Parathyroid Adenoma with Macrofollicular Growth Pattern

A Rare Histopathological Entity

Authors

DOI:

https://doi.org/10.15605/jafes.040.02.21

Keywords:

parathyroid adenoma, macrofollicular differentiation, parathyroidectomy

Abstract

The majority of parathyroid adenomas can be localized preoperatively using various imaging techniques. The success rate of focused parathyroidectomy exceeds 95% when performed by an experienced surgeon. Here, we report an apparent failure of focused right inferior parathyroidectomy performed for a preoperatively detected parathyroid adenoma. This misinterpretation arose due to macrofollicular growth pattern of the resected parathyroid adenoma, which mimicked thyroid tissue. The patient subsequently underwent re-exploration, including intraoperative ultrasound, which revealed that the culprit gland had, in fact, been successfully removed during the initial surgery. This finding was also supported by a significant decrease in the intraoperative parathyroid hormone level, as compared to the pre-operative level. This case highlights the rare macrofollicular histology of parathyroid adenoma and underscores the importance of a multidisciplinary team in successfully treating the condition.

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Author Biographies

Ramita Mukherjee, All India Institute of Medical Sciences

MCh Senior Resident, Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

Brijesh Kumar Singh, All India Institute of Medical Sciences, New Delhi, India

Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

Anubhav Narwal, All India Institute of Medical Sciences, New Delhi, India

Assistant Professor, Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Asuri Krishna, All India Institute of Medical Sciences, New Delhi, India

Additional Professor, Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi

Devasenathipathy Kandasamy, All India Institute of Medical Sciences, New Delhi, India

Additional Professor, Department of Radiology, All India Institute of Medical Sciences, New Delhi, India

Sushant Soren, All India Institute of Medical Sciences, New Delhi, India

Assistant Professor, Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

 

V Seenu, All India Institute of Medical Sciences, New Delhi, India

Professor, Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

References

1. Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018;14(2):115-25. https://pubmed.ncbi.nlm.nih.gov/28885621 https://pmc.ncbi.nlm.nih.gov/articles/PMC6037987 https://doi.org/10.1038/nrendo.2017.104

2. Absher KJ, Truong LD, Khurana KK, Ramzy I. Parathyroid cytology: Avoiding diagnostic pitfalls. Head Neck. 2002;24(2):157-64. https://pubmed.ncbi.nlm.nih.gov/11891946 https://doi.org/10.1002/hed.10003

3. Ha HJ, Kim EJ, Kim JS, et al. Major clues and pitfalls in the differential diagnosis of parathyroid and thyroid lesions using fine needle aspiration cytology. Medicina (Kaunas). 2020;56(11):558. https://pubmed.ncbi.nlm.nih.gov/33114338 https://pmc.ncbi.nlm.nih.gov/articles/PMC7690923 https://doi.org/10.3390/medicina56110558

4. Dimashkieh H, Krishnamurthy S. Ultrasound guided fine needle aspiration biopsy of parathyroid gland and lesions. Cytojournal. 2006;3:6. https://pubmed.ncbi.nlm.nih.gov/16569241 https://pmc.ncbi.nlm.nih.gov/articles/PMC1435923 https://doi.org/10.1186/1742-6413-3-6

5. Kumari N, Mishra D, Pradhan R, Agarwal A, Krishnani N. Utility of fine-needle aspiration cytology in the identification of parathyroid lesions. J Cytol. 2016;33(1):17-21. https://pubmed.ncbi.nlm.nih.gov/27011436 https://pmc.ncbi.nlm.nih.gov/articles/PMC4782397 https://doi.org/10.4103/0970-9371.175490

6. Basolo F, Macerola E, Poma AM, Torregrossa L. The 5th edition of WHO classification of tumors of endocrine organs: Changes in the diagnosis of follicular-derived thyroid carcinoma. Endocrine. 2023;80(3):470-6. https://pubmed.ncbi.nlm.nih.gov/36964880 https://pmc.ncbi.nlm.nih.gov/articles/PMC10199828 https://doi.org/10.1007/s12020-023-03336-4

7. Bakuła-Zalewska E, Długosińska J, Stanek-Widera A, et al. Fine needle aspiration biopsy of parathyroid; is it meaningful? A cytologic study of 81 cases with histological and clinical correlations. Cytopathology. 2024;35(3):362-70. https://pubmed.ncbi.nlm.nih.gov/38213192 https://doi.org/10.1111/cyt.13356

8. Ho KJ. Papillary parathyroid adenoma. A rare occurrence and its importance in differentiation from papillary carcinoma of the thyroid. Arch Pathol Lab Med. 1996;120(9):883-4. https://pubmed.ncbi.nlm.nih.gov/9140297.

9. Friedman M, Shimaoka K, Lopez CA, Shedd DP. Parathyroid adenoma diagnosed as papillary carcinoma of thyroid on needle aspiration smears. Acta Cytol. 1983;27(3):337-40. https://pubmed.ncbi.nlm.nih.gov/6575552.

10. Peterson CJ, Klasen JM, Bubendorf L, Freitag M, Delko T, Lazaridis II. Parathyroid adenoma mimicking Bethesda class III follicular thyroidal lesion: A case report. International Journal of Surgery Open. 2023;57:100612. https://www.semanticscholar.org/paper/Parathyroid-Adenoma-Mimicking-Bethesda-Class-III-a-Peterson-Klasen/2ad7b52924a2683614dbebacc20959268b1cc504

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Published

2025-11-12

How to Cite

Mukherjee, R., Singh, B. K., Narwal, A., Krishna, A., Kandasamy, D., Sushant Soren, & Seenu, V. (2025). Parathyroid Adenoma with Macrofollicular Growth Pattern: A Rare Histopathological Entity. Journal of the ASEAN Federation of Endocrine Societies, 40(2), 182–185. https://doi.org/10.15605/jafes.040.02.21

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Section

Case Reports