26350418 Visualization

A 50 Age - year Age - old Age male Sex patient was admitted Clinical_event to our Department Nonbiological_location for a thyroid Biological_structure nodule Sign_symptom on the right Biological_structure side Biological_structure of Biological_structure the Biological_structure neck Biological_structure , which was incidentally detected on carotid Biological_structure Doppler Detailed_description ultrasound Diagnostic_procedure scan.
Fine Diagnostic_procedure - needle Diagnostic_procedure aspiration Diagnostic_procedure cytology Diagnostic_procedure ( FNAC Diagnostic_procedure ) showed a follicular Detailed_description lesion Sign_symptom .
At the time of our evaluation Diagnostic_procedure , the patient was in good Lab_value health Diagnostic_procedure .
The medical history revealed hypertension History , vitiligo Disease_disorder , and celiac Disease_disorder disease Disease_disorder .
On physical Diagnostic_procedure examination Diagnostic_procedure , a small Detailed_description nodule Sign_symptom ( 1 Distance cm Distance ) was palpable Sign_symptom in the right Biological_structure thyroid Biological_structure lobe Biological_structure .
No enlarged Sign_symptom neck Biological_structure lymph Biological_structure nodes Biological_structure were palpable Sign_symptom .
Neck Biological_structure ultrasound Diagnostic_procedure showed a 1.3 Distance cm Distance hypoechoic Detailed_description nodule Sign_symptom with irregular Detailed_description margins Detailed_description in the right Biological_structure thyroid Biological_structure lobe Biological_structure together with bilateral Detailed_description small Detailed_description thyroid Biological_structure nodules Sign_symptom (4–5 mm Distance ) and the absence of enlarged Sign_symptom cervical Biological_structure bilateral Biological_structure lymph Biological_structure nodes Biological_structure .
Thyroid Diagnostic_procedure function Diagnostic_procedure tests Diagnostic_procedure were normal Lab_value with the absence of thyroid Sign_symptom autoantibodies Sign_symptom .
Serum Detailed_description calcium Diagnostic_procedure was normal Lab_value ( 9.7 Lab_value mg/dl Lab_value ; normal range, 8.4–10.4 mg/dL) and PTH Diagnostic_procedure , routinely measured together with serum Detailed_description calcium Diagnostic_procedure in our Center Nonbiological_location in patients undergoing thyroid Biological_structure surgery Therapeutic_procedure , slightly Lab_value elevated Lab_value ( 68 Lab_value pg/mL Lab_value (intact PTH, 2nd generation assay; normal range, 10–65 pg/mL)).
The re-review of the original slides of FNAC Diagnostic_procedure confirmed a follicular Biological_structure lesion Sign_symptom .
In particular, the cytology Diagnostic_procedure of the nodule Sign_symptom showed epithelial Other_event cells Other_event with Other_event hyperchromatic Other_event nuclei Other_event organized Other_event in Other_event small Other_event cohesive Other_event clusters Other_event resembling Other_event microfollicles Other_event typically observed in thyroid Biological_structure follicular Biological_structure lesions Sign_symptom were evident (Fig.1a).
The patients underwent right Detailed_description lobectomy Therapeutic_procedure .
During neck Biological_structure exploration Diagnostic_procedure , there were no macroscopic Detailed_description signs Detailed_description of local Detailed_description invasion Sign_symptom .
The intraoperative Detailed_description frozen Detailed_description - section Detailed_description pathological Diagnostic_procedure examination Diagnostic_procedure raised the suspicion of a PC Disease_disorder .
Definitive histology Diagnostic_procedure showed a markedly irregular Detailed_description infiltrative Sign_symptom growth Sign_symptom of the tumor Sign_symptom with invasion Sign_symptom of the thyroid Biological_structure tissue Biological_structure and cervical Biological_structure soft Biological_structure tissues Biological_structure (Fig.1b, c).
Immunostaining Diagnostic_procedure for thyroglobulin Diagnostic_procedure was negative Lab_value , whereas staining for chromogranin Diagnostic_procedure A Diagnostic_procedure and PTH Diagnostic_procedure showed a strong Lab_value reactivity Lab_value (Fig.1d–f).
Based on the light Diagnostic_procedure microscopic Diagnostic_procedure findings Diagnostic_procedure and the immunohistochemical Diagnostic_procedure profile Diagnostic_procedure , the tumor was diagnosed as a PC Disease_disorder .
Postoperative serum Detailed_description calcium Diagnostic_procedure ( 8.7 Lab_value mg/dl Lab_value ) and phosphate Diagnostic_procedure ( 3 Lab_value mg/dl Lab_value ) levels were in the normal Lab_value range Lab_value .
One Date month Date after Date surgery Therapeutic_procedure , serum Detailed_description calcium Diagnostic_procedure and plasma Detailed_description PTH Diagnostic_procedure were 9.6 Lab_value mg/dL Lab_value and 47 Lab_value pg/mL Lab_value , respectively.
Neck Biological_structure ultrasound Diagnostic_procedure and total Biological_structure body Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure scan were negative for local Detailed_description and metastatic Detailed_description disease Disease_disorder .
Eight Date months Date later Date , serum Detailed_description calcium Diagnostic_procedure and plasma Detailed_description PTH Diagnostic_procedure levels were 9.1–9.2 mg/dl Lab_value and 38–44 pg/ml Lab_value (1–84 PTH 3rd generation assay, normal range, 8–40 pg/mL), respectively.
Neck Biological_structure ultrasound Diagnostic_procedure did not show any pathological Detailed_description lesions Sign_symptom .
In order to exclude a familiar form of PHPT Disease_disorder , in which PC Disease_disorder may rarely occur as a nonfunctioning Detailed_description tumor Sign_symptom [11], the screening of serum Detailed_description calcium Diagnostic_procedure and neck Biological_structure ultrasound Diagnostic_procedure in the first Subject - degree Subject relatives Subject was normal Lab_value .