scholarly journals In Search of a Missing Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A203-A203
Author(s):  
Tammy Tavdy ◽  
Lakshmi P Mahali
Keyword(s):  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Parathyroid Tissue ◽  
Oral Intake ◽  
Diagnostic Challenge ◽  
Tissue Mass ◽  
Common Cause ◽  
Definitive Therapy ◽  
Increased Sensitivity ◽  
The Right

Abstract Background: The most common cause of primary hyperparathyroidism (PHPT) is overproduction of PTH by a parathyroid gland adenoma. While definitive therapy is parathyroidectomy, 4% of patients develop persistent PHPT - a sustained hypercalcemic state that is detected within six months of parathyroidectomy. A missed parathyroid adenoma is the most common cause of persistent PHPT, and accurately locating these glands presents a diagnostic challenge. We describe a rare case of persistent PHPT due to a missed mediastinal parathyroid adenoma. Case: A 54-year-old woman with a history of PHPT presented with abdominal pain, nausea, and decreased oral intake. She underwent parathyroidectomy six months ago with reimplantation of one parathyroid gland into the right sternocleidomastoid muscle (SCM). She was now hypercalcemic to 13.9 mg/dL (8.5–10.5) with intact PTH 1273 pg/mL (15.0–65.0), vitamin D 25-OH 31.4 ng/mL (>30.0), and normal PTHrP. She was not taking calcium, and other causes of hyperparathyroidism were excluded. Sestamibi scintigraphy localized only to the right SCM, and the initial impression was recurrent HPT due to the previously implanted gland. Follow-up CT neck with and without contrast failed to localize any regrowth in the SCM, but did reveal a 1.4 cm mediastinal soft tissue mass, suspicious for an ectopic parathyroid adenoma. She subsequently underwent video-assisted thoracoscopic excision, and pathology was consistent with ectopic hypercellular parathyroid tissue. Post-operatively, her PTH down-trended and calcium normalized. Conclusion: This case describes a small yet biochemically aggressive mediastinal adenoma causing persistent PHPT. While sestamibi scans have ~90% sensitivity for localization of ectopic adenomas, they can fail to identify a small culprit lesion in 12% of patients, whereas CT imaging with and without contrast has increased sensitivity for adenomas <2 cm. Thus, diagnosing persistent PHPT requires sestamibi scan in combination with other imaging modalities for accurate diagnosis of missed adenomas.

Intratracheal parathyroid gland: an unexpected diagnosis

2021 ◽  
Vol 14 (2) ◽  
pp. e239435
Author(s):  
Avery Bryan ◽  
Susan Kurian ◽  
Ashley B Flowers ◽  
Cherie Ann O Nathan
Keyword(s):  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Parathyroid Tissue ◽  
Case Series ◽  
Rare Occurrence ◽  
Laboratory Evidence ◽  
The Masses

Ectopic or supernumerary parathyroid tissue has been generally described in the literature in cases found during workup for parathyroid adenoma. We present two unique cases of intratracheal parathyroid gland, a rare occurrence that has not yet been described in the literature. In both cases, the masses were found incidentally and showed no clinical or laboratory evidence of hyperparathyroidism. In both cases, surveillance was chosen as the method of treatment. We present this case series to increase awareness of this potential diagnosis.

CHARACTERISTICS OF SOFT TISSUE MASS IN THE HAND BY ULTRASONOGRAPHIC EXAMINATION

2005 ◽  
Vol 09 (01) ◽  
pp. 45-51
Author(s):  
Alexander Blankstein ◽  
Aharon Chechick ◽  
Abraham Adunski ◽  
Uri Givon ◽  
Yigal Mirovski ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Mass ◽  
Wrist Joint ◽  
Imaging Modality ◽  
Routine Practice ◽  
X Rays ◽  
Diagnostic Challenge ◽  
Tissue Mass ◽  
Soft Tissue Masses ◽  
The Right

