An unusual presentation of papillary thyroid carcinoma: a case report


Manel Nouira
Imen Halloul
Mayssa Khribi
Raja Sfar
Mohamed Abdelkefi
Khalil Gnaba
Kaouthar Chatti


Parathyroid carcinoma (PC) is exceptional cause of primary hyperparathyroidism (PHPT). It has an estimated prevalence of 0.3 to 5.6%
and is rarely associated with non-medullary thyroid cancer. We report a case of parathyroid carcinoma resulting in a hyperparathyroidism
and revealing a papillary thyroid carcinoma, and emphasize on the management particularities of this entity.
A 37-year-old woman, with prolactin secreting pituitary microadenoma, presented with asthenia and bone pain. Laboratory findings were
consistent with PHPT. Neck ultrasonography showed a 3 cm nodule adjacent to the right thyroid lobe with no abnormalities in the thyroid
gland. Parathyroid scintigraphy showed a right inferior parathyroid adenoma. Because of the patient age and the decreased renal function,
surgical treatment was required. During the intra-operative neck exploration, a juxta-thyroid tumoral right mass was strongly adherent to
the right infra-hyoid muscle and the recurrent laryngeal nerve. The frozen examination of the mass demonstrated malignancy features
suggesting a poorly differentiated thyroid carcinoma. Thus, a total thyroidectomy with bilateral central neck dissection was carried out.
Final histopathological examination showed a 3.5 cm PC infiltrating the thyroid gland with a papillary thyroid microcarcinoma of the left
thyroid lobe. External radiotherapy of the neck, indicated for PC, was performed 1 month after surgery. A radioactive iodine therapy was
used 6 months postoperatively.
Despite its rarity, PC is to bear in mind in case of PHPT. The association between PC and differentiated thyroid carcinoma is not to be


Primary hyperparathyroidism, parathyroid carcinoma, differentiated thyroid carcinoma, multiple endocrine neoplasia



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