Incidental finding of metastatic papillary thyroid carcinoma in a patient with primary hyperparathyroidism.
OBJECTIVE
To report on the management of a patient with the rare concurrence of primary hyperparathyroidism and incidentally found metastatic papillary thyroid carcinoma in an adjacent lymph node.


METHODS
We present a case report, including scintigraphic and histologic documentation, and a summary of the related literature.


RESULTS
Primary hyperparathyroidism with concomitant occurrence of nonmedullary thyroid carcinoma is rare, occurring in less than 4% of patients. We report a case of a 53-year-old woman with no prior history of endocrine disease with primary hyperparathyroidism and an incidental finding of a concurrent thyroid carcinoma. In this patient, technetium 99m scintigraphy revealed a parathyroid adenoma beneath the inferior pole of the left thyroid bed. Parathyroidectomy was performed successfully with no complications. The final pathology examination showed a large parathyroid adenoma with an incidental finding of a small adjacent lymph node containing metastatic papillary thyroid carcinoma. The patient subsequently underwent total thyroidectomy, and the pathology evaluation revealed papillary thyroid carcinoma, follicular variant.


CONCLUSIONS
To our knowledge, this case of concomitant primary hyperparathyroidism and papillary thyroid cancer is unique in the way in which the diagnosis of metastatic papillary thyroid cancer was made. The presence of parathyroid adenoma should not exclude the diagnosis of thyroid carcinoma; therefore, careful thyroid evaluation should be considered for all patients with primary hyperparathyroidism.
Department of Surgery, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California 92093-0987, USA.
Jeffrey K
JK
Lee
Sebastian L
SL
Obrzut
Eunhee S
ES
Yi
Leonard J
LJ
Deftos
Michael
M
Bouvet
D000236:Adenoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D002291:Carcinoma, Papillary / Q000150:complications* / Q000000981:diagnostic imaging / Q000556:secondary; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging; D013964:Thyroid Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology