case_images: PMC6595384_01
case_images: The tumor has red brown solid part and a cystic space grossly (a). It has a thick fibrous capsule (blue arrow) and cystic space (yellow star) (b), bizarre atypical cells (c), and vascular proliferation (d). It also shows extensive foreign body type reactions surrounding the capsule (yellow star) and entrapped groups of normal appearing parathyroid cells (blue arrows) (e). There is adherence of strap muscles (yellow arrow) to the capsule and a possible needle tract from previous FNA (blue arrow) (f). Magnification for (b) is X20; (c), (d) X100; and (e), (f) X40.
case_images: CRIPA2019-4383698.001.jpg
case_images: PMC6595384_01_CRIPA2019-4383698.001.jpg
case_images: fig1
case_images: The tumor had both solid and cystic areas filled with thin blood-tinged fluid (Figure 1(a)). Microscopically, the tumor was surrounded by the thick capsule, demonstrated with a blue arrow (Figure 1(b)). Bizarre atypical cells were frequent with nucleomegaly and hyperchromasia (Figure 1(c)). The tumor demonstrated increased capillary vascular proliferation, but no definitive vascular invasion was noted (Figure 1(d)). Careful examination of the thick capsule revealed surrounding chronic inflammation, extensive foreign body type reactions with cholesterol clefts, and variable entrapped groups of normal appearing parathyroid cells (Figure 1(e)). The adherence to the capsule continued up to the surrounding strap muscles, and a possible needle tract from previous FNA procedure was noted (Figure 1(f)).