경부외과학 Vol.46 No.6

Parathyroid carcinoma is a rare entity accounting for only 0.5% to 5% of all cases of parathyroid neoplasm. Most of these mali-These tumors may also be nonfunctional, which is even rarer. Clinical detection of nonfunctioning parathyroid carcinoma prior to operation is primarily based on symptoms of an expanding neck mass and voice change. These condition may allow it to escape clinical attention until it has achieved an advanced state. So, the prognosis is relatively too bad. Most of these tumors often arise from preexisting parathyroid hyperplasia or adenoma. En bloc resection of primary lesion, ipsilateral thyroid lobe and this paper, we will introduce a case report of a bilateral nonfunctioning parathyroid carcinoma secondary to chronic renal failure. (Korean J Otolaryngol 2003 ;46 :532-5)

Parathyroid Crisis as Presentation of Atypical Parathyroid Adenoma: Two Diagnostically Challenging Cases

Balcázar-Hernández Lourdes,Alexis Trejo Montes,Tania Islem Gamboa Jimenéz,Vargas-Ortega Guadalupe,González-Virla Baldomero,Balcázar-Hernández Lourdes 대한골대사학회 2022 대한골대사학회지 Vol.29 No.2

Atypical parathyroid adenoma (APA) is a rare cause of primary hyperparathyroidism (PHPT) and represents a diagnostic challenge since it is an intermediate form of parathyroid neoplasm of uncertain malignant potential with atypical histological features that require differential diagnosis of parathyroid carcinoma (PC). We present 2 cases of parathyroid crisis as a presentation of APA. The first case was that of a 56-year-old man with parathyroid crisis, constitutional syndrome, and anemia, with evidence of APA after en bloc resection, evolving with hungry bone syndrome after surgery and curation criteria at 6 months after parathyroidectomy (PTX). The second case was a 64-year-old woman with acute chronic kidney disease and parathyroid crisis, with evidence of APA after selective PTX and >50% reduction in parathyroid hormone levels after surgery; however, persistent PHPT at 6 months post-surgery was observed. These cases represented a diagnostic challenge due to their rare clinical presentation (parathyroid crisis), with a heterogeneous spectrum of target organ damage and infrequent symptoms (constitutional syndrome and acute chronic renal disease), in turn caused by a rare pathology (APA). The presentation of these patients may be indicative of PC; however, histopathological diagnosis is a key to the diagnosis of APA. The differential diagnosis of APA vs. PC in clinical practice is indispensable.

Primary Hyperaparathyroidism due to Cystic Parathyroid Adenoma not Detected on 99mTc-Sestamibi Scan

강아름,김은기,남은영,변선주,김정희,온정헌,홍은실,최형진,정경천,성명훈,신찬수,박경수,김성연 대한내분비학회 2012 Endocrinology and metabolism Vol.27 No.1

Parathyroid cysts, which can be divided into functional and non-functional cysts, are rare causes of primary hyperparathyroidism. A technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi) parathyroid scan is a sensitive diagnostic tool for the localization, although it sometimes shows a false-negative result. Here we report a case of presumed cystic parathyroid adenoma based on clinical findings and analysis of cystic fluid with negative findings in a parathyroid scan. A 44-year-old male patient visited the hospital due to leg pain and compressive symptoms (dysphagia, hoarseness) that had started 4-5 months before. His serum calcium level was 14.4 mg/dL and his intact parathyroid hormone (iPTH) had increased to 478.1 pg/mL. On neck computed tomography, a cystic nodule measuring 6.2 cm was detected in the inferior part of the right thyroid gland. Sestamibi uptake for this nodule was not detected on 2-h delayed imaging, and fluorodeoxyglucose positron emission tomography showed only subtle uptake. Fine-needle aspiration was performed and intracystic iPTH had increased to 61,600 pg/mL. Focused parathyroidectomy guided by intraoperative iPTH monitoring led to successful enucleation of the right inferior parathyroid gland. A parathyroid adenoma was confirmed, and his laboratory results had normalized. This study shows that cystic parathyroid adenoma can sometimes be difficult to detect on a 99mTc-sestamibi parathyroid scan.