Soft tissue masses are amongst the commonest complaints encountered in orthopedic practice. Of these, masses found in the hand and the wrist are presented at higher frequency. They are often painful and may cause limitation of movement. This work describes the prevalence and the nature of soft tissue masses in the hand and wrist encountered in routine practice. This work was performed to assess the characteristics of soft tissue mass in the hand and the effectiveness of ultrasonography in the diagnosis of soft tissue masses and their differentiation from other lesions in the hand and wrist. Orthopedic surgical conditions that involve soft tissue in the hand and wrist may remain a diagnostic challenge when clinical diagnosis is uncertain and standard X-rays are non-diagnostic. High resolution ultrasound is widely available, non-invasive, without damage of radiation, imaging modality that can help the diagnosis. We reviewed retrospectively 25 patients with soft tissue masses. We compared the ultrasound findings with the histological findings in seven operated patients. A substantial majority of these lesions occurred in the right hand: 79% of the lesions were in the dorsal aspect of the hand, of which 37% were distal to the wrist joint, among them 42% at wrist either radial or ulnar; and 21% of the lesions were found in the volar aspect, among them 17% at wrist aspect, either radial or ulnar side. No predisposing factors could be found. The findings of this study reaffirm the utility of ultrasonography as primary diagnostic tool in routine orthopedic practice.

ERRATUM

2011 ◽  
Vol 135 (12) ◽  
pp. 1521-1521
Keyword(s):  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Cutaneous Melanoma ◽  
Rare Case ◽  
Tumor Metastasis ◽  
Arch Pathol ◽  
Tumor To Tumor Metastasis ◽  
The Right ◽  
Inferior Parathyroid Gland ◽  
Incorrect Data

An abstract published in the September 2011 issue of the Archives (Murugan P et al. Tumor-to-Tumor Metastasis: A Rare Case of Cutaneous Melanoma Metastatic to a Parathyroid Adenoma [CAP abstract 109, session 100]. Arch Pathol Lab Med. 2011;135[9]:1132) contains incorrect data in line 10 when referring to the right inferior parathyroid gland that was removed. The weight of the gland should have been shown as “…1200-mg (normal, 30–70 mg)…”

Paraganglioma: an unusual tumour of the parathyroid gland

1996 ◽  
Vol 110 (2) ◽  
pp. 196-199 ◽  
Author(s):  
W. G. McCluggage ◽  
C. H. S. Cameron ◽  
D. Brooker ◽  
M. D. O'Hara
Keyword(s):  
Electron Microscopy ◽  
Differential Diagnosis ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Incidental Finding ◽  
Squamous Carcinoma ◽  
Pathological Features ◽  
Unusual Variant ◽  
The Right ◽  
Inferior Parathyroid Gland

AbstractA case of paraganglioma arising within a parathyroid gland is reported. The lesion was an incidental finding in a block dissection of neck performed for squamous carcinoma of the pharynx. A well-circumscribed lesion, exhibiting the characteristic pathological features of a paraganglioma, was embedded within the right inferior parathyroid gland. Due to its location, the chief histological differential diagnosis was an unusual variant of parathyroid adenoma. Immunohistochemistry and electron microscopy assisted in reaching a diagnosis. This, as far as we are aware, is the first reported case of a paraganglioma of the parathyroid gland.

scholarly journals Rare Case of Severe Hypercalcemia Secondary to Atypical Sestamibi Negative Parathyroid Cystic Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A266-A267
Author(s):  
Timur Gusov ◽  
John Chen Liu ◽  
Sowjanya Naha ◽  
F N U Marium ◽  
Joseph Theressa Nehu Parimi ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Severe Hypercalcemia ◽  
Parathyroid Adenomas ◽  
Sestamibi Scan ◽  
Serum Pth ◽  
The Right ◽  
99Mtc Sestamibi ◽  
Cystic Adenoma

