Mediastinal Parathyroid Adenoma and Brown Tumors (original) (raw)
Related papers
Localization and management of mediastinal parathyroid adenoma – a case report
IMC journal of medical science, 2022
Ectopic parathyroid adenoma sometimes poses diagnostic challenge and can be a cause of persistent and recurrent primary hyperparathyroidism. Anterior mediastinum is one of the locations for ectopic parathyroid adenoma. Surgical excision is the only cure and for successful surgery, pre-operative localization is crucial. Chance of failed surgery is being increased without prior localization of the ectopic gland. The combination of single photon emission computed tomography (SPECT) and computed tomography (CT) has got high sensitivity for accurate localization of ectopic parathyroid. On the other hand, with accurate localization surgical outcome is excellent. Here we report, successful localization and management of a case of primary hyperparathyroidism due to adenoma in anterior mediastinum in 47-year-old man.
An Unusual Presentation of Parathyroid Adenoma: A Radiological Point of View
Journal of clinical research in radiology, 2019
Bone tumors are characterized by hyperparathyroidism. They are focal bone lesions found in any part of the skeleton. Brown tumors in the craniofacial bones are uncommon. The term "brown tumor" was derived by the color and presence of hemosiderin deposits in the tumor. The appearance of the tumor is also caused by vascularity and hemorrhage. The most common areas of brown tumors include extremities, ribs, clavicles, and pelvic girdle. In patients with craniofacial involvement, there is a significant morbidity. Most patients suffer from social stigma due to facial disfiguration. Patients may also suffer from normal function such as talking, chewing, and breathing. A multidisciplinary team is required for accurate diagnosis, treatment, and management of brown tumors. Herein, we report an unusual parathyroid adenoma presenting as a brown tumor of the mandible.
Atypical Parathyroid Adenoma with Multiple Brown Tumors as Initial Presentation: A Rare Entity
Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India
Brown tumors seen in hyperparathyroidism are rare, non-neoplastic lesions because of abnormal bone metabolism, and they can mimic benign bone tumors or malignancy. Although biopsy is considered as the gold standard for diagnosis, it can be inconclusive. As the diagnosis of brown tumors is often challenging, a high index of suspicion is essential for diagnosis. We present a case of 21-year-old woman who presented with multiple painful bony lesions, which were initially misdiagnosed as fibrous dysplasia. Due to persistent bone pain and deterioration in her physical mobility, she was referred to tertiary care centre. After thorough clinical workup, she underwent Tc-99m methylene diphosphonate bone scintigraphy that raised strong clinical suspicion of hyperparathyroidism and brown tumors. Subsequently, Tc-99m-methoxy isobutyl isonitrile (MIBI) parathyroid scintigraphy revealed a solitary MIBI avid focal lesion, suggestive of left inferior parathyroid adenoma. Later parathyroidectomy was...
Case Report Mediastinal Parathyroid Adenoma
2015
An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recur-rent primary hyperparathyroidism (PHPT) and is recog-nized as an important cause of failed primary neck explo-ration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first exploration whereas in the 3rd case, it was successfully removed with mediastinal exploration after 2 failed neck explorations. In established cases of PHPT with equivocal preoperative localization studies or negative neck explo-rations, an ectopically placed parathyroid adenoma should be considered and once localized, should be surgically removed for cure.
Primary Parathyroid Tumors of the Mediastinum
American Journal of Clinical Pathology, 2005
We describe 17 cases (9 women, 8 men; aged 36 to 72 years) of primary parathyroid tumors occurring primarily in the anterior mediastinum. Clinically and radiologically, all patients had an anterior mediastinal tumor. All patients had metabolic disturbances with calcium and phosphorus. Of 17 patients, 13 had clinical primary hyperparathyroidism, 1 had secondary hyperparathyroidism due to polycystic kidney disease, and 1 had a history of prostatic carcinoma and 1 of chronic obstructive pulmonary disease. In 1 patient, the tumor was found at autopsy. Grossly, the tumors varied in size from 2 to 7 cm in greatest dimension. Histologically, 2 tumors showed features of parathyroid carcinoma, and 15 tumors showed more conventional features of parathyroid adenomas. Six tumors were predominantly oncocytic, 6 were composed predominantly of chief cells, and 3 had mixed cellular composition. Immunohistochemical studies for chromogranin, synaptophysin, low-molecular-weight keratin (CAM 5.2), and parathyroid hormone were performed in 10 cases (8 parathyroid adenomas and 2 parathyroid carcinomas). All the tumors examined showed variable positive reaction for those antibodies. The cases highlight the importance of keeping primary parathyroid tumors in the differential diagnosis of anterior mediastinal tumors.
