Case Report Karsinoma Paratiroid Dr. Ihsan Ali Muharom FK Unpad RSHS

7/23/2019 Case Report Karsinoma Paratiroid Dr. Ihsan Ali Muharom FK Unpad RSHS

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Parathyroid CarcinomaCase Report

Ihsan Ali Muharom *, Achmad Dimyati **** Oncology Surgery Division, Surgery Department, Faculty of Medicine

Padjadjaran University / HasanSadikin Hospital, andung ! "esident of Surgery Department, Faculty of Medicine

Padjadjaran University / HasanSadikin Hospital, andung

ABSTRACT

INTRODCTION! This case report is intended to descri"e rare cases,namely parathyroid carcinoma# Parathyroid tumors are $ery rare, %henthere is usually a carcinoma, appro&imately '#( to () o all parathyroidtumors and is more common in youn+ %omen, most cases are thou+ht to"e a carcinoma turned out other%ise# Accepta"le criteria or mali+nancy isthe presence o tumor recurrence ater remo$al, distant metastasis orin$asion o adacent structures, adacent metastasis, metastasis to thelun+s, li$er, "one#

CAS- R-PORT! A %oman, a+ed (( years, Mrs#-R, present %ith a lump inthe nec. that come %ith the ri+ht ront o s%allo%in+ mo$ements, thene%ly percei$ed since si& months a+o, is not ound symptoms o in/ltration into surroundin+ or+ans# Since our years a+o, there is a lumpin the ri+ht lo%er le+ %hich elt directly "y chic.en e++# 0umps elt are notenlar+ed# Complaints accompanied "y lethar+y, myal+ia and arthral+iaand constipation# No symptoms o "ilateral metastasis to re+ional lymphnodes, no distant metastases symptoms# Treatment history toOrthopaedics, suspected tumor metastasis to "one# Then the 12raye&amination cruris %ith the results o lytic and sclerotic lesions %ere

"ersepta and demarcated in the pro&imal third ri+ht ti"ia and a e% smallones seen in the middle third o the ti"ia and /"ula and distal3 Bone prints%ith $isi"le results %hich increased patholo+ical increase o radioacti$ityin "one marro% os pro&imal ti"ia de.stra '45 and '45 medial portion o thelet ti"ia os3 and P-T2scan %ith the results appear enlar+ed parathyroid+land %ith parathyroid adenoma, there"y sho%in+ adanaya pictureparathyroid adenoma# -ndocrine consulted the IPD patients, perormed6NAB lump in the nec. %ith the results o papillary carcinoma a 4 rdi7erential dia+nosis o thyroid de.stra %ith undi#erentiated 8anaplastic9thyroid carcinoma and papillary thyroid carcinoma %ith epidermoid cyst,then consulted the Sur+ical Oncolo+y# :istory de.stra nephrectomysur+ery due to inection o .idney stones in ';;< at RS:S# 6rom the

physical e&amination ound our e&tremities motor %ea.ness# A 4 r collianterior de.stra there are masses %ho participated %ith s%allo%in+mo$ements, the s.in o$er the same mass %ith the surroundin+ s.in, /rm"oundaries, not 6i&ed, =at surace, hard consistency, si>e '&<,(&<,(cm# A 4r de.stra cruris '45 pro&imal medial aspect there is mass, the s.in o$erthe same mass %ith the surroundin+ s.in, ill de/ned, 6i&ed, =at surace,hard consistency, si>e ?&@&@cm# Do parotide.tomi de.stra,isthmolo"e.tomi de.stra, ro>en section histopatholo+ical e&aminationde.stra parathyroid and thyroid de.stra# Durante the operation, pole



parathyroid tumor mass %as ound under de.stra yello%ish %hite color,encapsulated, %ell de/ned, <#5 cm diameter, attached to the lo%er pole o thyroid de.stra, e&ploration o the let thyroid, parathyroid andparathyroid ri+ht upper pole let no a"normalities# 6rom the ro>en sectionhistopatholo+ical e&amination parathyroid and thyroid de.stra, o"tainedadenomatous +oiter and de.stra parathyroid carcinoma#

ey%ords! parathyroid carcinoma

Parathyroid

Carcinoma

Case Reports

I# ID-NTIT

Name : Mrs. Euis Rohayatoi

Age : 55 years

Address : Kp tile Bandung Barat

Occupation : Housewie

Education : Elementary !chool

"nspection #ate : #ecem$er %&' (&%)