Abstract Primary hyperparathyroidism (PHPT) is defined as excessive secretion of parathyroid hormone (PTH) originating from the parathyroid gland. The most common cause is a single parathyroid adenoma which is typically solid. Cystic parathyroid adenomas (CPA) are the cause of about 1–2% of cases of primary hyperparathyroidism. It is known that cystic parathyroid adenomas are a result of degeneration of an existing parathyroid adenoma. SestaMIBI is an imaging study based on uptake of radioactive technetium99 and used to localize parathyroid adenomas. We describe an unusual case of severe hypercalcemia secondary to 99mTc sestaMIBI negative atypical parathyroid cystic adenoma. A 56-year-old male presented to our facility with nausea and vomiting. His past medical history included hypertension and hepatitis C with no history of fractures or kidney disease. Physical examination was normal. Upon admission the patient was afebrile with blood pressure of 170/120 mmHg and heart rate of 62 bpm. Chemistry showed Calcium of 14.5 mg/dL (8.6–10.2mg/dL), phosphorus 2.2 (2.7–4.5) mh/dL, magnesium 1.8 (1.7–2.6)mg/dL, intact PTH of 375 (15–65) pg/mL, PTH-related peptide <2.0 pmol/L(<2 pmol/L), 25-OH vitamin D of 19 ng/ml (30–80), Creatinine 1.22 (0.7–1.2)mg/dL, alkaline phosphatase 95 (40–129) units/L. He was started on aggressive hydration, calcitonin 4 units/kg, 4 mg of IV Zolendroninc acid. Neck sonogram revealed a large, complex, predominantly anechoic lesion with solid vascular components and thick internal septations in the inferior and medial aspect of the right thyroid lobe measuring 3 x 2 x 5.5 cm. Findings were confirmed with CT of the neck. Since Sestamibi scan (planar and SPECT/CT) did not show uptake in parathyroid glands, the cyst was thought to be of thyroid origin. Fine needle aspiration was not able to detect cellular material, but PTH was >100 pg/ml on the FNA sample. Otolaryngology service was consulted for parathyroidectomy. During the surgical treatment, the right upper parathyroid gland was removed with no changes in serum PTH. Next, the cystic lesion was removed with normalization of serum PTH (from 218 pg/ml to 35.2 pg/ml respectively). Intraoperative frozen section analysis was read as a cystic parathyroid adenoma. The final pathology report revealed cystic parathyroid tissue favoring parathyroid adenoma with focal atypia. Hypercalcemia resolved. Conclusions: Atypical cystic parathyroid adenomas are a rare cause of PHPT. 90% of parathyroid cysts are nonfunctional. Above mention is a case of a patient presenting with hypercalcemic crisis secondary to cystic parathyroid adenoma, which posed a diagnostic challenge as both neck ultrasound and 99mTc sestaMIBI scan were inconclusive. These findings should trigger suspicion for functional parathyroid lesions. Cystic components should be evaluated for PTH levels and if significantly elevated should be treated as a parathyroid adenoma.

scholarly journals SAT-349 Cinacalcet Resistant Tertiary Hyperparathyroidism with One Large Parathyroid Gland

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Bayan Chaker ◽  
Hussam Alim ◽  
Wael Taha
Keyword(s):  
Hospital Stay ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Calcium Level ◽  
Parathyroid Glands ◽  
Incomplete Resection ◽  
Lower Pole ◽  
Tertiary Hyperparathyroidism ◽  
The Right ◽  
Inferior Parathyroid Gland

