case_images: PMC7218145_01
case_images: Early and late 99mTc MIBI Parathyroid Scan images of neck and mediastinum anteriorly at 20 min and 2 h.
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case_images: There was also a big cold nodule projecting from the lateral border of the right thyroid lobe, suggestive of thyroid nodule (Fig. 1).
case_images: A. photomicrograph depicting papillary structures with hyalinized stalks lined by epithelial cells exhibiting hobnailing into cystic spaces. A psammomatous calcification is also present (hematoxylin and eosin stain, x100). B. high-power view shows the hobnail growth pattern of the epithelial cells which have the nuclear features of papillary thyroid carcinoma in the form of nuclear enlargement, overlapping of the nuclei, irregular nuclear membranes with occasional nuclear grooves. The cells have abundant eosinophilic cytoplasm with oncocyte-like appearance (hematoxylin and eosin stain, x400).
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case_images: AJCC staging was pT1b (Fig. 2A and B).
case_images: Histological section shows a well-circumscribed parathyroid adenoma with a thin capsule surrounded by thyroid tissue (hematoxylin and eosin stain, x40).
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case_images: Also, an ITPA measuring 2 cm completely surrounded by thyroid tissue was identified (Fig. 3).
case_images: A. TTF1 immunohistochemical stain demonstrates negative staining in the parathyroid adenoma (left) and positive nuclear staining in the adjacent thyroid tissue (right). B. Thyroglobulin immunostain is also negative in the parathyroid adenoma and demonstrates positive staining in the adjacent thyroid tissue.
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case_images: TTF-1, thyroglobulin and chromogranin immunostains were performed (controls checked). The parathyroid adenoma was positive for chromogranin but negative for TTF-1 and thyroglobulin, which highlighted only the thyroid tissue (Fig. 4A, B).
case_images: Mutation in BRAFV600E gene demonstrates result due to a nucleotide change from Thymine (T) to Adenine (A) in codon number 600 in exon 15 of the BRAF gene. This change in nucleotide results in an amino acid change from Valine (V) to Glutamic acid (E). The red arrow shows the position of codon 600 (V) in exon 15.
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case_images: This change in nucleotide results in amino acid change from Valine (V) to Glutamic acid (E). This confirmed the BRAFV600E mutation in our case (Fig. 5).