DOCSLIB.ORG

Atypical Parathyroid Adenoma with Findings of Severe Hypercalcemia and Hyperparathyroidism

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Atypical Parathyroid Adenoma with Findings of Severe Hypercalcemia and Hyperparathyroidism Atypical Parathyroid Adenoma with Findings of Severe Hypercalcemia and Hyperparathyroidism Garrett Mockler, MD PGY-2 Faculty advisors: Dr Jeffrey Harrison, Dr Birgit Khandalavala Co-author of original paper: Dr Steve Miller and Dr Birgit Khandalavala Disclosures and conflict of interest: None Objectives 1) Evaluation of patients with thyroid and parathyroid masses 2) Evaluation of patients with hypercalcemia 3) Evaluation of patients with hyperparathyroidism Reminder! It is easy to criticize in hindsight The best way to look at an error is through root cause analysis. We are not doing that today as the point of this lecture is not to focus on morbidity and mortality but to use this case as a learning point for assessing a patient with elevated calcium and parathyroid levels. We are here to learn! Case presentation 67 yo Asian F presented to ENT clinic for anorexia, fatigue, weakness, rib pain, constipation, malaise, a documented weight loss of 30 lbs over 7 months, and a large left neck mass. Prior history from PCP: 12/08/14- serum Calcium elevated 10.6 (8.6-10.2). TSH normal 12/09/15- Routine health maintenance. Osteoporosis noted. Ca 11.6 (8.7-10.3) 5/02/16- US for Lt thyroid mass: right lobe 1.6 cm and left lobe 3.3 cm. Left lobe had a 3 cm dominate, solid mass Case presentation (cont) PCP timeline (cont) 5/16/16- US guided FNA: lymphocytitic thyroiditis 4/27/16- Swollen glands, no mention in PE, given Biaxin 500 mg BIDx 7 days 7/27/16- Constipation, given Linzess and colonoscopy ordered 8/31/16- normal colonoscopy 12/16/16- Documented weightloss of 22 lbs in 5 months. No mention of thyroid mass in PE but mention in assessment. Ca 16.0 (8.5-10.1) Referral to ENT Case presentation (cont) 12/19/16 Repeat calcium 15.0 (8.5-10.1) 12/20/16 Sees ENT. Visibly enlarged left thyroid that is mobile anterior- posteriorly but not superior-inferiorly. Non-tender. Nasolaryngeal endoscopy performed which was normal. Repeat labs ordered and a left thyroid lobectomy recommended. FNA repeated as well. TSH was normal at 0.426 mIU/L. Free T4 normal at 1.02 ng/dL Calcium 11.6 mg/dL. Repeat calcium 3 days later 15.0 mg/dL Alkaline phosphatase 223 U/L. Repeat 3 days later 233 U/L Hypercalcemia Multiple causes – Primary hyperparathyroidism – Inherited: MEN, Familial isolated hyperparathyroidism, Hyperparathyroidism-jaw tumor syndrome – Familial hypocalciuric hypercalcemia – Renal failure – Malignancy – Vitamin D intoxication – Chronic granulomatous disorders – Medications – Pituitary or adrenal cause – Immobilization – Nutrition – Milk-alkali syndrome Work-up algorithm for hypercalcemia Back to our case Repeat Calcium 16.0 mg/dL iPTH 1311 pg/mL Creatinine normal According to algorithm, DDx: primary hyperparathyroidism, MEN syndromes Primary Hyperparathyroidism • “Stones, bones, groans with psychiatric overtones” • Symptoms not necessarily due to hypercalcemia • Anorexia • Nausea • Constipation • Polydipsia • Polyuria • Nephrolithiasis most common complication of primary hyperparathyroidism (15-20% of newly diagnosed patients) • Patients with primary hyperparathyroidism and vitamin D deficiency have more significant disease with larger adenomas, increased PTH concentrations, increased bone turnover, and more frequent fractures Boonen, S & Vanderschueren, D & Pelemans, W & Bouillon, Roger. (2004). Primary hyperparathyroidism: Diagnosis and management in the older individual. European journal of endocrinology / European Federation of Endocrine Societies. 151. 297-304. 