BACKGROUND Parathyroid carcinoma represents about 0.005% of all malignancies and accounts for less than 1% of primary hyperparathyroidism cases. Precise preoperative diagnosis of parathyroid carcinoma is challenging, and it is usually diagnosed postoperatively by histological examination. Early suspicion of parathyroid carcinoma can lead to a more extensive surgical approach to reduce the risk of carcinoma recurrence. CASE REPORT The first case involves a 58-year-old woman who presented with severe back pain. An incidental finding on cervical magnetic resonance imaging of a soft-tissue-density mass at the right para-tracheal zone. The large size and the noticeable mass effect pushing the trachea and esophagus to the left side suggested the need for further investigations to rule out malignancy. Initially, it was thought to be a thyroid nodule investigated by fine-needle aspiration that revealed follicular thyroid cancer. After a histopathological examination, it was determined to be a parathyroid carcinoma. The second case involved a 30-year-old woman with a lower-limb tingling sensation. The significantly enlarged mass seen during thyroid ultrasound warranted surgical excision and histopathological analysis to rule out malignancy. Excision of what was considered a parathyroid adenoma revealed a histopathological finding of carcinoma, prompting a hemithyroidectomy. Both patients had high calcium and parathyroid hormone levels preoperatively. CONCLUSIONS Preoperative high calcium, intact parathyroid hormone, creatinine, and alkaline phosphatase, in addition to the lymphocyte-to-monocyte ratio and tumor diameter, are suggested to be predictive of parathyroid carcinoma diagnosis and should be carefully analyzed in all patients presenting with primary hyperparathyroidism.
Carcinoma , Hypercalcemia , Hyperparathyroidism, Primary , Parathyroid Neoplasms , Female , Humans , Middle Aged , Adult , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/surgery , Hyperparathyroidism, Primary/etiology , Hyperparathyroidism, Primary/surgery , Calcium , Neoplasm Recurrence, Local/complications , Parathyroid Hormone , Hypercalcemia/etiology
Inflammatory bowel disease (IBD) is a chronic condition that affects the gastrointestinal tract, with ulcerative colitis (UC) and Crohn's disease (CD) as the two major entities. While these conditions share some similarities in clinical presentation, they have distinct histopathological features. UC is a mucosal disease affecting the left colon and rectum, while CD can affect any part of the gastrointestinal tract and all layers of the bowel wall. Accurate diagnosis of UC and CD is important for effective management and prevention of complications. However, distinguishing between the two conditions based on limited biopsy specimens or atypical clinical presentations can be challenging. We present a case of a patient diagnosed with UC based on a single endoscopic biopsy from the sigmoid colon, who later presented with colonic perforation and was found to have CD on the colectomy specimen. This case emphasizes the importance of clinical guidelines when dealing with any patient of suspected IBD, considering alternative diagnoses in patients with atypical presentations and the need for careful clinical, endoscopic, and histological evaluation to make an accurate diagnosis. Delayed or missed diagnosis of CD can lead to significant morbidity and mortality.
INTRODUCTION AND IMPORTANCE: Anaplastic thyroid cancer is considered one of the most fatal aggressive malignancies with a survival duration estimated in months. When compared to anaplastic thyroid cancer, a well-differentiated thyroid tumor has a better prognosis and a longer survival duration even if it metastasized. Left untreated, the transformation of well-differentiated thyroid carcinoma to aggressive anaplastic malignancy has been considered one of the most devastating complications. CASE PRESENTATION: A 60-year-old male presented with a complaint of anterior neck swelling and hoarseness examination revealed a huge left thyroid swelling that was mobile, not tender, not attached to the underlying structures. Ultrasonographic examination of the thyroid gland showed a massively enlarged left thyroid lobe. Fine needle aspiration revealed undifferentiated (anaplastic) thyroid carcinoma. Preoperative CT excluded invasion or metastasis, and patient underwent total thyroidectomy and level 6 lymph node dissection. Histopathology showed anaplastic carcinoma foci within a background of Oncocytic (Hürthle cell) carcinoma and an incidental papillary thyroid carcinoma metastasizing into one lymph node. CLINICAL DISCUSSION: The predominance of an anaplastic thyroid tumor with a few foci of well-differentiated thyroid malignancy, although rare, is the known commonly observed histopathological finding. However, it is extremely rare to find Oncocytic (Hürthle cell) thyroid carcinoma within the anaplastic component. It's presumed that patients who have coexisting well-differentiated thyroid cancer with the anaplastic component are at an overall survival advantage when compared to those who have pure anaplastic thyroid cancer. Our patients had a predominantly well-differentiated component, with a ratio of 80/20, the lesser being anaplastic, which might explain his 10 months cancer free outcome. CONCLUSION: It's extremely rare to encounter a predominant Oncocytic (Hürthle cell) carcinoma with foci of anaplastic tumor and a separate papillary carcinoma that metastasized to one lymph node. This rare histopathological finding supports that theory of anaplastic transformation from a pre-existing well differentiated thyroid tumor.
Multiple primary malignant tumors (MPMT) can be defined as more than two different tumors synchronously or metachronously forming in the same organ or different organs. The incidence of MPMTs varies dramatically between antemortem and postmortem examinations, becoming a serious medical issue. Evidence shows that the overall incidence of MPMTs is between 2.4% and 17%. Double primary malignancy (DPM) is considered the most common type of MPMT. In this case series, we present three cases of MPMT. The first case involved the colon and the breast, the second case involved the colon and the kidney, and the third case involved rectum and kidney.
A case of a 51-year-old female on hemodialysis 3 times per week for the past seven years was admitted to the endocrine surgery department on July of 2018 in Al-Hada Armed Forces hospital in Taif city, Saudi Arabia. Presented with complains of bone ache in her hip and lower limbs. Her labs showed that parathyroid hormone (PTH) has reached 4,267.2 pg/mL and her calcium was 2.82 mmol/L, phosphate was 0.84. Her case was suggesting Tertiary Hyperparathyroidism (HPT). She was scheduled for total parathyroidectomy. Histopathological analysis of the resected parathyroid glands confirmed the presence of two parathyroid adenomas. Retrospective progression of PTH, calcium and phosphate were documented, starting from the time she started the hemodialysis seven years ago and it eliminated the presence of preexisting functioning adenomas prior to the kidney failure. The development of multiple parathyroid adenomas in a patient with Tertiary HPT who is on hemodialysis is rare with only one study of a similar case in Japan in 1982. We present a rare case of Tertiary HPT patient on hemodialysis for seven years with double parathyroid adenomas that developed after the establishment of kidney failure. This case may give some insight to the factors that might lead to the formation of parathyroid adenomas, and it provides a unique follow-up of biochemical parameters during 7 years of parathyroid adenomas development.