Mediastinal Parathyroid Adenoma Mimicking Cancer Metastatic to Bone
AACE clinical case reports, 2017
Objective: Mediastinal parathyroid adenomas are rare in clinical practice. We report a case that mimicked cancer metastatic to bone on initial workup to increase awareness of this differential diagnosis in the evaluation of patients presenting with multiple foci of uptake on technetium bone scanning without an established primary neoplasm. We also outline other diagnostic pitfalls that may be encountered in the workup and management of this uncommon condition. Methods: A 26-year-old man presented with a several-month history of back and pelvic pain. Initial plain radiography showed multiple lytic lesions in the pelvis. Technetium bone scanning revealed multiple foci of increased uptake in the thoracic vertebrae, ribs, clavicles, pelvis, and extremities. Results: A computed tomography (CT) scan demonstrated a mediastinal mass and an initial diagnosis of metastatic disease from a mediastinal primary malignancy was entertained. Further workup revealed markedly elevated serum ionized calcium of 1.97 mmol/L (normal, 1.19 to 1.31 mmol/L) and parathyroid hormone (PTH) of 154.8 pmol/L (normal, 2.0 to 9.4 pmol/L). Parathyroid scintigraphy showed intense tracer accumulation in the anterior mediastinal mass. A median sternotomy was performed and histopathology was consistent with a parathyroid adenoma. Postoperatively, the patient's ionized calcium and PTH levels normalized and pain resolved. Conclusion: This case illustrates two clinical pearls: (1) brown tumor secondary to hyperparathyroidism is an important differential in the evaluation of patients presenting with widespread lytic bone lesions on CT or multiple foci of uptake on bone scan; and (2) the mediastinum is a rare location but should be considered in the workup of primary hyperparathyroidism.
Unusual Ectopic Parathyroid Adenoma: A Case Report
Acta medica Iranica, 2016
An ectopically placed parathyroid in the mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism. They are rarely in a huge size. We report a case of a 70-year-old man with a history of total parathyroidectomy and thymectomy presented with a lack of appetite, nausea, and generalized bone pain, polydipsia and a calcium level of 14.4 mg/dl. 99mTc-sestamibi scintigraphy with single-photon emission computerized tomography (SPECT) showed a focal zone of radiotracer accumulation in the midline of anterior chest wall (xiphoid level). The mass excised from our patient surgically was 75 grams. This weight and location of the tumor is a very rare finding in parathyroid adenomas.
Neoplasms of the parathyroid glands and brown tumours – A case study
Radiography, 2012
A case of brown tumours concomitant with parathyroid adenoma is described. The patient described shoulder pain following minor trauma. Plain X-rays and MRI showed cystic bone lesions while blood analysis depicted high levels of calcium and parathyroid hormone ( ...
Advances in Molecular Imaging, 2020
We report herein a case of a 40-year-old male patient with chronic renal failure presenting a severe hyperparathyroidism with an elevation of parathormone level evaluated in nuclear medicine department for MIBI-Technetium-99m parathyroid scintigraphy. The parathyroid scintigraphy revealed the appearance of a preferential fixation of the MIBI-99mTc opposite the lower left pole of the thyroid and opposite the upper part of the right hemi thorax. A subsequent single-photon emission computed tomography-computed tomography focused on the cervico-thoracic region was performed and showed an ectopic parathyroid adenoma associated with an incidental brown tumor mimicking bone and lung metastases. Our case report confirms the usefulness of additional hybrid SPECT-CT imaging in the management of hyperparathyroidism.