II# :istory

Main *omplaint:

A lump on the right ront nec+

History #isease Now:

!ince , months ago new patients aware o a lump in the nec+ right ront part

mo-es during swallowing o peanuts. re-ious since ) years ago' the patient

complained o a lump in the right lower leg which elt directly $y chic+en egg.

/umps elt are not enlarged. *omplaints with wea+ $ody up can not wal+' aches

$one and muscle throughout the $ody. History *HA0ER noncurrent recogni1ed'

patients admitted BAB once e-ery )25 days.

No other $umps in the nec+ area. No complaints di3cult to swallow' with a

history o cough with -oice $ecomes hoarse. No complaints o shortness o $reath.

History radiation in the nec+ area denied. 4amily history o similar complaints

denied.

Because o the complaint' the patient went to Orthopaedics' said the

possi$ility o tumor metastasis to $one. 0hen lower etremity 62ray eamination'

Correspondent:

Ihsan Ali Muharom, MD.

Surgery Department, Faculty of Medicine Padjadjaran UniversitySUP dr. !asan Sadi"in #l. Pasteur $o. %& 'andung

(mail) ihsanalimuharom*yahoo.co.id



$one !idi+ and E02!can. Endocrine consulted the "# patients' perormed 4NAB

lump in the nec+' then consulted the !urgical Oncology.

atients with a history o +idney surgery right +idney stones remo-ed

$ecause o inection tahun%77& at R!H!.

III# P:SICA0 -1AMINATION

eneralists Status

Awareness: compost mentis

B: %8&9& mmHg

R: & 9 min

RR: (& 9 min

0: 8,. ; *

Head: not anemic con<uncti-a' sclera no <aundice

0hora:

"nspection: Mo-ement de-elopment symmetric dindingdada

alpation: =ocal remitus let > right

ercussion: !onor' let > right

Auscultation: =B! let > right' Rhon+i ?2 9 2@' whee1ing ?2 9 2@

Heart sounds !% and !( regular pure' murmur ?2@

A$domen:

"nspection: 4lat' -ene+tasi ?2@

alpation: !ot' nyerite+an ?2@' deansmus+ular ?2@.



no palpa$le enlarged li-er' spleen not palpa$le enlarged

ercussion: 0impani' pe+a+samping 9 pe+a+pindah ?2 9 2@

Auscultation: Bisingusus ?@ normal

Etremities: 0remor ?2@' Motor )9)' )9)

Status localist

a / r colli anterior dekstra:

"nspection: Massa who participated with swallowing mo-ements' the s+in o-er thesame mass with the surrounding s+in' -ene+tasi ?2@' hyperemia ?2@

alpation: Mass with distinct $orders' not 4ied' at surace' hard consistency'

mo-ing with the mo-ement' swallowing' N0 ?2@' the si1e %&'5&'5cm

a / r bilateral colli:

"nspection: not seem lymphadenopathy

alpation: no palpa$le lymphadenopathy

a / r dekstra cruris 1/3 proximal medial aspect:

"nspection: Massa' the s+in o-er the same mass with the surrounding s+in'

-ene+tasi ?2@' hyperemia ?2@

alpation: Mass with ill deCned' 4ied' at surace' hard consistency'

N0 ?2@' si1e ,))cm



Clinical picture!



I# R-SM-

A woman' aged 55 years' present with a lump in the nec+ that come with the

right ront o swallowing mo-ement. 0he history shows that the lump is elt since si

months ago' is not ound symptoms o inCltration into surrounding organs.

!ince our years ago' there is a lump in the right lower leg which elt directly

$y chic+en egg. /umps elt are not enlarged. *omplaints accompanied $y lethargy'

myalgia and arthralgia and constipation.