10.1530/eje.0.1510297. Primary Hyperparathyroidism DDx Parathyroid adenoma Parathyroid carcinoma Atypical parathyroid adenoma Familial hypocalciuric hypercalcemia Drugs: thiazides and lithium Differences between benign adenoma and parathyroid carcinoma Benign adenoma • Carcinoma Modest Ca elevation <15 Ca >15 Non-palpable neck mass PTH >3x upper limit of PTH <3x upper limit normal of normal Palpable neck mass Symptoms more profound What now? FNA – Can use to determine origin of the mass- in our sample case, the mass was found to be parathyroid tissue with positive test for parathyroid hormone and negative tests for TTF1, calcitonin, and thyroglobulin – Pathology could not determine if mass was malignant or benign in this case MRI- r/o MEN – Patient had 2 x 4 mm area of hypoenhancement along right pituitary which was read as volume averaging or cystic microadenoma – Abdominal MRI negative for any pathology Treatment options Medical – Asymptomatic – Non-surgical candidate • Avoid thiazides or lithium, eat low calcium diet, maintain exercise, stay hydrated, moderate calcium and vitamin D intake • Medications can include cinacalcet or bisphosphonates • Estrogen-progestin therapy- raloxifene • Denosumab- investigational Treatment options Surgery – Who is a surgical candidate when asymptomatic? • Serum Ca 1.0 mg/dL or more above upper limit of normal • Skeletal indications – Bone density at the hip, lumbar spine, and/or distal radius T- score <-2.5 • Renal indications • Age <50 years old Case surgery Pre-op PTH >2000 pg/mL Mass was mildly adherent to SCM and firm attachment to the left thyroid lobe Mass was 7.2 x 4.0 x 3.5 cm and was 42.2 gms No metastasis to lymph nodes 15 minutes after removal, PTH was 213 pg/mL Parathyroid hormone level remained >100 pg/mL months after surgery Histology Hypercellular tissue with mild pleomorphism and solid to glandular archicture. Thick acellular fibrous bands throughout the parathyroid tissue and abundant hemorrhage. No necrosis, lymphovascular invasion, or surrounding tissue invasion noted. Tissue positive for pnaacytokeratin. TTF-1 and chromogranin negative Gross specimen Fibrous bands with hemorrhage and thick acellular fibrous bands Solid pattern Pseudofollicular pattern and thick fibrous capsule What to make of this? Labs had features of carcinoma Presentation had features of carcinoma Surgery had features of benign adenoma due to there being a thick fibrous capsule and relative non-adherence to surrounding tissue Size consistent with carcinoma Histology has a mixed picture but does not meet the pathologic diagnosis of carcinoma Final diagnosis Atypical parathyroid adenoma Patient’s PTH remained elevated and she desired medical management with endocrinology versus more surgery. Patient lost to follow-up References Adam, M. A., Untch, B. R., & Olson Jr, J. A. (2010). Parathyroid Carcinoma: Current Understanding and New Insights into Gene Expression and Intraoperative Parathyroid Hormone Kinetics. The Oncologist, 61-72. Baser, H., Karagoz, A. C., Karanis, M. I., Sevimli, F., & Baser, S. (2013). Differential DIagnosis of Atypical Parathyroid Adenoma and Parathyroid Carcinoma in a Case with Severe Hypercalcemia. Journal of Medical Cases, Vol 4, No. 6, June 2013, 357-361. Cakir, B., Polat, S. B., Kilic, M., Ozdemir, D., Aydin, C., Sungu, N., & Ersoy, R. (2016). Evaluation of Preoperative Ultrasonographic and Biochemical Features of Patients with Aggressive Parathyroid Disease: Is There a Reliable Predictive Marker? Arch Endocrinol Metab, 537-544. Calson, D. (2010). Parathyroid Pathology. Archives of Pathological Lab Medicine, 1639-1644. Cao, J., Chen, C., Wang, Q.-l., Xu, J.-J., & Ge, M.