RESUMO
We report a case of a 55-year-old female with tertiary hyperparathyroidism and osteoporosis who had end stage renal disease and a history of hemodialysis for 15 years. Patient's informed is taken. Neck ultrasonography showed multinodular goiter together with a hypoechoic lesion compatible with a parathyroid adenoma. Dual phase technetium (Tc) Tc-99m MIBI single photon emission computed tomography (SPECT) showed pathological uptake in four parathyroid gland locations. Total thyroidectomy and subtotal parathyroidectomy revealed nodular hyperplasia and atypical adenomas in four parathyroid glands. Atypical parathyroid adenoma is a rare clinical entity. Multiple atypical adenomas are even less frequent. A very rare condition, detection of atypical adenomas in four of the parathyroid glands by dual phase Tc-99m MIBI SPECT, is presented in this case.
RESUMO
Background/aim: To define the cytomorphologic findings leading to difficulties in diagnosis of Warthin tumors (WTs). Materials and methods: Forty-eight histopathologically diagnosed WT patients who had fine needle aspiration cytology preoperatively were reevaluated for defining the presence or absence of lymphocytes, oncocytic cell layer, oncocytic cell papillae, granular debris background, mucoid background, macrophages, polymorphonuclear cells, mast cells, squamous-like cells, atypical vacuolated cytoplasmic cells, and giant cells. Results: Forty-seven tumors were in the parotid gland and one in the submandibular gland. There were 37 (77%) male and 11 (23%) female patients. Cytopathologically in 36 patients the diagnosis was benign neoplasm (WT); in 6, other benign entities; and in 6, suspicious for malignancy. The main characteristic cytomorphologic features of WTs were as follows: 92% lymphoid cells, 83% oncocytic cell layers, and 67% granular debris background. These percentages were 67%, 17%, and 17% in the benign cytology group and 67%, 50%, and 17% in the suspicious for malignancy group, respectively. Conclusion: Absence or lack of main features of WTs with or without presence of squamous-like cells, vacuolated cytoplasmic cells, and inflammatory reaction may cause diagnostic dilemma. The presence of the mast cells accompanied by epithelial tissue was striking for WT diagnosis.
