FINE-NEEDLE ASPIRATION (FNA) CYTOLOGY IN PRIMARY HYPERPARATHYROIDISM (PHPT
High-frequency
ultrasonography (US) is an accurate non-invasive method of localizing enlarged
parathyroid glands (PGs). However, ultrasonographic detection may be difficult
in patients with ectopic PGs, intrathyroid PGs (which can mimic thyroid
nodules) and undescended PGs situated along the course of the common carotid
artery or near the recurrent laryngeal nerve (may resemble lymph nodes). The
use of FNA preoperatively may increase the accuracy of preoperative
localization, especially in patients with:
I.Coexistent
reactive (benign) neck lymphadenopathy
II.History
of previous neck surgery, especially unsuccessful neck exploration with
persistent hyperparathyroidism
III.Suspicion
for ectopic parathyroid adenoma
IV.Parathyroid
lesions presenting as cystic lesions
V.Non-conclusive
US findings
Cytological
examination of the aspirate should be performed. Cytomorphological features can
be helpful in recognizing the origin of the cells from the parathyroid, but
they cannot be used to distinguish normal parathyroid from hyperplasia, adenoma
or carcinoma. Moreover, distinguishing cytologically parathyroid cells from
thyroid follicular cells can be very difficult. Occasionally, medullary thyroid
carcinoma (MTC) can be confused with cells originating from the PGs. Immunocytochemical
analysis is an important ancillary diagnostic tool to facilitate accurate
diagnosis.
Σχόλια
Δημοσίευση σχολίου