Primary hyperparathyroidism due to atypical vertically long cystic adenoma

Content Provider	Semantic Scholar
Author	Kawashima, Sachiko-Tsukamoto Usui, Takeshi Ueda, Yohei Kobayashi, Maiko-Kakita Tsuiki, Mika Tanase-Nakao, Kanako Nanba, Kazutaka Tagami, Tetsuya Naruse, Mitsuhide Watanabe, Yoshiki Asato, Ryo Kato, Sumiko Shimatsu, Akira
Copyright Year	2014
Abstract	UNLABELLED Parathyroid cystic adenomas are often misdiagnosed as thyroid cysts and routine preoperative diagnostic tools, such as ultrasonography (US) or 99m technetium-sestamibi (99mTc-MIBI) scans, cannot clearly distinguish between these entities. We present a 67-year-old hypercalcemic woman with a cervical cystic lesion who had negative sestamibi scan results. Her laboratory data indicated primary hyperparathyroidism (serum calcium concentration 14.0 mg/dl, phosphate concentration 2.3 mg/dl, and intact parathyroid hormone (PTH) concentration 239 pg/ml). The cervical US and computed tomography scans revealed a large and vertically long cystic mass (12×11×54 mm). A mass was located from the upper end of the left thyroid lobe to the submandibular region and was not clearly distinguishable from the thyroid. For preoperative definitive diagnosis, we carried out a parathyroid fine-needle aspiration (FNA) and PTH assay (PTH-FNA) of liquid aspirated from the cyst. The intact PTH-FNA concentration was 1.28×10(6) pg/ml, and the patient was diagnosed with primary hyperparathyroidism due to a cystic mass. She underwent a left upper parathyroidectomy and her serum calcium and intact PTH concentration immediately decreased to normal levels. This report describes the usefulness of PTH-FNA for localizing and differentiating an atypical functional parathyroid lesion from nonfunctional tissue in primary hyperparathyroidism. LEARNING POINTS Cystic parathyroid lesions, even in the case of elevated PTH levels, can produce negative results in 99mTc-MIBI scans.Preoperative diagnosis of parathyroid cysts detectable on US is possible by parathyroid FNA and PTH assay (PTH-FNA) of liquid aspirated from the cyst, if malignancy is not suspected. PTH-FNA could be helpful in the differential diagnosis of an equivocal cervical tumor.
Starting Page	709
Ending Page	714
Page Count	6
File Format	PDF HTM / HTML
Alternate Webpage(s)	https://edm.bioscientifica.com/downloadpdf/journals/edm/2014/1/EDM14-0086.pdf
Alternate Webpage(s)	https://www.edmcasereports.com/media//EDM14-0086.pdf
PubMed reference number	25379182
Alternate Webpage(s)	https://doi.org/10.1530/EDM-14-0086
DOI	10.1530/edm-14-0086
Journal	Endocrinology, diabetes & metabolism case reports
Volume Number	2014
Language	English
Access Restriction	Open
Subject Keyword	Addison Disease Adenoma Calcium Cyst Cystic Kidney Diseases Differential Diagnosis Fine needle aspiration biopsy Hyperparathyroidism Hyperparathyroidism, Primary Lymphangioma, Cystic Nanogram per Liter Neck Papillary thyroid carcinoma Parathyroid Diseases Parathyroid Gland Adenocarcinoma Parathyroid Hormone Parathyroid Neoplasms Parathyroidectomy Patients Sestamibi Scan Technetium 99m Technetium Tc 99m Sestamibi Uterine Cervical Neoplasm X-Ray Computed Tomography inorganic phosphate mg/dl
Content Type	Text
Resource Type	Article