Impact of preserving the parathyroid glands on hypocalcemia after total thyroidectomy with neckdissection

Yon Seon Kim 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.2

Purpose: The aims of this study were to determine the incidence and evaluate the risk factors for hypocalcemia after total thyroidectomy and to investigate how many parathyroid glands should be preserved to prevent postoperative hypocalcemia. Methods: From March 2007 to February 2011, a retrospective review of 866 patients who underwent total thyroidectomy and node dissection for thyroid cancer was performed. The incidence and predisposing factors for hypocalcemia were analyzed. Among them, a total of 191 cases had four of their parathyroid glands identified intraoperatively. These patients were then divided into one preserved parathyroid gland group (group I, n = 22) and two or more preserved parathyroid glands group (group II, n = 169). The incidence of hypocalcemia with regards to the number of preserved parathyroid glands was determined and the results between the two groups were compared. The total calcium, ionized calcium and parathyroid hormone levels were compared between the two groups. Results: The overall incidence of transient and permanent hypocalcemia was 9.2% and 0.5%, respectively. The decreased number of preserved parathyroid gland and increased number of removed central lymph node were the significant risk factors for developing postoperative hypocalcemia. In 191 cases identified with four parathyroid glands, the incidence of hypocalcemia was related to the number of preserved glands (group I, 22.7%; group II, 3.0%; P < 0.001). Conclusion: The insufficient number of preserved parathyroid glands is the only cause of hypocalcemia after total thyroidectomy and node dissection. At least one preserved parathyroid gland may prevent postoperative permanent hypocalcemia.

증례 : 신부전과 빈혈로 발현된 이소성 부갑상선암 1예

강명수 ( Myong Su Kang ),이호연 ( Ho Yun Lee ),서평주 ( Pyong Ju Seo ),김희진 ( Hee Jin Kim ),윤성철 ( Sung Chul Yun ),서필원 ( Phil Won Seo ),권미선 ( Mi Seon Kwon ) 대한내과학회 2006 대한내과학회지 Vol.71 No.4

저자들은 일차성 부갑상선기능항진증으로 인한 고칼슘혈증, 급성신부전, 대사성 골질환 및 심한 빈혈을 보인 환자에서 이소성 종격동 부갑상선암을 절제한 후 고칼슘혈증 뿐 아니라 골수섬유증에 의한 빈혈과 급성신부전도 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Parathyroid carcinoma is an uncommon cause of PTH-related hypercalcemia with a reported incidence of 0.4% to 5% of all cases of primary hyperparathyroidism. Even though the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma than in those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma preoperatively. Parathyroid carcinomas are usually larger and firmer than parathyroid adenomas and patients with parathyroid carcinoma have a higher incidence of renal dysfunction, bone disease and gastrointestinal symptoms. Anemia is an uncommon clinical feature of parathyroid carcinoma. There have been no prior cases of ectopic parathyroid carcinomas reported to date. In this article, we report the case of a 26-year-old man who developed severe anemia and acute renal failure due to an ectopic parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively. His serum calcium levels returned to normal and the anemia resolved postoperatively.(Korean J Med 71:435-441, 2006)

Coexistence of parathyroid adenoma and papillary thyroid carcinoma

Yong Sang Lee,Kee-Hyun Nam,Woong Youn Chung,Hang-Seok Chang,Cheong Soo Park 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.5

Purpose: Although several reports have been published regarding the coexistence of hyperparathyroidism and papillary thyroid carcinomas, concurrence of parathyroid adenoma and papillary thyroid carcinoma is extremely rare. The aim of this study was to describe experiences with concurrent parathyroid adenoma and papillary thyroid carcinoma. Methods: Seven patients with concurrent parathyroid adenoma and papillary thyroid carcinoma were identified between January 2006 and December 2007, and their medical records were reviewed retrospectively. Results: Of the seven patients identified, three were male and four were female; their mean age was 53.6 years. None of the patients presented with symptomatic hyperparathyroidism preoperatively. On laboratory findings, four patients had mild to moderate hypercalcemia, but serum parathyroid hormone concentrations were high in all patients. Preoperative imaging showed suspicious features of diseased parathyroid glands in four patients; two upon ultrasonography and computed tomography together and two upon ultrasonography only. The coexistence of parathyroid adenoma did not affect the extent of thyroid surgery. Laboratory values after surgery returned to within normal ranges in all patients. Conclusion: It is important not only to analyze serum calcium levels but also to carefully interpret imaging studies in order to identify asymptomatic hyperparathyroidism when performing thyroid cancer surgery.