A Case of Parathyroid Carcinoma Presenting Hyperparathyroidism that was Clinically Easy to Overlook

Jung Hoon Lee; Ja Won Koo; Sang Ouk Chin; Sang Youl Rhee; Moon Chan Choi; Suk Chon; Seungjoon Oh; Jeong-taek Woo; Sung Woon Kim; Jin-Woo Kim; Young Seol Kim

doi:10.11005/kjbm.2012.19.1.59

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Lee, Koo, Chin, Rhee, Choi, Chon, Oh, Woo, Kim, Kim, and Kim: A Case of Parathyroid Carcinoma Presenting Hyperparathyroidism that was Clinically Easy to Overlook

Case Report

Korean Journal of Bone Metabolism

Korean Journal of Bone Metabolism 2012; 19(1): 59-65.

Published online: 18 May 2012

DOI: https://doi.org/10.11005/kjbm.2012.19.1.59

A Case of Parathyroid Carcinoma Presenting Hyperparathyroidism that was Clinically Easy to Overlook

Jung Hoon Lee¹, Ja Won Koo¹, Sang Ouk Chin¹, Sang Youl Rhee¹, Moon Chan Choi¹, Suk Chon^1,², Seungjoon Oh^1,², Jeong-taek Woo^1,², Sung Woon Kim^1,², Jin-Woo Kim^1,², Young Seol Kim^1,²

¹Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.

²Research Institute of Endocrinology, Kyung Hee University School of Medicine, Seoul, Korea.

Address for Correspondence: Suk Chon, Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 1 Hoegi-dong, Dongdaemoon-gu, Seoul 130-702, Korea. Tel: +82-2-958-8200, Fax: +82-2-968-1848, imdrjs@khu.ac.kr

Received 16 April 2012 Revised 30 April 2012 Accepted 4 May 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Parathyroid carcinoma is very rare in patients with primary hyperparathyroidism, only accounts for 1% to 2% of all cases. It is characterized by higher incidence of renal dysfunction, metabolic bone disease and gastrointestinal symptoms. Although the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma when compared to those with those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma without pathologic confirmation. To our knowledge, there have only been a few cases of hyperparathyroidism due to parathyroid carcinomas reported to date. Here, we report a case of 63-year-old woman developing osteoporosis, hypercalcemia and hypophosphatemia due to a parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively.

Keywords: Hypercalcemia, Osteoporosis, Parathyroid cancer, Primary hyperparathyroidism

Figures and Tables

Fig. 1

Bone mineral density of L-spine and left femur neck shows osteoporosis of L-spine and left femur neck. (BMD, bone mineral density)

Fig. 2

Thyroid sonography shows extrathyroidal solid mass at right lobe with containing cystic portion (2.2 × 4.6 × 1.6 cm); (A) Transverse view, (B) longitudinal view.

Fig. 3

Parathyroid scan with 99^mTc-sestamibi scan shows irregular parathyroid mass below right thyroid gland with high uptake after two hours delayed image. (ANT, adenine nucleotide translocator)

Fig. 4

Neck computed tomography demonstrates non-enhanced parathyroid mass (2.7 × 2.0 cm sized) below the posterior portion of right thyroid gland that has extended to the inferior portion of thoracic inlet and marginal irregularity. There is no lymph node enlargement.

Fig. 5

Microscopic feature of parathyroid mass reveals a rather well circumscribed but partially infiltrating tumor tissue which consists of uniform, polygonal clear cells with mild nuclear pleomorphism. A few foci of vascular invasion and capsular penetration are noted (hematoxylin and eosin staining); (A) × 40, (B) × 400.

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