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Worrisome histologic alterations following fine-needle aspiration of the parathyroid

¹ Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network and Toronto Medical Laboratories, Toronto, Canada
² Department of Medicine (Endocrinology), University of Toronto
³ Department of Laboratory Medicine, Trillium Health Centre, Mississauga, Ontario
⁴ Department of Pathology, Lakeridge Health Centre, Oshawa, Ontario

Correspondence to:
Dr S L Asa
Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network and Toronto Medical Laboratories, 200 Elizabeth Street, 11th Floor, Toronto, Ontario M5G 2C4, Canada; sylvia.asa{at}uhn.on.ca
ABSTRACT
Fine-needle aspiration (FNA) is a procedure that is increasingly being performed. Artefacts occurring after FNA are reported to complicate the histological analysis of the tissue, mainly in the thyroid; WHAFFT (worrisome histologic alterations following FNA of thyroid) is well documented in the literature. The case of a male patient with hypercalcaemia who was subsequently found to have a nodule in the thyroid gland is reported here. He underwent FNA, followed by a total thyroidectomy and parathyroidectomy. The abnormality in the parathyroid gland showed worrisome histological changes that were suspicious of a malignant lesion, resembling the changes seen in the thyroid gland after FNA. Parathyroid cells were identified by a review of the previous FNA. The concept of WHAFFT, which can mimic the features of malignancy in the parathyroid gland, is therefore introduced.

Abbreviations: FNA, fine-needle aspiration; WHAFFT, worrisome histologic alterations following FNA of thyroid