Endocrine Abstracts

Background: Parathyroid cancer is a rare pathology, approximately 2 cases per 10, 000, 000 people/year. The five-year survival rate for this disease ranges from 20–85%, and the ten-year survival rate is approximately 15–80%. Timely detection and compliance with algorithms for parathyroid gland cancer diagnostics allows surgical treatment and maximum positive prognosis for patient.

Clinical case: Patient 18 y.o., was presented with complaints to aching pains in the bones and joints, repeated fractures of the bones with a fall from the height of the body. It was found out from medical history that patient marked this complaints at 2016. Youthful osteochondrosis was diagnosed by orthopedist of the large and small tibia, symptomatic therapy was performed without improvement. A fracture of the ulnar bone of the left arm was occurred after fall from the height of his own growth. A swelling in the anterior region of 1, 2, 3 ribs on the right, when chest radiography was performed and myeloma was suspected. On the results of myelography this pathology was excluded. Intensive accumulation of the drug in the bones of the cranial vault was noted on osteoscintigraphy, thus primary hyperparathyroidism was suspected.

Patient was hospitalized. Increased levels of PTH (2252 pg/ml), total calcium (3.06 mmol/l) and calcium ionized (1.66 nmol/l) were determined. At palpation, thyroid gland was enlarged, elastic volumetric formation is palpable on the right, so ultrasonography of thyroid and parathyroid glands was performed. At the result volumetric formation behind a capsule of the thyroid gland 35 × 32 mm in size was found. The tumor from the follicular epithelium was verified by fine needle aspiration biopsy, probably it was an adenoma. According to scintigraphy with 99 mTc, signs of large hyperfunction formation of parathyroid tissue / probably originating from the left lower parathyroid gland.

Thus, primary hyperparathyroidism was verified and surgical treatment was recommended.

The left lower parathyroid gland with a tumor was removed. According to histological study, parathyroid cancer was detected with foci of invasion into the tumor capsule.

Patient was discharged from the hospital with the final diagnosis of “Carcinoma of the left lower parathyroid gland” and recommendations: control of ionized calcium, phosphorus, PTH after 1 week.

Conclusion: This clinical case demonstrates that the correct interpreting of a clinical picture and keeping of algorithms of diagnostics allowed well-timed to tap parathyroid cancer of the young man and to carry out surgical treatment that allows hoping for the most positive forecast for this patient.