Atypical ultrasound features of parathyroid tumours may bear a relationship to their clinical and biochemical presentation

Abstract

ObjectivesTo describe atypical ultrasound features of parathyroid lesions and correlate them with clinical presentation and histopathology.Materials and methodsRetrospective review of 264 patients with primary hyperparathyroidism who underwent ultrasound imaging prior to parathyroidectomy was performed. Patients with atypical ultrasound findings (n = 26) were identified; imaging findings were correlated with clinical presentation and histopathology.ResultsTwenty-one (80 %) lesions were adenomas, two (8 %) were adenomas with cellular atypia, and three (11.5 %) were carcinomas. Seventeen (65 %) lesions showed cystic change; five (19 %) of them had >50 % cystic change. These lesions were adenomas with cystic degeneration. Cystic degeneration had significant positive correlation with the lesion size and PTH level, but cystic adenomas correlated negatively with lesion weight. Six (23 %) lesions were isoechoic and one (4 %) was hyperechoic; histology predominantly revealed haemorrhage, hyalinisation and fibrosis; one lesion showed fat deposition and another had multiple granulomas within the adenoma. Twenty (83 %) lesions had heterogeneous echotexture and showed combinations of acinar dilatation, necrosis, haemorrhage and fibrosis. Heterogeneous lesions tended to be significantly larger and heavier, and they were associated with higher PTH levels. Four (15 %) lesions had calcifications. Scintigraphy was concordant in 22 (96 %), n = 23. One scintigraphy-negative lesion was a cystic parathyroid adenoma.ConclusionAtypical ultrasound features of parathyroid lesions pose a diagnostic challenge. Awareness of these features would help improve lesion detection.Teaching pointsCystic change is significantly related to the size, weight and measured parathyroid hormone levels.Cystic change in parathyroid tumours indicated a slightly higher risk of malignancy.Heterogeneous parathyroid adenomas are larger in size and heavier, and they have higher PTH levels.Awareness of atypical ultrasound features will improve preoperative clinical prediction.

Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker?

“…There are scarce data in the literature concerning the prevalence and relevance of atypical ultrasound features for the evaluation of parathyroid lesions. Our study supports a previous report, which suggested that parathyroid lesions with atypical imaging features are associated with a higher incidence of malignancy (25). Moreover, in our study, the AUC for the longest adenoma diameter measured by ultrasonography was statistically significant, and the best cut-off value for predicting aggressive disease was 21.5 mm.…”

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign

“…Chandramohan et al analyzed atypical US features of 26 parathyroid lesions. According to their study the ratio of non-hypoechoic PAs reaches up to 27% due to haemorrhage, hyalinisation and fibrosis in adenomatous tissue [22]. In the presented series, 9% of the PAs were hyperor isoechoic relative to the echogenicity of thyroid gland.…”

Atypical parathyroid adenomas: challenging lesions in the differential diagnosis of endocrine tumors

“…In most consecutive series of patients undergoing surgery for PHPT, the incidence of atypical parathyroid adenoma ranged from 0.5 to 4.4% (de Meneses Montenegro et al 2006, Ippolito et al 2007, Juhlin et al 2010, O'Neal et al 2011, Ricci et al 2012, Chandramohan et al 2014, Haglund et al 2015, McCoy et al 2015, Quinn et al 2015, Schneider et al 2015, Ozolins et al 2016, Mamedova et al 2017. An incidence as high as 14% has been reported in the Asian countries (Cakir et al 2016, Hu et al 2018.…”