-H. (2015). Parathyroid Carcinoma: A Report of Six Cases with a brief Review of the Literature. Oncology Letters, 3363-3368. DeLellis, R. (2011). Parathyroid Tumors and Related Disorders. Modern Pathology, S78-S93. Duckworth, L. V., Winter, W. E., Vaysberg, M., Moran, C. A., & Al-Quran, S. (2013). Intrathyroidal Parathyroid Carcinoma: Report of an Unusual Case and Review of the Literature. Case Reports in Pathology, Vol 2013, 1-5. Fernandez-Ranvier, G. G., Khanafshar, E., Jensen, K., Zarnegar, R., Lee, J., Kebebew, E., . Clark, O. H. (2007). Parathyroid Carcinoma, Atypical Parathyroid Adenoma, or Parathyromatosis? Cancer, Vol 110 Number 2, 255-264. Gill, A., Clarkson, A., Gimm, O., Keil, J., Dralle, H., Howell, V. M., & Marsh, D. J. (2006). Loss of Nuclear Expression of Parafibromin Distinguishes Parathyroid Carcinomas and Hyperparathyroidin-Jaw Tumor (HPT-JT) Syndrome-related Adenomas From Sporadic Parathyroid Adenomas and Hyperplasias. American Journal of Surgical Pathology, Vol 30 Issue 9, 1140-1149. Haglund, F., Juhlin, C. C., Kiss, N. B., Larsson, C., Nilsson, I.-L., & Hoog, A. (2016). Diffuse PTH Experssion in Parathyroid Tumors Argues Against Important Functional Tumor Subclones. European Journal of Endocrinology, 583-590. Halenka, M., Karasek, D., & Frysak, Z. (2012). Four Ultrasound and Clinical Pictures of Parathyroid Carcinoma. Case Reports in Endocrinology, 1-5. Harari, A., Waring, A., Fernandez-Ranvier, G., Hwang, J., Suh, I., Mitmaker, E., . Clark, O. (2011). Parathyroid Carcinoma: A 43-year Outcome and Survival Analysis. Journal of Clinical Endocrinology and Metabolism, 3679-3686. Hosny Mohammed, K., Siddiqui, M. T., Willis, B. C., Zaharieva Tsvetkova, D., Mohamed, A., Patel, S., . Cohen, C. (2016). Parafibromin, APC, and MIB-1 Are Useful Markers for Distinguishing Parathyroid Carcinomas from Adenomas. Applied Immunohistochemistry and Molecular Morphology. Ioannis Christakis, N. B., Clarke, C., Kwatampora, L. J., Warneke, C. L., Silva, A. M., Williams, M. D., . Perrier, N. D. (2016). Differentiating Atypical Parathyroid Neoplasm from Parathyroid Cancer. Annal of Surgical Oncology, Vol 23, Issue 9, 2889-2897. Kim, H. K., Oh, Y. L., Kim, S.-H., Lee, D. Y., Kang, H.-C., Lee, J. I., . Kim, S. W. (2012). Parafibromin Immunohistochemical Staining to Differentiate Parathyroid Carcinoma from Parathyroid Adenoma. Head and Neck, 201-206. Ng, S.-H., & Lang, B.
Load more

Recommended publications
  • A Rare Case of Invasive Pituitary Macroadenoma with Hemorrhage in MEN 1 Syndrome - a Case Report
    E.A. Ashok Kumar, M. Ravi Teja Raidu. A rare case of invasive pituitary macroadenoma with hemorrhage in MEN 1 syndrome - A case report. IAIM, 2021; 8(4): 106-117. Case Report A rare case of invasive pituitary macroadenoma with hemorrhage in MEN 1 syndrome - A case report E.A. Ashok Kumar1*, M. Ravi Teja Raidu2 1Professor, 2Assistant Professor Department of General Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, India *Corresponding author email: [email protected] International Archives of Integrated Medicine, Vol. 8, Issue 4, April, 2021. Available online at http://iaimjournal.com/ ISSN: 2394-0026 (P) ISSN: 2394-0034 (O) Received on: 25-03-2021 Accepted on: 05-04-2021 Source of support: Nil Conflict of interest: None declared. How to cite this article: E.A. Ashok Kumar, M. Ravi Teja Raidu. A rare case of invasive pituitary macroadenoma with hemorrhage in MEN 1 syndrome - A case report. IAIM, 2021; 8(4): 106-117. Abstract Multiple Endocrine Neoplasia (MEN) disorders are very rare. These are hereditary diseases which develop into a number of endocrine glands and result in tumor formation. The MENs are run in families because they are the exact consequence of genetic mutations and their symptoms are completely dissimilar dependent on the involving glands. Multiple endocrine neoplasia (MEN) is characterized by the occurrence of tumors involving two or more endocrine glands in a single patient. Four major forms of MEN, which are autosomal dominant disorders, are recognized and referred to as: MEN type 1 (MEN1), due to menin mutations; MEN2 (previously MEN2A) due to mutations of a tyrosine kinase receptor encoded by the rearranged during transfection (RET) protoncogene; MEN3 (previously MEN2B) due to RET mutations; and MEN4 due to cyclin-dependent kinase inhibitor (CDNK1B) mutations.
