Langenbecks Arch Surg (2006) 391:623–626 DOI 10.1007/s00423-006-0095-8
CASE MANAGEMENT AND CLINICAL CONSEQUENCES
Implantation of parathyroid carcinoma along fine needle aspiration track Gaurav Agarwal & Sadhna Dhingra & Saroj K. Mishra & Narendra Krishnani
Received: 11 April 2006 / Accepted: 9 August 2006 / Published online: 5 October 2006 # Springer-Verlag 2006
Abstract Introduction Fine needle aspiration cytology is not a commonly employed diagnostic modality in the diagnosis of parathyroid tumors. Case report A 28 year old lady being followed-up for 5 years after en bloc resection of a parathyroid carcinoma presented with a nodule in the lower neck, away from the parathyroidectomy scar. The 1 cm isolated nodule was located in the muscular and subcutaneous plane and corresponded to the needle track of FNA performed on a neck nodule before the parathyroidectomy. On evaluation, she had mild hypercalcemia and high normal serum parathyroid hormone levels. FNAC and histology including immunohistochemistry for Chromogranin A after local excision of the nodule confirmed the nodule to be a recurrent parathyroid carcinoma along the needle track. Discussion To the best of the authors’ knowledge, this is only the second case of needle track implantation after FNA in parathyroid carcinoma reported to date. This case highlights the risk of engraftment of parathyroid tissue after FNA and cautions against the use of FNA as a preoperative diagnostic modality for the evaluation of parathyroid lesions.
Drs. Agarwal and Dhingra have contributed equally, as joint first authors. G. Agarwal (*) : S. K. Mishra Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India e-mail:
[email protected] S. Dhingra : N. Krishnani Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
Keywords Parathyroid neoplasm . Parathyroid carcinoma . Implantation . FNAC
Introduction Fine needle aspiration cytology (FNAC) is a common diagnostic modality used for the evaluation of palpable masses in the thyroid region. Palpable parathyroid lesions are rare, and are taken as an indicator for malignancy [1]. In an endemic iodine deficient region, it is difficult to differentiate a parathyroid mass from a coexistent thyroid nodule, which is of common occurrence, on clinical and radiological grounds. At times, FNAC is employed to ascertain the parathyroid origin or to determine the etiology of primary hyperparathyroidism [2]. The American Association of Clinical Endocrinologists and The American Association of Endocrine Surgeons, in their joint consensus statement on the management of primary hyperparathyroidism advocate ultrasound-guided fine needle aspiration of a parathyroid adenoma for PTH analysis as a sensitive method of localization [3]. Despite concerns over the risk for needle track tumor implantation resulting from needle aspiration, FNAC is considered a safe procedure because it is a rare complication and generally occurs in high-grade malignancies. We report a case of parathyroid carcinoma with subcutaneous tumor implant along the needle track.
Case report The 22 years old female was first managed in 1996 for complaints of a gradually increasing neck swelling, muscular and bony pains followed by pathological fracture of neck femur resulting in confinement to bed for 6 months.
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She was anemic and had proximal muscular weakness and multiple fractures of long bones and ribs along with bony swellings of the upper end of left tibia and both femurs. On examination of the neck, there was a 3 cm firm nodule palpable at the lower pole of right thyroid lobe. There were no palpable lymph nodes. The biochemistry picture was diagnostic of primary hyperparathyroidism with serum calcium of 13.6 mg/dl (normal range 8.5–10.8), inorganic phosphorus of 1.8 mg/dl (normal range 2.5–4.6), and intactPTH level of 1,800 pg/ml (normal range 9–55). She had high serum alkaline phosphatase levels (580 IU/L, normal
