Mediastinum - Parathyroid carcinoma of thymus

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Mediastinum

Thymic carcinoma

Parathyroid carcinoma of thymus

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 3 March 2013, last major update December 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● May arise within thymus or adjacent soft tissue of anterosuperior mediastinum

Clinical features
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● Usually extreme hypercalcemia (> 14 mg/dl), markedly elevated parathyroid hormone (PTH) levels

Poor prognostic factors
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● > 5 MF/HPF, thick fibrous capsule or infiltrative growth pattern

Case reports
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● 33 year old man with postoperative hungry bone syndrome (Endocr Pract 2003;9:152)
● Hemodialysis patient with unusual thymic involvement (J Laryngol Otol 2004;118:162)

Gross description
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● Resembles primary thymic carcinoma
● May invade adjacent lung, pericardium, thoracic great vessels
● Unencapsulated

Micro description
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● Modest to marked atypia
● Sheets, nests or cords of polyhedral cells with round/oval hyperchromatic nuclei, occasional nucleoli, clear/granular cytoplasm
● Focal mitotic activity, necrosis
● May have internal collagenous bands

Micro images
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Parathyroid carcinoma: site unknown

Positive stains
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● Diastase sensitive, PAS+, PTH (mosaic staining), variable chromogranin A or synaptophysin

Electron microscopy description
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● Primitive intercellular junctional complexes, prominent cytoplasmic glycogen, primitive blunt microvilli, sparse neurosecretory granules
● No tonofilaments

End of Mediastinum > Thymic carcinoma > Parathyroid carcinoma of thymus

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