    [Show full text]
  • Intrathyroidal Clear Cell Tumor of Parathyroid Origin with Review of Literature
    Hindawi Publishing Corporation Case Reports in Pathology Volume 2016, Article ID 7169564, 7 pages http://dx.doi.org/10.1155/2016/7169564 Case Report Intrathyroidal Clear Cell Tumor of Parathyroid Origin with Review of Literature Daniela Pirela,1 Daniela Treitl,2 Siba El Hussein,3 Robert Poppiti,3 Thomas Mesko,2 and Alex Manzano4 1 Mount Sinai Medical Center, Internal Medicine Department, 4300 Alton Road, Miami Beach, FL, USA 2Mount Sinai Medical Center, Surgery Department, Miami Beach, FL, USA 3Mount Sinai Medical Center, Pathology Department, Miami Beach, FL, USA 4The Thyroid, Parathyroid and Pituitary Center for Miami, Internal Medicine Department, Miami Beach, FL, USA Correspondence should be addressed to Daniela Pirela; [email protected] Received 18 July 2016; Revised 27 October 2016; Accepted 1 November 2016 Academic Editor: Yoji Nagashima Copyright © 2016 Daniela Pirela et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Water-clear cell adenoma (WCCA) of the parathyroid gland is an exceedingly rare neoplasm. To date, 17 cases have been reported in the literature, with only one of them being intrathyroidal. Here we report a case of a 34-year-old woman who presented for evaluation of a goiter and was found to have a thyroid nodule and abnormal thyroid function tests (TFT). Fine needle aspiration biopsy of the nodule revealed thyroid follicular cells without atypia and subsequent Afirma5 Gene Expression Classifier (GEC) testing results were suspicious for malignancy. As a result, the patient underwent a right thyroid lobectomy and isthmusectomy.
    [Show full text]
  • Essentials of Head and Neck Needle Aspiration Cytology
    ESSENTIALS OF HEAD AND NECK CYTOLOGY - ESSENTIALS OF HEAD AND NECK CYTOLOGY Gia-Khanh Nguyen 2009 1 ESSENTIALS OF HEAD AND NECK CYTOLOGY ESSENTIALS OF HEAD AND NECK CYTOLOGY Gia-Khanh Nguyen, M.D. Professor Emeritus Laboratory Medicine and Pathology University Of Alberta Edmonton, Alberta, Canada Copyright by Gia-Khanh Nguyen First edition, 2009. All right reserved. This monograph was legally deposited at Library and Archives Canada and was given an ISBN: 0-9780929-1-0 2 ESSENTIALS OF HEAD AND NECK CYTOLOGY TABLE OF CONTENTS Preface…………………………………………………………………………4 Contributors…………………………………………………………………… 5 Acknowledgments……………………………………………………………….6 Related Material…………………………………………………………………...6 Dedication………………………………………………………………………………7 Chapter 1: Thyroid………………………………………………………..............8 Chapter 2: Salivary glands and other neck masses…………………………40 Chapter 3: Lymph nodes…………………………………………………………………82 Chapter 4: Intracranial tumors…………………………………………………………105 3 ESSENTIALS OF HEAD AND NECK CYTOLOGY PREFACE Tumors arising from the head and neck are numerous and have complicated and diversified histopathologic patterns. Cytodiagnosis of those neoplasms by fine needle aspiration is challenging and compounded with diagnostic pitfalls. However, with a representative cell sample and careful evaluation of different cellular and non-cellular components, a correct diagnosis may be safely made in the majority of cases. This monograph is written for practicing pathologists in community hospitals, pathology residents and cytotechnologists who are interested in acquiring a basic knowledge in diagnostic cytology of head and neck tumors. It consists of four chapters describing the cytologic manifestations of important tumors of the thyroid, parathyroid, salivary glands, lymph nodes, soft tissues and brain. The text is concise and illustrations are abundant. For most tumors, cytologic and histologic images are presented side by side for cytohistologic correlation.
