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14 Thyroid Cancers
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213
statements about controversies in thyroid surgery for differentiated thyroid cancer is incorrect?
A. Active surveillance is a management option for papillary thyroid
microcarcinoma.
B. The extent of thyroid surgery for low-risk differentiated thyroid cancer is a
subject of ongoing debate.
C. Molecular testing plays no role in guiding decision-making about the neces-
sity and extent of initial surgery.
D. Innovative thyroidectomy techniques include robotic and transoral
approaches.
E. Patient preferences are crucial in decision-making regarding the extent of
surgery and long-term surveillance.
Answer: C
Explanation: Molecular testing plays no role in guiding decision-making
about the necessity and extent of initial surgery. This statement is incorrect
as molecular testing can guide decision-making regarding the necessity and
extent of surgery.
43. A patient with differentiated thyroid cancer is being counseled about surgical
options. Which of the following statements regarding total thyroidectomy for
differentiated thyroid cancer is incorrect?
A. Total thyroidectomy followed by radioiodine ablation and thyroid hormone
suppression is appropriate for most patients.
B. Total thyroidectomy is associated with higher recurrence rates compared to
partial thyroidectomy.
C. The approach reduces the risk of cancer recurrence and facilitates postop-
erative monitoring.
D. Surgeon volume is associated with patient outcomes following total
thyroidectomy.
E. Retrospective analyses support total thyroidectomy for reducing recurrence
risk and addressing multifocal intrathyroidal cancer.
Answer: B
Explanation: Total thyroidectomy is associated with higher recurrence
rates compared to partial thyroidectomy. This statement is incorrect as total
thyroidectomy, when indicated, can reduce the risk of cancer recurrence
compared to less extensive surgery.
44. A patient with a bilateral nodular goiter is considering surgical treatment
options. Which of the following statements about total thyroidectomy in the
treatment of thyroid disease is incorrect?
A. Total thyroidectomy is indicated for bilateral nodular goiter, Graves’ dis-
ease, and chronic thyroiditis.
B. The rapid frozen diagnosis being equivocal for carcinoma is a contraindica-
tion for total thyroidectomy.
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C. Cosmetic outcomes are a signicant concern for patients undergoing thy-
roid surgery.
D. Minimally invasive procedures for thyroid disease aim to improve cosmetic
outcomes.
E. Total thyroidectomy has been performed for both malignant and benign thy-
roid diseases.
Answer: B
Explanation: The rapid frozen diagnosis being equivocal for carcinoma
is a contraindication for total thyroidectomy. This statement is incorrect as
an equivocal diagnosis for carcinoma may be an indication for total thyroidectomy to ensure complete removal and facilitate further treatment.
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American Thyroid Association. Thyroid. 2015;25(11):1675–730.
27. Noussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol. 2011;165(3):375–82.
28. Tran P, Desimone S, Barrett M, Bachrach B.I-131 treatment of graves' disease in an unsuspected rst trimester pregnancy; the potential for adverse effects on the fetus and a review of
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30. Macedo F, Ladeira K, Pinho F, Saraiva N, Bonito N, Pinto L, Goncalves F.Bone metastases: an overview. Oncol Rev. 2017;11(1):321. https://doi.org/10.4081/oncol.2017.321. PMID:
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31. Baloch ZW, LiVolsi VA. Our approach to follicular-patterned lesions of the thyroid. J Clin
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Mod Pathol. 2011;24:S10–S8.
33. Grani G, Lamartina L, Durante C, Filetti S, Cooper DS.Follicular thyroid cancer and Hürthle
cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes
Endocrinol. 2018;6(6):500–14.
34. Tuttle RM, Ball DW, Byrd D, Daniels GH, Dilawari RA, Doherty GM, Duh QY, Ehya
H, Farrar WB, Haddad RI, Kandeel F. Medullary carcinoma. J Natl Compr Cancer Netw.
2010;8(5):512–30.
35. Pacini F, Castagna MG, Cipri C, Schlumberger M.Medullary thyroid carcinoma. Clin Oncol
(R Coll Radiol). 2010;22(6):475–85.
36. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo
L.Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004;28:271–6.
37. Gil Z, Patel SG.Surgery for thyroid cancer. Surg Oncol Clin N Am. 2008;17(1):93–120.
38. Barczyński M, Konturek A, Hubalewska-Dydejczyk A, Gołkowski F, Cichoń S, Nowak
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39. Uslu A, Okut G, Tercan IC, Erkul Z, Aykas A, Karatas M, Simsek C, Tatar E.Anatomical
distribution and number of parathyroid glands, and parathyroid function, after total parathyroidectomy and bilateral cervical thymectomy. Medicine. 2019;98:23.