No symptoms o $ilateral metastasis to regional lymph nodes' no distant

metastases symptoms.

0reatment history to Orthopaedics' suspected tumor metastasis to $one. 0hen

the 62ray eamination cruris' !idi+ $one and E02!can. Endocrine consulted the "#

patients' perormed 4NAB lump in the nec+' then consulted the !urgical Oncology.

History de+stra nephrectomy surgery due to inection o +idney stones in

%77& at R!H!.

4rom the physical eamination ound status o$tained generalist motor

wea+ness our etremities' status localist a 9 r colli anterior de+stra there are

masses who participated with swallowing mo-ements' the s+in o-er the same mass

with the surrounding s+in' -ene+tasi ?2@' hyperemia ?2@' well deCned' not 4ied' at

surace' hard consistency' si1e %&'5&'5cm. a 9 r de+stra cruris %98 proimal medial

aspect there is mass' the s+in o-er the same mass with the surrounding s+in'

-ene+tasi ?2@' hyperemia ?2@' with deCned' 4ied' at surace' hard consistency' N0

?2@ ' si1e ,))cm

# DIANOSIS



%. #e+stra suspected parathyroid tumor is not malignant inCltration o the

trachea' esophagus' N/R' yet KDB regional metastasis' distant metastasis

un+nown

(. #e+stra suspected malignant thyroid tumors that were not inCltrating the

trachea' esophagus' N/R' yet KDB regional metastasis' distant metastasis is

un+nown suspect a thyroid carcinoma oli+ulare8. #e+stra suspected malignant thyroid tumors that were not inCltrating the

trachea' esophagus' N/R' yet KDB regional metastasis' distant metastasis is

un+nown suspect a thyroid carcinoma papilare

=". DIANOSIS Clinical oncolo+ists

#e+stra suspected parathyroid tumor is not malignant inCltration o the trachea'

esophagus' N/R' yet KDB regional metastasis' distant metastasis un+nown

="". PR-0IMINAR -1AMINATION R-S0TS

%. Ront+en cruris De.stra

/ytic and sclerotic lesions were $ersepta and demarcated in the proimal third

right ti$ia and a ew small ones seen in the middle third o the ti$ia and C$ula

and distal.

(. 6in+erprint Bone 8<?4'E4F<'@9! /oo+s increase in radioacti-ity which

increased pathological $one marrow os proimal ti$ia de+stra %98 and %98

medial portion o the let ti$ia os.8. P-T scan 8?4'<4'@9! /oo+s enlarged parathyroid gland with parathyroid

adenoma. 0hus picture showed parathyroid adenoma adanaya

). 6NAB 86#'@''G<9 <E4F<4F<'@!

0hyroid 4NAB de+stra: necrotic mass mied with $lood

reparations aspiration $iopsy consists o necrotic masses and colloids. *ells

appear round shape' o-al which group preparing ollicles' papillary and



monolayer' partly dispersed. Round cell nuclei' coarse chromatin' orming the

core portion pseudoin+lusion structure and little cytoplasm. "t also seems

superCcial suamous cells that spread to the core rather large' polimorC'

chromatin is rather rough.

Conclusions!

apillary *arcinoma a 9 r 0hyroid detra dd 9 undiFerentiated ?anaplastic@

carcinoma' thyroid carcinoma papilary with epidermoid cyst.

=""". -1AMINATION O6 PROPOS-D P-NNHAN

%. *alcium serum

% !erum phosphate

( arathyroid hormone ?0H@

8 0hyroid unction tests

) 0hyroid ultrasound and $ilateral colli

5 0hora hotos

"6. DIANOSIS SPPORT

%. !erum *alcium: 5.77

(. !erum phosphate: no results

8. 0H: no results

). 0hyroid 4unction 0ests

08 > %'7nmol 9 /40) > &'%ng 9 d/

0!Hs > &., "G 9 m/

5. 0hyroid ultrasound and $ilateral colliRight intrathyroid cystic nodules with calciCcation suggesti-e o a parathyroidadenoma dd 9 thyroid nodules' thyroid let this time does not seem +elianan'does not seem lymphadenopathy $ilateral colli

,. 0hora hotos/oo+s intrapulmonary metastasis



1# T:-RAP

• arathyroide+tomi de+stra

• "sthmolo$e+tomi de+stra

• Histopathologic eamination o the ro1en section

Durante operation 8'F4'E4F<'@9, ound!