    [Show full text]
  • Delayed Surgery for Parathyroid Adenoma Misdiagnosed As a Thyroid Nodule and Treated with Radiofrequency Ablation
    Case Endocrinol Metab 2013;28:231-235 http://dx.doi.org/10.3803/EnM.2013.28.3.231 Report pISSN 2093-596X · eISSN 2093-5978 Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation Ho-Su Kim1, Bong Hoi Choi2, Jung Rang Park1,3, Jong Ryeal Hahm1,3, Jung Hwa Jung1,3, Soo Kyoung Kim1,3, Sungsu Kim1, Kyong-Young Kim1, Soon Il Chung1, Tae Sik Jung1,3 Departments of 1Internal Medicine, 2Nuclear Medicine, 3Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A 99mtechnetium (99mTc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the proce- dure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL.
    [Show full text]
  • International Journal of Infection Prevention Issn No: 2690-4837
    Freely Available Online INTERNATIONAL JOURNAL OF INFECTION PREVENTION ISSN NO: 2690-4837 Research DOI: 10.14302/issn.2690-4837.ijip-20-3176 The Genetic Multiplicity- Multiple Endocrine Neoplasia type I Anubha Bajaj1,* 1MD. (Pathology) Panjab University, Department of Histopathology, A.B. Diagnostics, A-1, Ring Road, Rajouri Garden, New Delhi, 110027, India Abstract Multiple endocrine neoplasia type 1 (MEN1) is a syndrome emerging from characteristic mutations of MEN1 gene with concurrently enunciated multiple endocrine and tumours and associated non-endocrine neoplasm. Previously designated as Werner’s syndrome, MEN1 syndrome denominates genomic mutation within chromosome 11q13 or a tumour suppressor gene with a distinctive protein product nomenclated as “menin”. MEN1 syndrome demonstrates an autosomal dominant pattern of disease inheritance where genomic mutations delineate a comprehensive (100%) disease penetrance. MEN1 gene was initially identified in 1997 upon chromosome 11q13. Although twelve genetic mutations were primarily identified, currently beyond eighteen hundred genomic mutations are scripted [1,2]. MEN1 syndrome is comprised of diverse combination of twenty or more endocrine and non-endocrine tumours exemplifying a classic triad of pituitary, parathyroid and pancreatic neoplasm. Diverse non endocrine tumours enunciated with MEN1 syndrome are denominated with meningioma, ependymoma or angiofibroma [1,2]. Endocrine tumours are discerned on account of excessive hormonal secretion engendered from various neoplasm or on account of neoplastic evolution. Approximately 10% instances can occur due to a de-novo genomic variant. Offspring of an individual with MEN1 syndrome quantifies a 50% possibility of inheriting the genomic variant. Cogent prenatal diagnosis can be determined in instances where specific genomic variant of a particular family is known.
