Parathyroid carcinoma with sarcomatoid differentiation: a case report and literature review
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CASE REPORT
Open Access
Parathyroid carcinoma with sarcomatoid differentiation: a case report and literature review Liang Hu and Xiaojun Xie*
Abstract Background: Parathyroid carcinoma (PC) is a rare thyroid tumor. PC with sarcomatoid differentiation(PCSD) is even rarer and its exact etiology remains unclear. We here report a case of PCSD, and present the clinicopathological features and pathological diagnosis and review the literature. Case presentation: A 71-year-old man presented with a mass of 4.5 cm × 3.5 cm in the right neck. The tumor was composed of nest-like transparent cells, and the septum had heterotypic rhabdoid cells with sarcomatoid differentiation. Immunophenotype was as follows: myogenic differentiation 1(MyoD1), myogenin and desmin were positive; clear cells were positive for chromogranin A(CGA), synaptophysin(Syn) and GATA-3; and Ki-67 proliferation index was 40%. Hematoxylin and eosin staining and immunohistochemistry were performed. The patient was diagnosed with PCSD, and died 6 months after surgery. Conclusions: PCSD is a rare type of primary parathyroid tumor with high malignancy and poor prognosis. Definitive diagnosis should be based on histopathological morphology and immunophenotype, and surgical treatment should be performed as soon as possible. Keywords: Parathyroid carcinoma, Sacroma, Parathyroid, Case report, thyroid, sarcomatoid differentiation
Background Parathyroid carcinoma(PC) is one of the rare cancers, accounting for less than 4% of cases of parathyroid diseases in the United States. DeQeurvain first described PC in 1904, which is characterized by high blood calcium and parathyroid hormone (PTH) levels [1]. However, PCSD is even rarer as a clinical solid tumor type. Nacamuli Randall first described this special type of parathyroid tumor in 2002 [2]. Since then, only four such cases have been reported including 2 cases abroad and 2 cases in China. The exact etiology of PC with sarcomatoid differentiation remains
* Correspondence: [email protected] Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, PR China
unclear. Typical clinical manifestations may include hypercalcemia and high PTH level. It does not differ significantly from a general PC, but the tumor is more aggressive and has poor prognosis.
Case presentation A 71–year-old male patient was admitted to hospital for hoarseness for > 1 month. Ultrasound showed that the right thyroid was enlarged, bilateral thyroid nodules were present, the right larger nodules were about 4.5 × 3.5 cm, belonging to TI-RADS 4a type, and the left nodules belonged to TI-RADS 3 type (Fig. 1). Enhanced computed tomography (CT) showed a space-occupying lesion in the right thyroid area, invading the trachea and mediastinum (Fig. 2).
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as
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