Indian Journal of Endocrinology and Metabolism

LETTER TO THE EDITOR
Year
: 2018  |  Volume : 22  |  Issue : 1  |  Page : 173--174

Parathyromatosis


Vipul D Yagnik 
 Department of Surgical Gastroenterology, Ronak Endo-Lawparoscopy and General Surgical Hospital, Patan, Gujarat, India

Correspondence Address:
Vipul D Yagnik
77, Siddhraj Nagar, Rajmahal Road, Patan - 384 265, Gujarat
India




How to cite this article:
Yagnik VD. Parathyromatosis.Indian J Endocr Metab 2018;22:173-174


How to cite this URL:
Yagnik VD. Parathyromatosis. Indian J Endocr Metab [serial online] 2018 [cited 2021 Sep 24 ];22:173-174
Available from: https://www.ijem.in/text.asp?2018/22/1/173/225014


Full Text



Sir,

I read with great interest an article entitled “Parathyromatosis following endoscopic parathyroid surgery: A rare occurrence” by Aggarwal et al.[1] It is an interesting and unusual case. I would like to congratulate all the authors for reporting such a nice case and indeed an excellent management in such difficult case. However, I have a few observations in this connection which you may find useful. I would also like to add some interesting point about this condition.

The authors had mentioned that index case was the first case of parathyromatosis following endoscopic parathyroidectomy for benign adenoma.[1] I would like to state that such incident had already been reported and diagnosed by fine-needle aspiration cytology coupled with immunohistochemistry.[2] Another case following endoscopic parathyroidectomy was also reported by Wu et al.[3] It has also been mentioned that in the minimally invasive technique, dissection must be performed carefully to avoid nerve injury and rupture of the capsule which can cause parathyromatosis.

A differential diagnosis between parathyroid carcinoma and parathyromatosis can be challenging during surgery. Parathyromatosis usually present as small and numerous nodules and is often surrounded by dense fibrous tissue due to prior operative intervention, which gives the false impression of a parathyroid carcinoma.

Some immunohistochemical studies have been conducted to distinguish parathyroid carcinoma from benign masses. A recent study indicates that molecular profiles of parathyromatosis are similar to those of benign parathyroid tumors concerning expression of parafibromin expression, Rb expression, and galectin-3.[4]

Parathyromatosis shows positivity for neuroendocrine markers chromogranin and synaptophysin and is positive for Parathyroid hormone (PTH) and cytokeratin (CAM 5.2) and negative for thyroid transcription factor-1.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Aggarwal A, Wadhwa R, Aggarwal V. Parathyromatosis following endoscopic parathyroid surgery: A Rare occurrence. Indian J Endocrinol Metab 2017;21:641-2.
2Sharma S, Dey P, Gude G, Saikia UN. Parathyromatosis – A rare occurrence along the endoscopic tract detected on fine needle aspiration cytology. Diagn Cytopathol 2016;44:1125-7.
3Wu TJ, Wang YT, Chang H, Lin SH. Parathyromatosis. Kidney Int 2012;82:1140.
4Fernandez-Ranvier GG, Khanafshar E, Tacha D, Wong M, Kebebew E, Duh QY, et al. Defining a molecular phenotype for benign and malignant parathyroid tumors. Cancer 2009;115:334-44.
5Erickson LA. Endocrine pathology. In: Cheng L, Bostwick DG, editors. Essential of Anatomic Pathology. Switzerland: Springer; 2016. p. 975-1026.