    [Show full text]
  • Atypical Parathyroid Adenomas: Challenging Lesions in the Differential Diagnosis of Endocrine Tumors
    26 7 Endocrine-Related F Cetani et al. Atypical parathyroid 26:7 R441–R464 Cancer adenomas REVIEW Atypical parathyroid adenomas: challenging lesions in the differential diagnosis of endocrine tumors Filomena Cetani1, Claudio Marcocci2, Liborio Torregrossa3 and Elena Pardi2 1University Hospital of Pisa, Unit of Endocrinology, Pisa, Italy 2Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy 3University Hospital of Pisa, Division of Surgical Pathology, Pisa, Italy Correspondence should be addressed to F Cetani: [email protected] Abstract Atypical parathyroid adenomas represent a group of intermediate form of parathyroid Key Words neoplasms of uncertain malignant potential which show some atypical histological f parathyroid adenoma features that represent a challenge for the differential diagnosis with parathyroid f parathyroid carcinoma carcinomas. They may occur as sporadic or as a part of hereditary syndromes. The f primary molecular signature of these neoplasms is still unknown and the germline CDC73 hyperparathyroidism mutations appears to be the most common anomaly in this setting suggesting that f CDC73 these cases might represent variants of the hyperparathyroidism-jaw tumor syndrome. f parafibromin The identification of markers predicting the outcome is of great importance to guide an f PGP9.5 adequate postoperative monitoring and, the same time, relieve of the anxiety of relatively f galectin-3 strict monitoring patients not at risk. This review will summarize the current knowledge of the clinical, biochemical, molecular and histological profile of atypical parathyroid adenomas. Endocrine-Related Cancer (2019) 26, R441–R464 Introduction Parathyroid tumors are a heterogeneous group of tumors type 4 (MEN4) and the hyperparathyroidism-jaw tumor that affect 0.1–0.3% of the general population.
    [Show full text]
  • Sleep Disorders in Cervical Dystonia, Parkinson's Disease and Depression
    Southeastern European Medical Journal (SEEMEDJ) Published by University Josip Juraj Strossmayer Osijek Faculty of Medicine Osijek Editor-in-Chief Ines Drenjančević, MD, PhD, Osijek, Croatia Editorial Board Selma Uzunović, MD, PhD, Zenica, Bosnia and Herzegovina Dolores Biočina-Lukenda, MD, PhD, Split, Croatia Irena Drmić Hofman, MD, PhD, Split, Croatia Pavo Filaković, MD, PhD, Osijek, Croatia Ljubica Glavaš-Obrovac, MSc, PhD, Osijek, Croatia Nandu Goswami, MD, PhD, Graz, Austria Mitja Lainšćak, MD, PhD, Ljubljana, Slovenia Helena Lenasi, MD, PhD, Ljubljana, Slovenia Julian H. Lombard, PhD, Milwaukee, WI, USA Peter Nemeth, MD, PhD, Pécs, Hungary Shane A. Phillips, MSc, PhD, Chicago, Illinois, USA Rostyslav Stoika, PhD, Dr. Sci, Lviv, Ukraine Sandor G. Vari, MD, Los Angeles, CA, USA Aleksandar Včev, MD, PhD, Osijek, Croatia Oksana Zayachkivska, MD, PhD, DSc, Lviv, Ukraine George Wu, MD, PhD, Farmington, CT, USA Secretary: Marija Raguž, PhD English Language Proofreaders: AdHoc Cover: minimal.com.hr Technical Editors: minimal.com.hr Web page: minimal.com.hr Published online: http://seemedj.mefos.unios.hr ISSN 2459-9484 Contents Experimental Liver Peroxidation Against the Background of Limb Ischemia - Reperfusion Injury – Is There a Pathogenic Difference Between Its Modifications? .......................................... 1 Stature Estimation from the Right External Ear of Undergraduate Students in South-East Nigeria ........................................................................................................................................................................................
    [Show full text]
  • Miscp101.Pdf
    Animal Health in Minnesota Annual Report of the Minnesota Veterinary Diagnostic Laboratory Fiscal Year 1999 (July 1, 1998- June 30, 1999) in cooperation with Department of Veterinary Diagnostic Medicine College of Veterinary Medicine University of Minnesota and Minnesota Board of Animal Health Miscellaneous Publication 101-1999 Minnesota Agricultural Experiment Station University of Minnesota St. Paul, Minnesota The University of Minnesota, including the Minnesota Agricultural Experiment Station, is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, color, creed, religion, national origin, sex, marital status, disability, public assistance status, veteran status, or sexual orientation. -Printed on Recycled Paper Containing a Minimum of 10 Percent Post-Consumer Material- FOREWORD The Veterinary Diagnostic Laboratory (VDL) is a program of the College of Veterinary Medicine in the University of Minnesota Academic Health Center. The VDL was established in 1904 in the Agricultural Experiment Station of the University of Minnesota, by agreement between the Minnesota Livestock Sanitary Board and the University. It's purpose is to satisfy the need for accurate diagnosis of animal diseases that threaten Minnesota's livestock and poultry industries, companion animals, wildlife and human health. As the official laboratory of the Minnesota Board of Animal Health, the VDL provides laboratory support to the state's animal disease control and eradication programs. The VDL was administratively separated from the College's Department of Veterinary Diagnostic Medicine on July 1, 1998. This was done to enhance the interdisciplinary service and research through the participation of faculty across several non-traditional Collegiate and University departments.
