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      Papillary thyroid carcinoma associated with non‑functioning parathyroid carcinoma with Warthin's tumor of the parotid gland: A case report and brief literature review

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          Abstract

          Multiple neck pathologies occurring simultaneously are a rare condition. The present study describes an extremely rare case of papillary thyroid carcinoma, non-functioning parathyroid carcinoma (PC) and Warthin's tumor of the parotid gland. A 59-year-old male presented with a 3-month history of anterior neck swelling. The neck ultrasound revealed a left-sided thyroid nodule associated with pathological lymph nodes. There was a parotid gland mass. A fine-needle aspiration of the left parotid mass was not diagnostic, although the left thyroid nodule revealed a malignancy with metastasis to the left cervical group lymph nodes. The patient underwent total thyroidectomy, left central and left lateral cervical lymph node dissection. A superficial parotidectomy was also performed. A histopathological examination revealed three different pathologies: Papillary thyroid microcarcinoma, PC and Warthin's tumor. The simultaneous occurrence of a Warthin's tumor, papillary thyroid microcarcinoma and PC is an unusual condition. The concurrent findings of these three pathologies have not yet been reported in the literature, at least to the best of our knowledge. The synchronous findings of PTC, non-functioning PC and Warthin's tumor are extremely rare, yet possible. Surgical intervention remains the most appropriate treatment strategy.

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          Most cited references27

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          Parathyroid carcinoma: a 22-year experience.

          Because parathyroid carcinoma is rare, clear consensus is not available regarding the optimal management of patients with this condition. Treatment strategies generally derive from clinical and anecdotal experiences. We report our experience with this entity. We included all patients with parathyroid carcinoma seen at The University of Texas M. D. Anderson Cancer Center since January 1, 1980. The medical records and pathology specimens were reviewed and verified in all cases. Since 1980, 27 patients (16 men and 11 women) registered at M. D. Anderson Cancer Center with parathyroid carcinoma and a minimum follow-up of 2 years. The age at initial diagnosis (mean +/- SD) was 46.7 +/- 15.3 years. All patients were seen with hypercalcemia (mean calcium, 13.4 +/- 1.5 mg/dL). Eighteen patients had locally invasive disease, eight had localized disease, and one had distant metastasis. Parathyroid cancer was treated with complete surgical excision with curative intent in 18 patients. In the other nine patients, who had clinical and/or radiographic evidence of soft tissue extension, the tumor was treated by comprehensive "en bloc" soft tissue resection. Of six patients who received adjuvant radiotherapy after initial surgery, only one had a local relapse. In contrast, of 20 patients who did not receive adjuvant radiotherapy, 10 had a local relapse, excluding the one patient who had distant metastases. The 5-year survival was 85%, and the 10-year survival was 77%. Five patients died of parathyroid carcinoma; all deaths were hypercalcemia related. Parathyroid carcinoma can be an indolent disease with morbidity and mortality related to hypercalcemia. Adjuvant radiotherapy may improve local control and limit the occurrence of local relapse. A comprehensive multidisciplinary approach with surgery, radiation therapy, and medical treatment for hypercalcemia is needed to optimize patient outcome. Copyright 2004 Wiley Periodicals, Inc.
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            Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Salivary Glands

            The salivary gland section in the 5th edition of the World Health Organization Classification of Head and Neck Tumours features a description and inclusion of several new entities, including sclerosing polycystic adenoma, keratocystoma, intercalated duct adenoma, and striated duct adenoma among the benign neoplasms; and microsecretory adenocarcinoma and sclerosing microcystic adenocarcinoma as the new malignant entities. The new entry also includes mucinous adenocarcinoma subdivided into papillary, colloid, signet ring, and mixed subtypes with recurrent AKT1 E17K mutations across patterns suggesting that mucin-producing salivary adenocarcinomas represent a histologically diverse single entity that may be related to salivary intraductal papillary mucinous neoplasm (IPMN). Importantly, the number of entities in the salivary chapter has been reduced by omitting tumors or lesions if they do not occur exclusively or predominantly in salivary glands, including hemangioma, lipoma, nodular fasciitis and hematolymphoid tumors. They are now discussed in detail elsewhere in the book. Cribriform adenocarcinoma of salivary gland origin (CASG) now represents a distinctive subtype of polymorphous adenocarcinoma (PAC). PAC is defined as a clinically, histologically and molecularly heterogeneous disease group. Whether CASG is a different diagnostic category or a variant of PAC is still controversial. Poorly differentiated carcinomas and oncocytic carcinomas are discussed in the category "Salivary carcinoma not otherwise specified (NOS) and emerging entities". New defining genomic alterations have been characterized in many salivary gland tumors. In particular, they include gene fusions, which have shown to be tightly tumor-type specific, and thus valuable for use in diagnostically challenging cases. The recurrent molecular alterations were included in the definition of mucoepidermoid carcinoma, adenoid cystic carcinoma, secretory carcinoma, polymorphous adenocarcinoma, hyalinizing clear cell carcinoma, mucinous adenocarcinoma, and microsecretory adenocarcinoma.
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              Papillary thyroid carcinoma: an update.

              The past two decades have seen numerous developments in the understanding of the origins and biology of papillary thyroid carcinoma. Advances in molecular biology, clinicopathologic studies of new entities, facility with fine-needle aspiration biopsy, and new radiologic imaging techniques have allowed for earlier diagnosis of these tumors. However, these advances have also caused controversies in cytologic and histopathologic diagnoses as well as therapy decisions. This paper will focus on several pathologic aspects of papillary carcinoma, which impact on its biology and prognosis.
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                Author and article information

                Journal
                Med Int (Lond)
                Med Int (Lond)
                MI
                Medicine International
                D.A. Spandidos
                2754-3242
                2754-1304
                May-Jun 2023
                15 May 2023
                15 May 2023
                : 3
                : 3
                : 26
                Affiliations
                [1 ]Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
                [2 ]Department of Pathology, Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46000, Iraq
                [3 ]Department of Radiology, Shorsh Teaching Hospital, Sulaimani, Kurdistan 46000, Iraq
                [4 ]College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
                [5 ]Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46000, Iraq
                Author notes
                Correspondence to: Dr Fahmi H. Kakamad, College of Medicine, University of Sulaimani, H9G5+HX7, Madam Mitterrand Street, Sulaimani, Kurdistan 46000, Iraq fahmi.husseinunivsul.edu.iq njaiqing@ 123456njmu.edu.cn
                Article
                MI-3-3-00086
                10.3892/mi.2023.86
                10251473
                37304572
                707be108-545b-48bb-8040-ca9d393bf513
                Copyright: © Abdullah et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 24 January 2023
                : 28 April 2023
                Funding
                Funding: No funding was received.
                Categories
                Case Report

                papillary thyroid carcinoma,non-functioning parathyroid carcinoma,warthin's tumor,parotid gland,synchronous multiple pathology

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