PURPOSE: Recently Tc99m MIBI (methoxyisobutylisonitrile) has been described as an alternative to thallium for localizing parathyroid lesions. The purpose of this study was to compare the efficacy of a Tc99m MIBI scan with a Tl201/Tc99m subtraction scan for localizing parathyroid lesions in patients with primary hyperparathyroidism. METHODS: Among 31 cases of primary hyperparathyroidism operated on at the Department of Surgery, Seoul National University Hospital from January 1997 to June 2001, a Tl201/Tc99m subtraction scan was performed on 16 patients and a Tc99m MIBI scan on 22 patients. Seven patients underwent both. RESULTS: The pathology was a single adenoma in 28 patients, a hyperplasia in 1 patient and a carcinoma in 2 patients. Hypercalcemia was controlled postoperatively in all cases. The sensitivities of the Tl201/Tc99m subtraction scan and Tc99m MIBI scan were 53.3% and 86.4%, respectively. The positive predictive values were 100% of the two study groups. CONCLUSION: We concluded that the better accuracy, superior image quality and lower cost of Tc99m MIBI scan will make it the new radiopharmaceutical parathyroid scan of choice. A unilateral approach can be used with a high degree of success, as in case of a preoperatively localized single parathyroid adenoma, which was confirmed when surgical exploration identified of a normal ipsilateral gland.
Adenoma ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary* ; Hyperplasia ; Parathyroid Neoplasms ; Pathology ; Seoul ; Thallium

Primary hyperparathyroidism is a rare disease in children and is characterized by conspicuous skeletal and renal changes. A 12 year old male patient presented with symptoms of polydipsia, polyuria, general weakness, nausea, and vomiting which had begun 3 months earlier, and showed typical laboratory findings of primary hyperparathyroidism. Confirmatory diagnosis was made by elevated parathyroid hormone concentration in serum, technetium-thallium subtraction scan imaging method and histopathologic finding of chief cell hyperplasia. The laboratory findings revealed elevated levels of BUN, creatinine and decreased GFR. Kidney biopsy showed typical calcium deposits in tubules with marked tubulointerstitial infiltration. After subtotal parathyroidectomy, clinical findings improved remarkably.
Case Report ; Child ; Human ; Hypercalcemia/*etiology ; Hyperparathyroidism/*complications/pathology ; Hyperplasia ; Kidney/pathology ; Kidney Diseases/*etiology ; Male ; Parathyroid Glands/pathology

Biopsy, Fine-Needle ; Female ; Humans ; Hypercalcemia ; etiology ; Mediastinal Cyst ; diagnosis ; diagnostic imaging ; pathology ; Middle Aged ; Parathyroid Diseases ; diagnosis ; diagnostic imaging ; pathology ; Ultrasonography

Plasma cell leukemia (PCL) is an aggressive form of multiple myeloma where there is hematogenous spread of abnormal plasma cells into the periphery. This is opposed to multiple myeloma, where the abnormal plasma cells stay in the bone marrow. PCL is more common in males than females, and is also more common in African-Americans than Caucasians. Signs and symptoms of PCL include, but are not limited to, renal insufficiency, hypercalcemia, anemia, lytic bone lesions, thrombocytopenia, hepatomegaly, and splenomegaly. Here, we discussed a case of a 71-year-old Caucasian female recently diagnosed with primary PCL with radiographic features of this disease throughout the body, with an emphasis on the maxillofacial skeleton and relevance from a dental standpoint.
Aged ; Anemia ; Bone Marrow ; Female ; Hepatomegaly ; Humans ; Hypercalcemia ; Leukemia, Plasma Cell* ; Male ; Maxilla* ; Multiple Myeloma ; Pathology ; Plasma Cells* ; Plasma* ; Renal Insufficiency ; Skeleton ; Splenomegaly ; Thrombocytopenia

*Carcinoma, Renal Cell/pathology/surgery ; *Carcinoma, Transitional Cell/pathology/surgery ; Case Report ; Human ; Hypercalcemia/etiology ; Kidney Calculi/complications/surgery ; *Kidney Neoplasms/pathology/surgery ; Kidney Pelvis ; Male ; Middle Age ; *Neoplasms, Multiple Primary/pathology/surgery ; Nephrectomy

OBJECTIVETo study the clinicopathologic features of small cell carcinoma of ovary, hypercalcemic type (SCCOHT) and to evaluate the diagnostic significance of loss of SMARCA4 expression.

METHODSThe clinicopathologic characteristics of 5 cases of SCCOHT were reviewed. The expression of SMARCA4 protein was detected by immunohistochemistry in the cases of SCCOHT and 240 cases of other primary malignant tumors of ovary and peritoneum.

RESULTSThe mean and medium age of these patients was 30 years and 28 years, respectively. The presenting symptoms included abdominal pain, distention and a pelvic mass. Hypercalcemia was found in 3 patients. The maximum diameter of tumors ranged from 13.5 to 22.0 cm. Extraovarian spread was demonstrated in all of the patients on presentation. Histologically, the tumors were composed of closely packed small round cells with scanty cytoplasm, hyperchromatic nuclei and irregular chromatin clumps. The tumor cells grew in sheets, nests, cords or trabecular pattern. Follicle-like spaces were observed in 4 cases. Three of the tumors contained large cells with abundant eosinophilic cytoplasm. Spindle cell morphology was found in 1 case. There were 2 cases with myxoid or hyaline stroma. Four out of five of SCCOHT cases showed loss of SMARCA4 protein while only 6.3% (15/240) of the other primary malignant tumors of ovary and peritoneum , including undifferentiated carcinoma (1/5), high-grade serous carcinoma (4.6%, 5/109), endometrioid carcinoma (7.7%, 2/26), clear cell carcinoma (1/9), mucinous carcinoma (1/5), mixed carcinoma (4.9%, 3/61), carcinosarcoma (1/9) and high-grade serous carcinoma of peritoneum (1/9), were negative.