Abstract Tertiary hyperparathyroidism is thought to develop after long term secondary hyperparathyroidism, such as CKD on dialysis. In This case, all parathyroid glands are significantly enlarged. We report a case of an 84-year-old female with a past medical history of ESRD on HD and recurrent nephrolithiasis who was found to have an enlarged multinodular goiter with the dominant mass in the lower pole of the right gland measuring about 4.7 cm on thyroid ultrasound. Blood work was done which showed elevated intact PTH levels at 2720 pg/mL (12–88). Her calcium level was normal at that time at 10.5 mg/dL (8.6–10.8) with an albumin of 4.2 g/dL (3.5–5.7), and a phosphorus of 5.7 mg/dL (2.5–4.5). Patient had a DEXA scan which showed severe osteoporosis in the lumbar spine, left hip, and right forearm. Patient had increased PTH levels despite being on Cinacalcet. She had a nuclear medicine parathyroid scan with SPECT CT which showed increased uptake along the right inferior thyroid concerning for a large right lower parathyroid adenoma or functional thyroid nodule. FNA of the nodule was done and showed colloid nodule but PTH wash showed elevated PTH at 7634 pg/mL. She was referred for right lower parathyroidectomy and Cinacalcet was discontinued prior to surgery. She had right and left inferior parathyroidectomy and 4 gland exploration. Pathology showed the right inferior parathyroid gland to be markedly hyper-cellular, weighing 36 grams consistent with hyperplasia and the left inferior parathyroid gland to be slightly hyper-cellular parathyroid gland consistent with hyperplasia. No evidence of malignancy was noted on pathology. Prior to surgery her calcium level of 10.6 mg/dL which went down to 9.6 mg/dL post-operatively. Patient then developed severe hypocalcemia and hungry bone syndrome following the surgery requiring a calcium drip for 3 days post-operatively. Was changed to oral calcium but required large amounts of calcium gluconate and calcitriol supplementation and an extended hospital stay of 13 days. However, throughout the hospital stay, PTH levels continued trending back up to 239 which may represent either increased activity from remaining parathyroid glands or residual parathyroid adenoma with incomplete resection. Post-operative US neck showed Post-surgical collection in the lower pole of the right gland measuring 4.8 cm compatible with recent resection. In conclusion, tertiary hyperparathyroidism can develop due to one enlarged parathyroid gland or an adenoma, which can be resistant to cinacalcet.

scholarly journals The case of late diagnosis of giant parathyroid adenoma in combination with fibrocystic osteitis and brown tumor of the upper jaw: a case report

2021 ◽  
Vol 67 (2) ◽  
pp. 49-56
Author(s):  
G. A. Bersenev ◽  
E. A. Ilyicheva ◽  
E. G. Griroryev
Keyword(s):  
Case Report ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Malignant Neoplasm ◽  
Late Diagnosis ◽  
Focal Lesion ◽  
Brown Tumor ◽  
Increased Risk ◽  
Upper Jaw ◽  
The Right

In this case report the authors inform about late diagnosis of giant adenoma of the parathyroid gland with primary hyperparathyroidism (PHPT) and the development of fibrocystic osteitis with a «brown» tumor of the upper jaw. The patient has been under the care endocrinologist with type 2 diabetes mellitus and multinodular goiter for 8 years.The last 5 years there was a clinical manifestation of PHPT, but the diagnosis was made by an oncologist after the detection of a «brown» tumor of the upper jaw. According to multispiral computed tomography and scintigraphy with 99mTc-MIBI, a focal lesion was found in the upper jaw on the right, lytic foci in the bones of the cranial vault, pelvis, lower extremities, ribs on the right, as well as a giant parathyroid adenoma on the right. According to the increased risk of the patient having a malignant neoplasm of the parathyroid gland, an extended surgical treatment of PHPT in the enblock volume was carried out with the achievement of remission of the PHPT. This clinical case illustrates a variant of the severe course of PHPT with the development of such a rare complication as fibrocystic osteitis and demonstrates the importance of timely diagnosis.

scholarly journals Intramuscular Haemangioma with Diagnostic Challenge: A Cause for Strange Pain in the Masseter Muscle

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Krithika Chandrasekar Lakshmi ◽  
Sathasivasubramanian Sankarapandiyan ◽  
Venkata Sai Pulivadula Mohanarangam
Keyword(s):  
Soft Tissue Mass ◽  
Surgical Excision ◽  
Vascular Tumors ◽  
Diagnostic Challenge ◽  
Tissue Mass ◽  
Intramuscular Hemangioma ◽  
Intramuscular Haemangioma ◽  
The Right ◽  
Deep Location ◽  
Progressive Enlargement

Intramuscular hemangiomas are unique vascular tumors which are benign in nature, most commonly occurring in the trunk and extremities. When present in head and neck, they most frequently involve the masseter and trapezius muscles, accounting for less than 1% of all hemangiomas. Most of these lesions present with pain and discomfort and some patients may demonstrate progressive enlargement. Due to their infrequency, deep location, and unfamiliar presentation, these lesions are seldom correctly diagnosed clinically. Our report is a clinically misdiagnosed case of a painful soft tissue mass in the right side masseteric region of a 23-year-old female patient, confirmed as intramuscular hemangioma based on imaging studies and histopathologic examination, treated by surgical excision which had no recurrence after a 3-year followup.

