Cytopathological variables in parathyroid lesions: A study based on 1,600 cases of hyperparathyroidism

Bondeson, Lennart; Bondeson, Anne‐Greth; Nissborg, Anders; Thompson, Norman W.

doi:10.1002/(sici)1097-0339(199706)16:6<476::aid-dc2>3.0.co;2-8

Cited by 57 publications

(46 citation statements)

References 19 publications

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“…Moreover, the presence of oncocytic cells and naked nuclei of chief cells in parathyroid cytologic specimen can be mimicking Hürthle cells and lymphocytes, respectively [19, 20]. This can be more challenging when the parathyroid lesion is mainly composed of oncocytic cells.…”

Section: Discussionmentioning

confidence: 99%

Fine-Needle Aspiration Cytology of Parathyroid Carcinoma Mimic Hürthle Cell Thyroid Neoplasm

Sriphrapradang

Sornmayura

Chanplakorn

et al. 2014

Case Reports in Endocrinology

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Background. Fine-needle aspiration (FNA) can cause misdiagnosis of cytomorphological findings between parathyroid and thyroid lesions. Case Presentation. A 31-year-old man presented with a palpable neck mass on the right thyroid lobe. FNA cytology was reported as intrathyroidal lymphoid hyperplasia. After 5 years, repeated FNA was done on the enlarged nodule with result of Hürthle cell lesion. Prior to right lobectomy, laboratories revealed elevated serum calcium and parathyroid hormone (PTH). Careful history taking revealed chronic knee pain and ossifying fibroma at the maxilla. Ultrasonography showed a 2.8 cm mass inferior to right thyroid lobe. Pathology from en bloc resection was parathyroid carcinoma and immunohistochemical study revealed positivity for PTH. Genetic analysis found somatic mutation of CDC73 gene in exon1 (c.70delG) which caused premature stop codon in amino acid 26 (p.Glu24Lysfs*2). The final diagnosis was hyperparathyroidism-jaw tumor syndrome. Conclusions. FNA cytology of parathyroid can mimic thyroid lesion. It is important to consider and correlate the entire information from clinical history, laboratory, imaging, and FNA.

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Section: Discussionmentioning

confidence: 99%

Fine-Needle Aspiration Cytology of Parathyroid Carcinoma Mimic Hürthle Cell Thyroid Neoplasm

Sriphrapradang

Sornmayura

Chanplakorn

et al. 2014

Case Reports in Endocrinology

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“…The parameters were identified from a literature search[31012141516] and findings from our own observations, which included epithelial cellularity, predominant pattern (flat sheets, 2D, 3D, microfollicles, loose clusters, papillary, single cells), naked nuclei, vascularity, perivascular epithelial cells, cell size, cell shape, nuclear-to-cytoplasmic (N:C) ratio, chromatin quality, nuclear contour, anisonucleosis, presence/size of nucleoli, cytoplasmic quality, cytoplasmic vacuoles, cytoplasmic borders, and presence of histiocytes and/or hemosiderin-laden macrophages.…”

Section: Methodsmentioning

confidence: 99%

“…[1] Often, these nodules are evaluated by fine-needle aspiration (FNA), which is recognized as the gold standard to evaluate thyroid nodules as it is a minimally invasive procedure that provides an approach for management and assists in determining the correct surgical procedure if necessary. [2345] Unsuspected proliferations, however, may confer a diagnostic challenge. For example, parathyroid glands are located in the neck near the thyroid gland and are sometimes in the thyroid (intrathyroid parathyroid).…”

Section: Introductionmentioning

confidence: 99%

Cytomorphologic features distinguishing Bethesda category IV thyroid lesions from parathyroid

