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21st European Congress of Pathology
Istanbul, Turkey, September 08-13, 2007
http://www.ecp2007istanbul.org/
Slide Seminar 5, September 10th
New and Controversial Entities of the New WHO Classification of Endocrine Tumors
Chairpersons: P. Komminoth (Switzerland), G. Rindi (Italy) |
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Return to seminar page |
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Case 6
Presented by: Prof. C. Sokmensuer, Turkey
Clinical History
A 36 year old woman presented with a complaint of a defect in her palate that occurred after surgical excision of a mass localized on the right lateral side of the hard palate at another clinic. Otorhinolaryngological examination confirmed a 2x2 cm defect of the hard palate connecting the nasal cavity with the oral cavity and a 3x3 cm palpable thyroid nodule on the right side was incidentally detected at that time.
The computerized tomographic (CT) scan showed a huge nodule (42x30x27 mm) which was compressing the trachea on the right thyroid lobe, and a soft tissue lesion in the right mandibular canal. Tc-99m Sestamibi scintigraphy demonstrated diffuse radiopharmaceutical uptake, which correlated with a thyroid nodule, within the thyroid region. It was reported as a thyroid nodule, with an additional note saying that a parathyroid adenoma could not be excluded. Before further surgery, the slides of the previous biopsy were sent for review to our pathology department and reported as a giant cell granuloma. On the other hand, the fine needle aspiration of the thyroid nodule revealed highly atypical, hyperchromatic cells. It was reported as a malignant neoplastic process.
In further laboratory investigations serum alkaline phosphatase was elevated (329 U/l), serum total calcium was markedly elevated at 13.8 mg/dl and intact PTH was 13 times above the normal range. Decalcification of the bones was observed in the densitometries and in the direct bone images. Fifteen days later her serum calcium level dropped to 10.5 mg/dl. Based on the above clinical findings, the patient underwent surgical exploration. During surgery, a firm, 3x3 cm mass partially infiltrating the thyroid capsule on the right pole of the thyroid gland was noticed. En bloc resection of the mass was performed, along with the entire thyroid gland and the surrounding connective tissue, both of which were apparently involved by the tumor.
Macroscopic findings: Bilateral total thyroidectomy of 66 g had normal cut sections. But an irregular solid grayish mass of 4x3,5x2,3 cm in size was seen at the inferior pole of the right thyroid lobe.
Follow up: The patient had severe postoperative hypocalcemia, necessitating calcium and vitamin D replacement. She also received postoperative radiotherapy. She ıs free of symptoms since one year.
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PARATHYROID CARCINOMA
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28.12.2007 |
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