40. An S, Kim K.Surgical management of locally advanced thyroid cancer. Curr Opin Otolaryngol
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41. Venkat R, Guerrero MA.Recent advances in the surgical treatment of differentiated thyroid
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Laryngoscope. 1987;97(8 Pt 1):1044–6.
T. A. Majeed et al.
Chapter 15
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Parathyroid Carcinoma
RaafatRaoofAltur, WaseemM.Al Hamidy, MunthirA.Alobaidi,
andMustafaIsmail
1. A 58-year-old patient presents with persistent hypercalcemia and is undergoing
evaluation for parathyroid disease. In parathyroid carcinoma (PC), which of the
following is incorrect?
A. Rare tumor that can occur sporadically or as a part of a syndrome.
B. A greater number of parathyroid tumors are hormonally active for parathy-
roid hormone (PTH).
C. The symptoms of hypercalcemia in parathyroid benign tumors are often
more marked than in cases of PC patients.
D. Incidence is equal between males and females.
E. Many initially present with parathyrotoxicosis.
Answer: C
Explanation: The symptoms of hypercalcemia are often more marked in
cases of PC patients than in parathyroid benign tumors, making it a crucial
diagnostic distinction.
2. A 45-year-old patient is being evaluated for familial syndromes that might
increase the risk of developing PC. Regarding the syndromes that increase the
risk of PC, the incorrect statement is:
A. MEN1 is associated with an increased risk of parathyroid cancer.
B. MEN2A is associated with an increased risk of parathyroid cancer.
R. R. Altur
Department of Digestive Surgery, Gastroenterology and Hepatology Teaching Hospital,
Baghdad, Iraq
W. M. Al Hamidy
Gastroenterology and Hepatology Teaching Hospital, Medical City, Baghdad, Iraq
M. A. Alobaidi · M. Ismail (*)
Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq
Switzerland AG 2024
A. S. Mahmood, A. Koulouris (eds.), MCQs in General Surgical Oncology,
https://doi.org/10.1007/978-3-031-65738-2_15
217© The Author(s), under exclusive license to Springer Nature
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C. Familial hyperparathyroidism is associated with an increased risk of para-
thyroid cancer.
D. Hyperparathyroidism-jaw tumor syndrome is associated with an increased
risk of parathyroid cancer.
E. MEN2B is associated with an increased risk of parathyroid cancer.
Answer: E
Explanation: MEN2B is not associated with an increased risk of parathy-
roid cancer, unlike the other syndromes listed.
3. A 50-year-old patient is undergoing genetic testing for HRPT2 mutations due
to a family history of hyperparathyroidism. Regarding HRPT2 mutation and
PC, which of the following is incorrect?
A. Mutations are common with familial isolated hyperparathyroidism.
B. Calcium and PTH levels are the main biochemical screening tests for
hyperparathyroidism.
C. High level of calcium is much typical of early PC associated with germline
HRPT2 mutations.
D. Additional surveillance measures, particularly neck ultrasonography, may
improve sensitivity and lead to early detection of tumors.
E. Parabromin is an important tumor suppressor of parathyroid gland tissue
and mutations in the HRPT2 gene are associated with high-grade PC.
Answer: C
Explanation: High levels of calcium are not typical of early PC associated with germline HRPT2 mutations, as these tumors can be normocalcemic or mildly hypercalcemic.
4. A 45-year-old patient is diagnosed with PC, and genetic testing is being considered. Regarding genetic and PC, which of the following is incorrect?
A. HRPT2 mutations have a role in sporadic PC.
B. Molecular pathogenesis of PC is affected by mutation of the HRPT2
(CDC73) which is a tumor suppressor gene.
C. HRPT2 mutations have a role in the hyperparathyroidism-jaw tumor
syndrome.
D. Checking HRPT has no role in sporadic cases of parathyroid cancer.
E. HRPT2 has a role in some isolated familial hyperparathyroidism cases.
Answer: D
Explanation: In sporadic cases of PC, checking for HRPT2 mutations is
not typically performed; however, sporadic PC can sometimes have HRPT2
germline mutations, raising the possibility of hyperparathyroidism-jaw
tumor syndrome.
5. A 30-year-old patient has a strong family history of hyperparathyroidism and
jaw tumors. They are concerned about the possibility of developing PC.Which
of the following is incorrect regarding hyperparathyroidism-jaw tumor
(HPT- JT) syndromes?
