The hyperfunctioning intrathyroidal parathyroid gland: A potential pitfall in parathyroid surgery

Wheeler, Malcolm H.; Williams, E. D.; Wade, J. S. H.

doi:10.1007/bf01658473

Cited by 42 publications

(12 citation statements)

References 14 publications

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“…It is quite unusual that these intrathyroidal glands can develop into hyperfunctioning adenomas. 16 To the best of our knowledge, only four other patients with intrathyroidal PC have been described in the literature. [17][18][19][20] In case #2, a diagnosis of primary hyperparathyroidism was made by endocrinologists on the basis of the skeletal involvement (bone pain, severe osteroporosis and multiple vertebral fractures), but clinical and biochemical data did not allow differentiation between cancer-associated hyperparathyroidism and the much more common benign counterpart.…”

Section: Casementioning

confidence: 97%

Parathyroid carcinoma as a challenging diagnosis: Report of three cases

Campennì¹,

Ruggeri²,

Sindoni³

et al. 2012

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Parathyroid carcinoma (Pc) is a rare malignancy with an indolent but progressive course. This rare tumour is often difficult to diagnose preoperatively, thus limiting the efficacy of surgery. As long-term survival is largely dependent on the extent of the primary surgical resection, it is of great importance to consider Pc in the differential diagnosis of hyperparathyroidism. We herein report three Pc patients with different clinical histories who were followed up at our hospital for over a 5-year period, emphasizing the variability in clinical presentation of this rare tumour. Moreover, NOrA (Nucleolar Organizer regions, a standardised silver-stain, marker of proliferation rate) values encountered in these Pc patients confirm that AgNOr analysis may be regarded as an additional tool when the pathologist encounters difficulties in defining parathyroid lesions which are not clearly benign.

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Section: Casementioning

confidence: 97%

Parathyroid carcinoma as a challenging diagnosis: Report of three cases

Campennì¹,

Ruggeri²,

Sindoni³

et al. 2012

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“…The hyperfunctioning parathyroid gland present within the parenchyma of the thyroid gland has been previously reported (6). Wheeler et al (6) described eight intrathyroid hyperfunctioning parathyroid glands.…”

Section: Case Reportmentioning

confidence: 94%

“…Wheeler et al (6) described eight intrathyroid hyperfunctioning parathyroid glands. Seven of the eight glands were thought to be inferior parathyroids.…”

Section: Case Reportmentioning

confidence: 99%

Intrathyroidal Parathyroid Cancer Presenting as a Left Neck Mass

Crescenzo

Shabahang²,

Garvin³

et al. 1998

Thyroid

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Parathyroid carcinoma is a rare clinical entity with a reported incidence of between 0.5% and 4% of all patients with primary hyperparathyroidism. Equally as unusual is the presence of an intrathyroidal parathyroid gland, which is usually found at the time of exploration by exclusion after extensive dissection has been performed in the usual anatomic locations for the parathyroid glands. This is the description of a case of intrathyroidal parathyroid cancer that presented as primary hyperparathyroidism with a left neck mass. On exploration, an enlarged left lobe of the thyroid was present and no left superior pole parathyroid gland was found with exploration. A left thyroid lobectomy was performed that confirmed a parathyroid cancer that was entirely intrathyroidal. This is the first known reported case in the literature of a carcinoma arising within the thyroid gland.

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“…Thus, there is a high risk of permanent hypocalcemia as most surgeons prefer to remove as much as transplanted tissue as possible. Intrathyroid adenomas are rare (0.5-3.5%) and may require an en-bloc lobectomy resection [42]. In the majority of cases, adenomas are located just under thyroid capsule and thus can be removed without performing a lobectomy.…”

Section: En-bloc Resectionmentioning

confidence: 99%

Persistent and recurrent hyperparathyroidism

et al. 2017

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Despite remarkable progress in imaging modalities and surgical management, persistence or recurrence of primary hyperparathyroidism (PHPT) still occurs in 2.5-5% of cases of PHPT. The aim of this review is to expose the management of persistent and recurrent hyperparathyroidism. A literature search was performed on MEDLINE using the search terms "recurrent" or "persistent" and "hyperparathyroidism" within the past 10 years. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. Before considering reoperation, the surgeon must confirm the diagnosis of PHPT. Then, the patient must be evaluated with new imaging modalities. A single adenoma is found in 68% of cases, multiglandular disease in 28%, and parathyroid carcinoma in 3%. Others causes (<1%) include parathyromatosis and graft recurrence. The surgeon must balance the benefits against the risks of a reoperation (permanent hypocalcemia and recurrent laryngeal nerve palsy). If surgery is necessary, a focused approach can be considered in cases of significant imaging foci, but in the case of multiglandular disease, a bilateral neck exploration could be necessary. Patients with multiple endocrine neoplasia syndromes are at high risk of recurrence and should be managed regarding their hereditary pathology. The cure rate of persistent-PHPT or recurrent-PHPT in expert centers is estimated from 93 to 97%. After confirming the diagnosis of PHPT, patients with persistent-PHPT and recurrent-PHPT should be managed in an expert center with all dedicated competencies.

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The hyperfunctioning intrathyroidal parathyroid gland: A potential pitfall in parathyroid surgery

Cited by 42 publications

References 14 publications

Parathyroid carcinoma as a challenging diagnosis: Report of three cases

Parathyroid carcinoma as a challenging diagnosis: Report of three cases

Intrathyroidal Parathyroid Cancer Presenting as a Left Neck Mass

Persistent and recurrent hyperparathyroidism

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