Needle biopsy of Parathyroid adenoma: The cells can look like follicular neoplasm or papillary thyroid cancer.
Parathyroid adenoma diagnosed as papillary carcinoma of thyroid on needle aspiration smears.
Needle aspiration of a neck mass was performed on a 55-year-old white female with hypercalcemia. The cytologic material showed cohesive clusters of monomorphic hyperchromatic cells resembling follicular cells. Papillary formation and follicle-like arrangements suggested papillary carcinoma of the thyroid. The histopathologic section of the excised mass, however, revealed a parathyroid adenoma. The diagnostic difficulties in differentiating parathyroid adenoma from well-differentiated thyroid carcinoma are discussed. Data published in the literature emphasize similar difficulties, and it is concluded that a final diagnosis can be established only on histopathologic sections.
- Comment: Prior to needle washout for PTH and thyroglobulin which is how we diagnose parathyroid disease now the cytology could lead to the wrong diagnosis.
- Richard Guttler MD,FACE,ECNU
The cells lie. They can look like thyroid neoplasms, but the needle washout from the adenoma will have high PTH and low thyroglobulin confirming the etiology is parathyroid not a thyroid tumor.
Image below is of a parathyroid adenoma ultrasound