Korean J Bone Metab.  2012 May;19(1):59-65. 10.11005/kjbm.2012.19.1.59.

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

• Lee JH
• Koo JW
• Chin SO
• Rhee SY
• Choi MC
• Chon S
• Oh S
• Woo JT
• Kim SW
• Kim JW
• Kim YS

• KMID: 1464237
• DOI: http://doi.org/10.11005/kjbm.2012.19.1.59

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.

Keyword

Hypercalcemia; Osteoporosis; Parathyroid cancer; Primary hyperparathyroidism

MeSH Terms

Adenoma
Bone Diseases, Metabolic
Female
Humans
Hypercalcemia
Hyperparathyroidism
Hyperparathyroidism, Primary
Hypophosphatemia
Incidence
Middle Aged
Osteoporosis
Parathyroid Neoplasms

Figure

• 

  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)

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  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.

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  Fig. 3 Parathyroid scan with 99mTc-sestamibi scan shows irregular parathyroid mass below right thyroid gland with high uptake after two hours delayed image. (ANT, adenine nucleotide translocator)

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  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.

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  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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