Endocrine Abstracts

Introduction: We report a case of a parathyroid carcinoma with very unusual and revealing features.

Case report: DAB, male aged 66 was subjected to subtotal gastrectomy because of a localized gastric adenocarcinoma (intestinal type). A mild primary hyperparathyroidism (PTH<200 pg/ml) was simultaneously found. Calcium oxalate nephrolythiasis at 50 years was noted. Sonography revealed a nodular lesion in the right lower thyroid pole, while NMR showed a nodular lesion at the left lower thyroid pole and in the sestamibi scan late hyperfixation at the right lower pole. Bilateral inferior parathyroidectomy was performed and revealed on both sides adenoma with moderate nuclear polymorphism and no mitotic figures; on the left side a central cystic area was found. Clinical and biochemical cure apparently followed. Six months later a presumed unrelated nodular lesion in the right thigh muscular mass was removed and found to be a metastatic lesion of a carcinoma, with numerous mitotic figures and immunoreactivity for PTH. A sestamibi scan showed marked hyperfixation in the right leg and PET- FDG-F18 hyperfixation at the right quadricipital area.

Discussion: Some unusual features may shed light on the pathologic process. There is evidence for a long standing disease since nephrolytiasis was found 14 years before. Long standing hyperparathyroidism and increased gastric acid secretion can lead to chronic gastritis, intestinal metaplasia and gastric adenocarcinoma. There is evidence for evolution along bilateral hyperplasia, adenoma and carcinoma since bilateral disease was present and a left cystic nonfunctioning lesion was found. Neither clinical nor pathological a priori suspicion of a carcinoma was present. Most surprisingly a single metastatic lesion was later found in a very unusual location and this lesion was highly undifferentiated in sharp contract with the primitive lesion.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.