An unusual presentation of papillary thyroid carcinoma: a case report

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Published Aug 24, 2023
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Vol. 101 No. 3 (2023): Tunis Med mars 2023

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Manel Nouira
Nuclear Medicine Department, Sahloul Teaching Hospital, Sousse, TUNISIA / University of Sousse, Faculty of Medicine of Sousse, Tunisia
Imen Halloul
Nuclear Medicine Department, Sahloul Teaching Hospital, Sousse, TUNISIA / University of Sousse, Faculty of Medicine of Sousse, Tunisia
Mayssa Khribi
ENT Department, Les Aghlabides Surgical Division, IBN EL JAZZAR Teaching Hospital, Kairouan, TUNISIA / University of Sousse, Faculty of Medicine of Sousse, Tunisia,
Raja Sfar
Nuclear Medicine Department, Sahloul Teaching Hospital, Sousse, Tunisia / University of Monastir, Faculty of Medicine of Monastir, Tunisia
Mohamed Abdelkefi
ENT Department, Farhat Hached Teaching Hospital, Sousse, Tunisia / University of Sousse, Faculty of Medicine of Sousse, Tunisia
Khalil Gnaba
ENT Department, Les Aghlabides Surgical Division, IBN EL JAZZAR Teaching Hospital, Kairouan, TUNISIA / University of Sousse, Faculty of Medicine of Sousse, Tunisia,
Kaouthar Chatti
Nuclear Medicine Department, Sahloul Teaching Hospital, Sousse, Tunisia / University of Monastir, Faculty of Medicine of Monastir, Tunisia

Abstract

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
ignored.

Keywords:

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

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