How to deal with parathyroid carcinoma: case report, histological difficulties and literature review
2021
The histological diagnosis of parathyroid carcinoma is often difficult due to the
existence of many potentially misleading similarities, between this malignant
entity and its main differential diagnosis: parathyroid adenoma.
Several histological criteria of malignancy have been proposed in order to solve
this diagnosis problem: the presence of fibrous bands emerging from a thick
capsule dividing the tumor proliferation into lobules, tumor cells arranged in
clusters and trabeculae, moderate to clear cytonuclear atypia and low mitotic
activity. Unfortunately, these criteria are not exclusive to carcinomas and can also
be seen in cases of adenomas.
The more relevant histological criteria of malignancy are proposed, such as atypical
mitosis, capsular invasion, vascular invasion or the exceptional perineural invasion.
But these criteria are rarely found. Infiltration of the thyroid gland, adjacent soft
tissue and the occurrence of metastases remain the only indisputable signs of
malignancy.
Immunohistochemistry can contribute to the differential diagnosis, especially
with the loss of expression of Parafibromin, commonly found in carcinomas unlike
adenomas, or the expression of parathormone, allowing the elimination of a
thyroid tumor.
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