ECE2015 Eposter Presentations Clinical Cases–Thyroid/Other (101 abstracts)
Concurrent mediastinal parathyroid carcinoma and parathyroid adenoma
Mustafa Caliskan , Selvihan Beysel 1 , Esra Tutal 1 , Bekir Ucan 1 , Taner Demirci 1 , Seyfullah Kan 1 , Mahmut Apaydin 1 , Muhammed Kizilgul 1 , Guleser Saylam 2 , Erman Cakal 1 , Mustafa Ozbek 1 & Tuncay Delibasi 1,
1Department of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey; 2Department of Otorhinolaryngology, Diskapi Teaching and Research Hospital, Ankara, Turkey; 3School of Medicine (Kastamonu), Hacettepe University, Ankara, Turkey.
Introduction: While mediastinal parathyroid carcinoma is a rare entity by itself, multiglandular coexistence of parathyroid carcinoma and adenoma represents an extremely rare condition. Herein, we report such a rare presentation of multiglandular parathyroid neoplasm with an ectopic carcinoma in the mediastinum and adenoma on the right side of neck in a patient with persistent primary hyperparathyroidism (PHP).
Case report: A 38-year-old female patient who initially presented with nephrolithiasis and osteopenia was subsequently diagnosed as having PHP. Tc-99m-methoxybutylisonitrile scintigraphy showed no parathyroid lesions, while a neck ultrasound determined the presence of a solid hypoechoic nodular lesion (4×4×8 mm) at the postero-inferior aspect of the right thyroid lobe. Following bilateral surgical neck exploration, existence of a parathyroid adenoma was revealed. However, due to the persistence of hypercalcaemia postoperatively, a single photon emission computed tomographic examination showed a mass lesion in the anterior mediastinum and no lesion in the neck region. A second surgical procedure was performed and histopathological examination revealed the presence of a mediastinal parathyroid carcinoma with evidence of invasion in the capsule and surrounding adipose tissue, without metastatic lymph nodes. At 1-year of follow-up there was no hypercalcaemia. The chest computed tomography failed to demonstrate any lesions in the mediastinum and neck region.
Discussion: To our knowledge, only four cases have been described in the literature with concurrent occurrence of multiglandular parathyroid adenoma and carcinoma, with all cases having the multiglandular parathyroid carcinoma localised in the neck. This is the first patient who had coexistent ectopic mediastinal parathyroid carcinoma and parathyroid adenoma in the neck with persistent PHP.
Conclusion: Concurrent occurrence of ectopic mediastinal parathyroid carcinoma and parathyroid adenoma may be result in significant diagnostic challenges for the clinicians. Multiple diagnostic studies appear to be required and essential for the identification of multiple parathyroid glands in patients with persistent PHP.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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