• Gnder the pole parathyroid tumor mass de+stra yellowish white color'

encapsulated' well deCned' &.8 cm diameter' attached to the $ottom pole

thyroid de+stra

• Eploration o the let thyroid' parathyroid and parathyroid right upper pole

let no a$normalities.

• 4ro1en section histopathological eamination parathyroid and thyroid de+stra'o$tained adenomatous goiter and de+stra parathyroid carcinoma.



DISCSSION

Parathyroid +lands

0hese glands produce parathyroid hormone and calcitonin that play a role inthe meta$olism o calcium and phosphorus. Dlandular secretion is regulated $y the

le-el o calcium in the +idney tu$ules' decreased le-els o parathormone and

calcitonin plasma will lead to heightened rea$sorption o calcium rom $one and

+idney tu$ules' causing an increase in plasma calcium.



P:SIO0O





:P-RPARAT:ROIDISM-

A situation where the production o primary ele-ated parathormone secretion

increases whereas i the secondary when production increases due to the need.rimary Hyperparathyroid caused a parathyroid adenoma which can lead to a state

o C$rous Osteitis Kisti+a. "n the 62ray picture o thinning $ones appear

accompanied $y the ormation o multiple cysts that' and oten racture patalogis'

which normally occur in the $one plate' pel-is and s+ull. Grinary tract stones are

oten due to high plasma calcium le-els.

!econdary Hyperparathyroid occurs $ecause parathyroid gland hyperplasia

and hypertrophy due to +idney disease' multiple myeloma' metastatic carcinoma to

the $one' agets disease and osteogenesis imperecta.



Neoplasms

=ery rarely' when there is usually a carcinoma' approimately %.5 to 5I o all

parathyroid tumors and is more common in young women' most cases are thought

to $e a carcinoma turned out otherwise. Accepta$le criteria or malignancy is the

presence o tumor recurrence ater remo-al' distant metastases or in-asion o ad<acent structures' metastases ad<acent' could metastases to the lungs' li-er'

$one.



$%& PO'()S

%. Focused mini-incision Parathyroidectomy, ha-ing +nown with certainty its

location to $e chosen procedure or the handling o primary

hyperparathyroidism.

(. arathyroidectomy can impro-e symptoms and meta$olic complications o

primary hyperparathyroidism.

8. *alcium le-els and high parathyroid hormone J suspected parathyroid

carcinoma.



BIB0IORAP:

%. Acosta' ose. et al.' Chapter 36 - Thyroid and Chapter 3 - The Parathyroid

!land" "n !a$iston #*' 0et Boo+ o !urgery' % th ed' LB !aunders'hiladelphia' (&&.

(. Regato A' del Regato s. *ancer #ia$nosis Treatment and Pro$nosis, 6 th ed,

0he *= Mos$y *o.' 0oronto' %75' pp )(52))8

8. Brunicardi' 4. *harles. et al. Chapter 3% - Thyroid, Parathyroid, and &drenal" "n

!cwart1s rinciples o !urgery' 7 th ed' "nternational Edition' Mc Draw Hill

"nternational Boo+. (&%&.

). !adler' 0L et al.' Chapter 16 - 'ead ( )eck" "n /angmans Medical

Em$ryology %& th edition $y =ishal. Maryland *omposition *o. "nc. (&&7.

5. Kumar =' *otran R!' Ro$$ins. The *ndocrine +ystem: Thyroid and

Parathyroid" "n ROBB"N! BA!"* athology' E#' Else-ier. (&&.

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Case Report Karsinoma Paratiroid Dr. Ihsan Ali Muharom FK Unpad RSHS