Roy Mac Clare. Secondary insufficiency of the parathyroid glands after removal of the parathyroid adenoma and the ineffectiveness of treatment with extracts of the parathyroid glands. (Arch. Of Surgery, vol. 33, no. 5, 1936)

1937 ◽  
Vol 33 (12) ◽  
pp. 1506-1507
Author(s):  
Е. Auslander
Keyword(s):  
Thyroid Gland ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Parathyroid Glands ◽  
Lower Pole ◽  
Right Lobe ◽  
The Right

A 51-year-old woman underwent surgery to remove the parathyroid glands for fibrocystic osteitis with spontaneous fractures. A tumor of the parathyroid gland was found adjacent to the lower pole of the right lobe of the thyroid gland, as a result of which the entire right lobe was removed.

scholarly journals SUN-473 Primary Hyperparathyroidism and Papillary Thyroid Carcinoma, Association or Coincidence?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nitish Singh Nandu ◽  
Janice L Gilden
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Gland ◽  
Primary Hyperparathyroidism ◽  
Thyroid Carcinoma ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Total Serum ◽  
Papillary Thyroid ◽  
Thyroid Lobe ◽  
The Right

Abstract Background: The Parathyroid glands originate from the Pharyngeal pouches, Inferior from the third and superior from the fourth. Rarely these glands migrate to the thyroid gland, isthmus or thymus and become ectopic. Primary Hyperparathyroidism (PHPT) is a common cause of hypercalcemia in ambulatory patients. It is also more frequent in women and increases with age. Its treatment is often surgical removal of the affected parathyroid gland. We present a case of an ectopic parathyroid adenoma hidden within the thyroid lobe, treated by thyroid lobectomy ultimately leading to the diagnosis and management of Papillary thyroid carcinoma. Case report: A 73-Year-old female with DM, HTN, hyperlipidemia, osteoporosis was referred to the Endocrine clinic for a history of fractures to the right upper and lower extremities after trivial falls, She was subsequently evaluated for metabolic bone disease, noted to have a PTH 78 (n=14-64 pg/ml) with a total serum calcium 9.7 (n=8.6-10.4 mg/dl), 25-OH Vit-D 14 (n=30-100 ng/ml), urinary calcium to creatinine ratio 20 (n=10-320 mg/g). The parathyroid scan showed persistent activity in the area of the inferior margin right thyroid lobe, suggesting a parathyroid adenoma. She had a parathyroidectomy and during the procedure, the parathyroid gland was unable to be visualized. Hence the Right inferior thyroid lobe was removed. The pathology also showed papillary thyroid carcinoma and the patient had a total thyroidectomy. Discussion: The relationship between PHPT and Papillary thyroid carcinoma still remains unclear. Our patient demonstrated a rare circumstance, wherein the presence of a parathyroid adenoma within the thyroid gland has led to early diagnosis and timely treatment of papillary thyroid carcinoma. Few authors reported thyroid malignancy as the most prevalent cancer among patients with PHPT as the primary disorder. While others report concurrence as a coincidental pathology. Nevertheless, we emphasize the importance of surveillance for thyroid pathology in patients with PHPT that can provide better overall patient outcomes. References: 1. Vargas-Ortega, G., et al. (2018). “Symptomatic Primary Hyperparathyroidism as a Risk Factor for Differentiated Thyroid Cancer %J Journal of Thyroid Research.” 2018: 6. 2. Miccoli, P., et al. (2006). “Incidental thyroid carcinoma in a large series of consecutive patients operated on for benign thyroid disease.” ANZ J Surg 76(3): 123-126. 3. Bentrem, D. J., et al. (2002). “Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperparathyroidism?” Thyroid 12(12): 1109-1112.

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