Sung¹,

Saqi

Margolskee³

et al. 2017

CytoJournal

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Background:Thyroid follicular cells share similar cytomorphological features with parathyroid. Without a clinical suspicion, the distinction between a thyroid neoplasm and an intrathyroidal parathyroid can be challenging. The aim of this study was to assess the distinguishing cytomorphological features of parathyroid (including intrathyroidal) and Bethesda category IV (Beth-IV) thyroid follicular lesions, which carry a 15%–30% risk of malignancy and are often followed up with surgical resection.Methods:A search was performed to identify “parathyroid” diagnoses in parathyroid/thyroid-designated fine-needle aspirations (FNAs) and Beth-IV thyroid FNAs (follicular and Hurthle cell), all with diagnostic confirmation through surgical pathology, immunocytochemical stains, Afirma® analysis, and/or clinical correlation. Unique cytomorphologic features were scored (0-3) or noted as present versus absent. Statistical analysis was performed using R 3.3.1 software.Results:We identified five FNA cases with clinical suspicion of parathyroid neoplasm, hyperthyroidism, or thyroid lesion that had an eventual final diagnosis of the parathyroid lesion (all female; age 20–69 years) and 12 Beth-IV diagnoses (11 female, 1 male; age 13–64 years). The following cytomorphologic features are useful distinguishing features (P value): overall pattern (0.001), single cells (0.001), cell size compared to red blood cell (0.01), nuclear irregularity (0.001), presence of nucleoli (0.001), nuclear-to-cytoplasmic ratio (0.007), and nuclear chromatin quality (0.028).Conclusions:There are cytomorphologic features that distinguish Beth-IV thyroid lesions and (intrathyroidal) parathyroid. These features can aid in rendering correct diagnoses and appropriate management.

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“…Several authors have reported aspiration of parathyroid cells resulting in an erroneous diagnosis of follicular thyroid carcinoma, papillary thyroid carcinoma, and MTC. 14,15 Most commonly, parathyroid cells with microfollicular pattern could be interpreted as suggestive of follicular neoplasm. Many studies have noted that parathyroid cells in contrast to thyroid cells are likely to present as scattered naked nuclei and loose clusters with nuclei having a stippled chromatin pattern.…”

Section: Differential Diagnosismentioning

confidence: 99%

Fine-Needle Aspiration Cytology of Parathyroid Lesions

Legesse

Staats

2015

Pathology Case Reviews

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Parathyroid tissue is not uncommonly encountered in evaluation of "thyroid nodules," either due to radiologic misinterpretation of a parathyroid neoplasm as thyroidal in origin or due to incidental sampling during aspiration of a thyroid nodule. Recognition of the cytologic features of parathyroid is important to prevent misdiagnosis of these relatively common lesions and subsequent inappropriate surgical management. In addition, fine-needle aspiration is occasionally used in the preoperative workup of patients with hyperparathyroidism. Fine-needle aspiration can be used as an adjunct to imaging for preoperative localization of hyperfunctioning parathyroid tissue, which helps to minimize the extent of surgical exploration. This report reviews the cytomorphologic features of parathyroid lesions, differential diagnostic considerations, and ancillary methods that can be used to arrive at the right diagnosis.A 39-year-old man with history of papillary thyroid cancer treated with total thyroidectomy and subsequently 131 iodine and end-stage renal disease secondary to hypertensive nephropathy presented for surveillance 4 years after initial diagnosis. He underwent positron emission tomography/computed tomography that showed an area of increased metabolic activity in the anterior superior mediastinum, which was excised and found to be thymic tissue. A subsequent ultrasound examination performed a few months later revealed that the right thyroid bed contained an area of soft tissue echogenicity measuring 5 Â 7 Â 8 mm. Because of suspicion of recurrent papillary thyroid carcinoma, the nodule was targeted for fine-needle aspiration (FNA). With ultrasound guidance, the nodule was aspirated using a 25-gauge needle. Smears were air dried and stained with a modified Giemsa stain, and after the aspirate was deemed adequate, the rest of the smears were alcohol fixed and stained with Papanicolaou stain.Cytologic examination revealed a hemorrhagic, mildly cellular smear containing small round cells, which formed loosely cohesive clusters (Fig. 1). Single cells and naked nuclei were present. The cells had monomorphic, small, round nuclei with fine chromatin. The cytoplasm was moderate in amount and granular. There was sufficient material in the needle rinse to prepare multiple cytospin slides, on which immunocytochemistry was performed. The cells were positive for parathyroid hormone (PTH) and chromogranin A and negative for thyroglobulin and TTF-1. A diagnosis of parathyroid lesion was rendered.Subsequent review of medical records revealed a normal serum calcium level. No serum PTH assays were performed. The patient was presumed to have subclinical parathyroid enlargement secondary to renal failure.

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Cytopathological variables in parathyroid lesions: A study based on 1,600 cases of hyperparathyroidism

Cited by 57 publications

References 19 publications

Fine-Needle Aspiration Cytology of Parathyroid Carcinoma Mimic Hürthle Cell Thyroid Neoplasm

Fine-Needle Aspiration Cytology of Parathyroid Carcinoma Mimic Hürthle Cell Thyroid Neoplasm

Cytomorphologic features distinguishing Bethesda category IV thyroid lesions from parathyroid

Fine-Needle Aspiration Cytology of Parathyroid Lesions

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