    [Show full text]
  • Major Clues and Pitfalls in the Differential Diagnosis Of
    medicina Article Major Clues and Pitfalls in the Differential Diagnosis of Parathyroid and Thyroid Lesions Using Fine Needle Aspiration Cytology Hwa Jeong Ha 1,2, Eun Ju Kim 3,4 , Jung-Soon Kim 1, Myung-Soon Shin 1, Insup Noh 2,5 , Sunhoo Park 1, Jae Soo Koh 1 and Seung-Sook Lee 1,* 1 Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; [email protected] (H.J.H.); [email protected] (J.-S.K.); [email protected] (M.-S.S.); [email protected] (S.P.); [email protected] (J.S.K.) 2 Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, Seoul 01811, Korea; [email protected] 3 Division of Radiation Biomedical Research, Korea Institute of Radiological & Medical Sciences, Seoul 0182, Korea; [email protected] 4 Radiological & Medico-Oncological Sciences, University of Science & Technology, Daejeon 34113, Korea 5 Department of Chemical and Biomolecular Engineering, Seoul National University of Science and Technology, Seoul 01811, Korea * Correspondence: [email protected]; Tel.: +82-2970-1268 Received: 25 September 2020; Accepted: 21 October 2020; Published: 24 October 2020 Abstract: Background: It is difficult to distinguish parathyroid lesions (PLs) from thyroid lesions using fine needle aspiration cytology (FNAC) because of their proximity and their similar cytomorphological features. Methods: FNAC smears of 46 patients with pathologically proven PLs that were histologically diagnosed as parathyroid adenoma (PA, n = 35), parathyroid hyperplasia (PH, n = 3), atypical parathyroid adenoma (APA, n = 1), and parathyroid carcinoma (PC, n = 7) were retrospectively reviewed and analyzed.
    [Show full text]
  • Essentials of Head and Neck Needle Aspiration Cytology
    Essentials of Head and Neck Cytology Gia-Khanh Nguyen Thomas A. Thomson 2012 Essentials of Head and Neck Cytology Gia-Khanh Nguyen, MD, FRCPC University of Alberta Edmonton, Alberta, Canada And Thomas A. Thomson, MD, FRCPC University of British Columbia Vancouver, British Columbia, Canada Second edition, 2012 All right reserved. Legally deposited at Library and Archives Canada ISBN: 978-0-9780929-8-6 2 Table of Contents Preface and Acknowledgments 7 Contributors and Related Material by Dr. Nguyen 8 Remarks and abbreviations 9 Chapter 1: Thyroid 10 Indication and goal of thyroid FNA Contraindications and complications of thyroid FNA Procurement and preparation of cell samples 11 Specimen adequacy 12 Cytodiagnosis and reporting 13 • The Papanicolaou Society of Cytopathology cytodiagnostic groups • The Bethesda System for reporting thyroid cytopathology Cytologic findings 15 • Non-diagnostic category 16 • Benign lesions - Benign colloid nodule and Thyroiditis • Indeterminate lesions 20 • - Atypia of uncertain significance/Suspicious for follicular neoplasm • Malignant lesions and suspicious for malignant lesions 23 - Papillary carcinoma - High-grade follicular carcinoma and insular carcinoma - Medullary carcinoma - Anaplastic carcinoma - Non-Hodgkin lymphoma - Metastatic cancers • Other lesions 31 - Cystic lesions - Graves disease Diagnostic accuracy and reporting 33 Adjunctive diagnostic value of ancillary techniques 33 - Ultrafast Pap stain, Immunohistochemistry, Molecular markers Bibliography 35 Chapter 2: Salivary glands and other neck
    [Show full text]
  • Sir Richard Owen
