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JOURNALS || EIJO Journal of Science, Technology and Innovative Research (EIJO – JSTIR) [ ISSN : 2455 - 9938 ]
A Rare Case of Synchronous Papillary Carcinoma of Thyroid and Carcinoma of Parathyroid

Author Names : 1Naveen Kumar A, 2Vijayabaskar,  Volume 11 Issue 5
Article Overview

Background: Parathyroid carcinoma is an uncommon endocrine malignancy with an estimated incidence of 5.73 per 10 million population and accounts for less than 1% of primary hyperparathyroidism (PHPT). Synchronous occurrence with differentiated thyroid carcinoma is exceptionally rare, with only a handful of cases reported worldwide. The overlapping clinical and biochemical picture with parathyroid adenoma makes preoperative recognition difficult.

Case Presentation: An 82-year-old male presented with an anterior neck swelling of four years duration and altered voice. Examination showed a firm 4 x 4 cm swelling moving with deglutition and bilateral cervical lymphadenopathy. Biochemistry revealed markedly raised parathyroid hormone (368.7 pg/ml), hypercalcaemia (11.9 mg/dl) and euthyroid status. Fine needle aspiration cytology was reported as papillary thyroid carcinoma, and nasopharyngolaryngoscopy demonstrated left vocal cord palsy. Contrast-enhanced computed tomography of the neck showed an infiltrative left thyroid mass (3.8 x 3.6 cm) with tracheal compression and bilateral cervical lymphadenopathy. The patient underwent total thyroidectomy with left radical neck dissection and right modified neck dissection. Intraoperatively, a 2 x 2 cm right superior parathyroid mass was identified, and frozen section reported parathyroid carcinoma, prompting en bloc right superior parathyroidectomy. Final histopathology confirmed well-differentiated papillary thyroid carcinoma, grade I, pT3 N1b Mx, and parathyroid carcinoma.

Conclusion: Synchronous papillary thyroid carcinoma and parathyroid carcinoma should be actively considered in patients with thyroid malignancy accompanied by biochemical hyperparathyroidism. Routine preoperative estimation of serum calcium and parathyroid hormone is recommended in all patients evaluated for thyroid nodules, and intraoperative inspection of every parathyroid gland with liberal use of frozen section for any suspicious lesion should be integrated into the surgical protocol so that curative en bloc single-stage resection can be achieved.

Keywords: Parathyroid Carcinoma, Papillary Thyroid Carcinoma, Synchronous Malignancy, Primary Hyperparathyroidism, Total Thyroidectomy; HRPT2 (CDC73).

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