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A. Autosomal recessive disease related to familial hyperparathyroidism.
B. Strong association between HRPT2 mutations and HPT-JT.
C. PC occurs with higher frequency in HPT-JT than in sporadic PHPT.
D. Patients that have sporadic PC may have the HPT-JT syndrome.
E. HPT-JT-associated diseases include cystic parathyroid adenomatosis, ossi-
fying broma.
Answer: D
Explanation: Patients with sporadic PC are not typically associated with
HPT-JT syndrome. HPT-JT is an autosomal dominant type of familial
hyperparathyroidism.
6. A 50-year-old patient is undergoing genetic counseling due to a family history
of parathyroid disorders. The geneticist is evaluating the potential genetic factors that could be associated with an increased risk of PC. Regarding the genes
associated with PC, the incorrect statement is:
A. CCND1/PRAD1 is associated with PC.
B. APC is associated with PC.
C. HRPT2 is associated with PC.
D. MEN1 is associated with PC.
E. RET is associated with PC.
Answer: B
Explanation: APC is not associated with PC; it is primarily associated
with CRC. The other genes listed have roles in the development of parathyroid cancer.
7. A 52-year-old male patient presents with memory decits and paresthesia.
Laboratory ndings reveal elevated calcium levels. Regarding possible clinical
presentations of PC, the incorrect statement is:
A. A 55-year-old female patient with lab calcium of 14.5 mg/dL.
B. A 47-year-old asymptomatic patient with a calcium level of 13.4 mg/dL.
C. A 45-year-old female patient with a known cause of chronic kidney disease
on dialysis.
D. A 50-year-old male patient with a cervical mass and fatigue.
E. A 52-year-old male patient with memory decit and paresthesia.
Answer: C
Explanation: Most PC patients present with signs and symptoms of
hyperparathyroidism. A patient with a known cause of kidney disease and
hyperparathyroidism is usually due to secondary hyperparathyroidism
related to renal failure, making this presentation less likely to be PC.
8. A 52-year-old patient with hyperparathyroidism is experiencing various symptoms. Regarding symptoms of hyperparathyroidism, which of the following is
incorrect?
A. Clinical symptoms are mainly related to tumor spread rather than high
secretion of PTH.
B. Hypercalcemia.
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C. Renal failure.
D. Cardiac arrhythmia.
E. Neurocognitive dysfunction.
Answer: A
Explanation: Clinical symptoms of hyperparathyroidism are mainly
related to the high secretion of PTH, which leads to various systemic effects.
9. A 48-year-old patient undergoes a parathyroidectomy, and an immunohistochemical panel is used to analyze the tissue. Regarding the role of immunohistochemical panel in PC, which is incorrect?
A. Useful in the identication of parathyroid tissue.
B. Differentiates between parathyroid cancer and other tumors like thy-
roid cancer.
C. Has no role in small biopsies or ectopic locations suspected to be of para-
thyroid origin.
D. Differentiates between parathyroid adenoma and carcinoma.
E. Identication of supernumerary parathyroid glands.
Answer: C
Explanation: Immunohistochemical panels are useful in various aspects
of parathyroid pathology, including the identication of parathyroid tissue
and differentiation between different parathyroid conditions, but they may
have limited utility in small biopsies or ectopic locations suspected to be of
parathyroid origin.
10. A 60-year-old female patient is diagnosed with primary hyperparathyroidism
(PHPT), and her treatment options are being discussed. Which of the following
is incorrect regarding PHPT?
A. Benign solitary adenoma is accountable for 80%–90% of all cases of PHPT.
B. Ultrasonography and sestamibi scan are considered typical imaging for
parathyroid lesions.
C. Common, occur in females more than males with an age range of
50–70years.
D. Minimally invasive intervention isn’t useful if the patient having a preop-
erative scan is suspicious for a single solitary lesion.
E. Minimally invasive intervention is useful in the majority of cases of PHPT.
Answer: D
Explanation: Minimally invasive intervention is mostly useful when
there is a preoperative scan suspicious for a single solitary lesion, or when
the lesion is a benign solitary adenoma, which is the most common cause
of PHPT.
11. A 45-year-old patient with a cervical mass undergoes surgical evaluation, and
pathology results are awaited. In PC and atypical parathyroid adenoma, which
of the following is incorrect?
A. Hypercalcemia crisis has a higher incidence in atypical adenoma than PC.
B. PC size is larger than atypical parathyroid adenoma.
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C. Mean serum calcium is much higher in PC than in atypical adenoma.
