Yunhui Xin1, Teng Zhao1, Bojun Wei2, Hua Gu3, Mulan Jin4, Hong Shen1, Xing Liu1, Jiacheng Wang1, Qian Wang1. 1. Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China. 2. Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China. weibojun1015@126.com. 3. Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China. 4. Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China.
Abstract
PURPOSE: Ectopic parathyroid glands are thought to be the cause of a significant portion of failed primary surgery for hyperparathyroidism. Parathyroid carcinoma (PTCA) is a rare malignant tumor, and ectopic PTCA is a particularly unusual situation. Here, we describe, for the first time, a case of intrapericardial PTCA. METHODS: We describe the case of a 53-year-old female presented with 1-year history of backache, multiple fractures, nephrolithiasis, nausea, vomiting, fatigue, and unexplained myocardial ischemia-like symptoms. Physical examination revealed a barrel chest and sternal tenderness with stable vital signs. Blood tests confirmed hypercalcemia (3.70 mmol/L) and hyperparathyroidism (>1900 pg/ml). 99mTc-sestamibi scan indicated ectopic findings in the mediastinum highly suggestive of parathyroid adenoma. RESULTS: After more tests, cardiac magnetic resonance imaging (MRI) revealed a mass closely related to the great vessels of the heart. The ectopic tumor in the pericardium was successfully resected through sternotomy, with subsequent histopathological confirmation of PTCA. The metabolism of calcium and phosphorus and the level of PTH returned to normal after surgery. CONCLUSION: This unique case reinforces the tremendous variety of possible ectopic locations of parathyroid glands. Although most patients with primary hyperparathyroidism (PHPT) carry a high suspicion of a benign course, the entity of ectopic PTCA also needs to be considered. Accurate preoperative locating diagnosis as well as en bloc tumor resection offers the highest chance of cure in patients with PHPT.
PURPOSE: Ectopic parathyroid glands are thought to be the cause of a significant portion of failed primary surgery for hyperparathyroidism. Parathyroid carcinoma (PTCA) is a rare malignant tumor, and ectopic PTCA is a particularly unusual situation. Here, we describe, for the first time, a case of intrapericardial PTCA. METHODS: We describe the case of a 53-year-old female presented with 1-year history of backache, multiple fractures, nephrolithiasis, nausea, vomiting, fatigue, and unexplained myocardial ischemia-like symptoms. Physical examination revealed a barrel chest and sternal tenderness with stable vital signs. Blood tests confirmed hypercalcemia (3.70 mmol/L) and hyperparathyroidism (>1900 pg/ml). 99mTc-sestamibi scan indicated ectopic findings in the mediastinum highly suggestive of parathyroid adenoma. RESULTS: After more tests, cardiac magnetic resonance imaging (MRI) revealed a mass closely related to the great vessels of the heart. The ectopic tumor in the pericardium was successfully resected through sternotomy, with subsequent histopathological confirmation of PTCA. The metabolism of calcium and phosphorus and the level of PTH returned to normal after surgery. CONCLUSION: This unique case reinforces the tremendous variety of possible ectopic locations of parathyroid glands. Although most patients with primary hyperparathyroidism (PHPT) carry a high suspicion of a benign course, the entity of ectopic PTCA also needs to be considered. Accurate preoperative locating diagnosis as well as en bloc tumor resection offers the highest chance of cure in patients with PHPT.
Entities:
Keywords:
Case report; Ectopic; MRI; Parathyroid carcinoma; Pericardium
Authors: Fernando Mendoza-Moreno; Ángel Rodriguez-Pascual; María Rocío Díez-Gago; Marina Pérez-González; Laura Jiménez-Alvárez; Isabel Furtado-Lobo; Manuel Díez-Alonso; Fernando Noguerales-Fraguas Journal: Case Rep Otolaryngol Date: 2018-09-09
Authors: Lorenzo Zelano; Pietro Locantore; Carlo Antonio Rota; Caterina Policola; Andrea Corsello; Esther Diana Rossi; Vittoria Rufini; Luca Zagaria; Marco Raffaelli; Alfredo Pontecorvi Journal: Front Endocrinol (Lausanne) Date: 2022-07-07 Impact factor: 6.055