CONCLUSIONSSCCOHT is a rare malignant tumor and often misdiagnosed as other types of ovarian small cell tumor. Loss expression of SMARCA4 protein is characteristic and facilitates the diagnosis and differential diagnosis of SCCOHT.

Adenocarcinoma, Mucinous ; Adult ; Carcinoma, Small Cell ; genetics ; metabolism ; pathology ; DNA Helicases ; genetics ; metabolism ; Female ; Humans ; Hypercalcemia ; pathology ; Immunohistochemistry ; Neoplasms, Glandular and Epithelial ; genetics ; metabolism ; pathology ; Nuclear Proteins ; genetics ; metabolism ; Ovarian Neoplasms ; genetics ; metabolism ; pathology ; Transcription Factors ; genetics ; metabolism

We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year-old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopathy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed of small, medium and large cells with pleomorphic nuclei. Smears of peripheral blood (PB) showed lymphopenia (16%) with the appearance of a few atypical lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T(H), CD3/CD4+, 57%) and decreased CD8+ T cell counts (T(S), CD3/CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tax of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction. Ultrastructural examination of PBMC confirmed numerous type c virus particles in extracellular space. This case was an acute type of ATLL without overt leukemic features in PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.
Biopsy ; Bone Marrow/pathology ; Case Report ; DNA, Viral/analysis ; Fatal Outcome ; Female ; Flow Cytometry ; Gene Products, env/genetics ; Gene Products, pol/genetics ; Gene Products, tax/genetics ; HTLV-BLV Infections/pathology ; HTLV-I ; Human ; Hypercalcemia/virology ; Hypercalcemia/pathology ; Immunophenotyping ; Korea ; Leukemia, T-Cell/virology ; Leukemia, T-Cell/pathology* ; Leukemia, T-Cell/immunology ; Lymph Nodes/pathology ; Lymphopenia/virology ; Lymphopenia/pathology* ; Lymphopenia/immunology ; Microscopy, Electron ; Middle Age ; Support, Non-U.S. Gov't ; T-Lymphocytes/virology ; T-Lymphocytes/ultrastructure ; T-Lymphocytes/pathology

Paraneoplastic hypercalcemia without bone metastasis occurs rarely in esophageal cancer. A 75-year-old man was admitted for general weakness and lethargy. Laboratory data showed high serum calcium level (corrected calcium 14.6 mg/dL), low parathyroid hormone level (3.3 pg/mL) and high parathyroid hormone-related peptide level (3.5 pmol/L). Esophagogastroscopy showed a malignant tumor in the esophagus. Histology showed moderately differentiated squamous cell carcinoma. Bone scan showed no evidence of bone metastasis. Since the patient's calcium levels remained high and mental state did not show improvement despite intravenous fluid therapy, diuretics and intravenous bisphosphonate, hemodialysis was started. After hemodialysis treatment, the serum calcium level subsequently normalized and his mental status improved. Herein, we report a rare case of paraneoplastic hypercalcemia in a patient with esophageal cancer.
Aged ; Calcium/blood ; Carcinoma, Squamous Cell/*diagnosis/pathology ; Endoscopy, Digestive System ; Esophageal Neoplasms/*diagnosis/pathology ; Humans ; Hypercalcemia/*diagnosis/pathology ; Male ; Parathyroid Hormone-Related Protein/blood ; Renal Dialysis ; Severity of Illness Index ; Tomography, X-Ray Computed

Most of primary hyperparathyroidism results from parathyroid adenoma, and is characterized by hypercalcemia, reduced bone density, frequent renal stone, gastric ulcer, duodenal ulcer, muscle weakness, depression, hypertension, anemia, and rarely brown tumor. We had a case of an 80-year-old man having brown tumor caused by primary hyperparathyroidism on the right 10th rib confirmed by CT guided bone biopsy. The patient presented with decreased level of consciousness, acute gastric ulcer, acute duodenal ulcer, GB stones, renal insufficiency, depression, and osteoporosis. Serum calcium level was 16.7 mg/dL and the intact parathyroid hormone level was 3901pg/mL. A parathyroid mass was detected by neck CT and 99mTc-tetrofosmin parathyroid scan. The parathyroid tumor was removed and confirmed as a parathyroid adenoma by pathology. After operation, the patient was treated with vitamin D and calcium in response to the resulting hungry bone syndrome. The intact PTH level returned to a normal range after the removal of the parathyroid adenoma.
Aged, 80 and over ; Anemia ; Biopsy ; Bone Density ; Calcium ; Consciousness ; Depression ; Duodenal Ulcer ; Humans ; Hypercalcemia* ; Hyperparathyroidism, Primary ; Hypertension ; Muscle Weakness ; Neck ; Osteoporosis ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Pathology ; Reference Values ; Renal Insufficiency ; Ribs ; Stomach Ulcer ; Vitamin D

No abstract available.
Acute Kidney Injury/diagnosis/*etiology/therapy ; Biopsy ; Fluid Therapy ; Glucocorticoids ; Humans ; Hypercalcemia/diagnosis/*etiology/therapy ; Male ; Middle Aged ; Multimodal Imaging ; Positron-Emission Tomography ; Renal Dialysis ; Sarcoidosis/*complications/diagnosis/therapy ; Subcutaneous Tissue/pathology ; Tomography, X-Ray Computed ; Treatment Outcome