D. PTH level is much higher in PC than in adenoma.
E. PC usually doesn’t have a distinct capsule and adheres to nearby structures,
while loss of parabromin expression is the same as in atypical adenoma.
Answer: A
Explanation: Hypercalcemia crisis is more commonly associated with
PC than atypical adenoma.
12. A 45-year-old patient is being evaluated for PHPT and is discussing diagnostic
options with their endocrinologist. In parathyroid gland pathologies, which of
the following is incorrect?
A. PC is least likely to be a cause of PHPT than parathyroid adenoma.
B. Diagnosis of parathyroid cancer can be made using radiological imaging.
C. Knowledge of the unusual anatomic locations for enlarged parathyroid
glands is crucial to operative success during both initial and reoperative
parathyroid surgery.
D. Eighty-four percent of individuals have four parathyroid glands.
E. Localization studies should not be used to establish the diagnosis of PHPT.
Answer: B
Explanation: The diagnosis of parathyroid cancer is made by pathology,
typically during surgical excision. Radiological imaging alone cannot
denitively diagnose parathyroid cancer.
13. A surgeon is explaining parathyroid gland anatomy to a medical student.
Regarding parathyroid glands’ surgical anatomy, which is incorrect?
A. The superior glands originate from the third branchial pouch. The inferior
glands originate from the fourth branchial pouch.
B. Ectopic parathyroid glands occur along with tissues that have similar
embryological origin.
C. Ectopic parathyroid gland may be any one of the four glands or a supernu-
merary gland (more than four).
D. Supernumerary glands may be responsible for persistent hyperparathyroid-
ism after parathyroidectomy.
E. The most common location for supernumerary parathyroid glands is within
the thymus or near the thyrothymic ligament.
Answer: A
Explanation: The superior parathyroid glands originate from the fourth
branchial pouch, while the inferior glands originate from the third branchial pouch.
14. A medical student is learning about the vascular supply of parathyroid glands.
Which of the following is incorrect?
A. The parathyroid glands are supplied by branches from the external
carotid artery.
B. The superior parathyroid glands are supplied by the inferior thyroid artery.
C. The inferior parathyroid glands are supplied by the inferior thyroid artery.
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D. Each parathyroid gland has its own end arterial supply.
E. Parathyroid veins drain into the thyroid vein plexus and hence to superior,
middle, and inferior thyroid veins.
Answer: A
Explanation: The parathyroid glands are supplied by branches from the
thyrocervical trunk of the subclavian artery, including the inferior thyroid
artery that supplies both the superior and inferior parathyroid glands. They
are not supplied by branches from the external carotid artery.
15. A 50-year-old patient with suspected PC is undergoing preoperative diagnostic
evaluations. In preoperative diagnostic studies of PC, which of the following is
incorrect?
A. The most sensitive imaging for pathologic parathyroid gland is sestamibi
scintigram.
B. The most sensitive technique for the detection of possible signs of malig-
nancy was CT scan.
C. The most widely used imaging for PC is ultrasonography.
D. Ultrasound is more sensitive than a sestamibi scan for the detection of PC.
E. Usage of nuclear magnetic resonance and PET scan was unusual.
Answer: D
Explanation: Ultrasound is not more sensitive than a sestamibi scan for
the detection of PC.CT scan is the most sensitive technique for detecting
possible signs of malignancy, followed by ultrasound and sestamibi scan.
16. A 55-year-old patient is being evaluated for PHPT and is discussing treatment
options with their endocrinologist. Regarding the approach for PHPT, which of
the following is incorrect?
A. Persistent or recurrent PHPT is an indication for re-exploration.
B. Symptomatic cervical disc disease is an absolute contraindication for
parathyroidectomy.
C. Asymptomatic PHPTH is an indication for surgery in certain
circumstances.
D. Parathyroid cancer is considered an indication for surgical exploration.
E. Patients with familial hypocalciuric hypercalcemia should not undergo
parathyroidectomy.
Answer: B
Explanation: Symptomatic cervical disc disease is a relative contraindication for parathyroidectomy, meaning it should be carefully considered
and evaluated on an individual basis.
17. A pathologist is examining tissue samples from a suspicious parathyroid lesion.
Regarding the diagnosis of PC, the incorrect statement is:
A. The absence of brous bands arranged in a trabecular design is required for
diagnosis.
B. Inltration of surrounding structures is a key diagnostic feature.
C. Vascular invasion is necessary for diagnosing PC.
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