Concurrent thyroid carcinoma and parathyroid adenoma is rare, they can and do coexist. We present here a 63-year old man who had bilateral papillary thyroid carcinoma and a parathyroid adenoma in the right thyroid lobe. Thyroid cancer was confirmed surgically. After the operation, the patient was found hypercalcemie and hypophosphatemia along with an elevated parathyroid hormone (PTH), indicating primary hyperparathyroidism. Also, the parathyroid 99mTc-MIBI scan demonstrated parathyroid adenoma in the right lower pole of the thyroid. The abnormal parathyroid tissue was carried out, and then serum calcium and PTH levels decreased to normal ranges.
Calcium ; blood ; Carcinoma ; pathology ; surgery ; Carcinoma, Papillary ; Humans ; Hyperparathyroidism, Primary ; Male ; Middle Aged ; Parathyroid Glands ; pathology ; Parathyroid Hormone ; blood ; Parathyroid Neoplasms ; pathology ; surgery ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; pathology ; surgery

No abstract available.
Aged ; Biological Markers/blood ; Biopsy ; Calcium/blood ; Female ; Humans ; Hyperparathyroidism/blood/diagnosis/*etiology/surgery ; Hyperplasia ; Parathyroid Glands/metabolism/*pathology/radionuclide imaging/surgery/ultrasonography ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/blood/*complications/diagnosis/surgery ; Parathyroidectomy ; Treatment Outcome ; Up-Regulation

We report a rare case of distant subcutaneous parathyroid carcinoma recurrence. A 50-year-old woman was referred to our hospital because of sustained hypercalcemia despite surgical removal of a parathyroid carcinoma. A focal uptake in the upper mediastinal area was detected in a 99mTc-sestamibi scan, and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) imaging demonstrated a subcutaneous mass. She underwent tumor resection, and the pathological findings were consistent with a parathyroid carcinoma. The postoperative serum parathyroid hormone (PTH) level remained within normal limits. However, a new palpable solitary mass was identified in the upper portion of the left breast 1 year postoperatively. Both a 99mTc-sestamibi scan and 18F-FDG PET/CT imaging revealed an abnormal lesion in the upper breast, and subsequent pathology reports confirmed parathyroid carcinoma metastasis. Serum PTH and calcium levels fell within normal ranges after tumor resection. Two subcutaneous recurrent lesions appeared likely due to tumor seeding during the previous endoscopic operation at a local hospital.
Biological Markers/blood ; Breast Neoplasms/blood/radiography/*radionuclide imaging/*secondary/surgery ; Carcinoma/blood/radiography/*radionuclide imaging/*secondary/surgery ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Middle Aged ; Multimodal Imaging ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/blood/*pathology/surgery ; *Positron-Emission Tomography ; Predictive Value of Tests ; Radiopharmaceuticals/*diagnostic use ; Technetium Tc 99m Sestamibi/*diagnostic use ; Time Factors ; *Tomography, X-Ray Computed ; Treatment Outcome

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.
Calcium ; blood ; Female ; Humans ; Hypercalcemia ; etiology ; Hyperparathyroidism ; diagnosis ; Hypocalcemia ; drug therapy ; etiology ; Mediastinal Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Middle Aged ; Parathyroid Glands ; pathology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Postoperative Complications ; Technetium Tc 99m Sestamibi ; pharmacology ; Tomography, X-Ray Computed ; Ultrasonography