    1 Indian Journal of Endocrine Surgery Vol.15 Issue 1 Seeptember 2020 Founder President Dr. S Vittal Padmashri Awardee President Honorary Secretary Honorary Treasurer Dr. Sai Krishna Vittal Dr. Anand Kumar Mishra Dr. M. Saba Retnam President Elect Immediate Past President Dr. M.J. Paul Dr. Amit Agarwal Vellore Lucknow Vice-Presidents Dr. Manish Kaushal Indore Dr. P.V. Pradeep Kazi Kode Dr. Dhalpathy Sadacharan Chennai Joint Secretaries Executive Committee Members Dr. Kul Ranjan Singh Dr. V. Sai Vishnupriyaa Lucknow Chennai Dr. R. Manivannan Dr. Nikhil Singh Chennai Lucknow Editorial Board Dr. Deependra Narayan Singh Editor in Chief Jaipur Dr. M.J. Paul Vellore Dr. Roma Pradhan Board Members Lucknow Dr. Ranjith Sukumar Kazi Kode Dr. Sendhil Ranjan Dr. Sudhi Agrawal Bengaluru Meerut Aims and Scope IAES, a section of ASI was started in the year 1993 by Padmashri Prof. S. Vittal as its founder president. The Association has evolved into a vibrant organisation is one of the best performing sections of ASI. The association has been a pillar of strength in the development of Department of Endocrine Surgery in Madras Medical College, SGPGIMS, Lucknow, KGMU, Lucknow, AIIMS, New Delhi, AIIMS, Patna and CMC, Vellore. The Association takes pride in the dissemination of Principles and practice of Endocrine Surgery to all Surgeons. It conducts CME Programmes, Organises Annual Meetings and awards Fellowship (FAES) as part of its initiative to update its member and to popularise Endocrine Surgery amongst the Surgeons. The aim of Indian Journal of Endocrine Surgery is to promote and encourage development and advancement of Endocrine Surgery and allied specialties.
    [Show full text]
  • (Minen) of the Parathyroid Gland Exist? First Description of a Possible Case
    Head and Neck Pathology (2021) 15:381–387 https://doi.org/10.1007/s12105-020-01178-4 CASE REPORTS Does Mixed Neuroendocrine‑Nonneuroendocrine Neoplasm (MiNEN) of the Parathyroid Gland Exist? First Description of a Possible Case Silvana Di Palma1,4 · Moonim Mufaddal2 · Vishwas Iyer1 · Amedeo Sciarra3 · Stefano La Rosa3 Received: 11 March 2020 / Accepted: 20 May 2020 / Published online: 6 June 2020 © The Author(s) 2020 Abstract We describe the histological, histochemical, and immunohistochemical features of an unusual neoplasm of the parathyroid gland showing the histologic criteria of a mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN). To the best of our knowledge, this is the frst report of such a tumor. A 43-year old male presented with acute and severe abdominal pain due to acute pancreatitis. On physical examination a painless lump in the right neck was detected and laboratory analyses revealed hyperparathyroidism (parathormone: 146 pmol/L, normal range 1.05–6.83) and hypercalcemia (calcium level: 3.02 mg/ dL, normal range 2.25–2.5), which fell to 2.55 mg/dL after parathyroidectomy. Histologically, the tumor was a parathyroid carcinoma associated with a mucous secreting adenocarcinoma also confrmed by histochemical (Alcian blue—periodic acid Schif) and immunohistochemical stainings. The present case expands the spectrum of MiNENs that can be found in endocrine organs. Keywords Mixed neoplasm · Mixed neuroendocrine-nonneuroendocrine neoplasm · MiNEN · Composite tumor · Combined tumor · Parathyroid gland Introduction clinico-pathologic, pathogenetic, molecular, and prognostic features are still to be elucidated [1]. Mixed neuroendocrine-nonneuroendocrine neoplasms MiNENs can virtually occur in any organ of the body and (MiNENs) are epithelial malignancies composed of both have been described in the pituitary gland, thyroid, nasal neuroendocrine and non-neuroendocrine components, which cavity, larynx, lung, digestive system, urinary system, male are morphologically and immunohistochemically recogniz- and female genital organs, and skin.
    [Show full text]