J Endocr Surg.  2018 Dec;18(4):236-239. 10.16956/jes.2018.18.4.236.

Hyperplastic Autotransplanted Parathyroid Tissue Migrating into Fatty Tumor after Total Parathyroidectomy

• Reza JA
• Wiese GK
• Portoghese JD

• KMID: 2429811
• DOI: http://doi.org/10.16956/jes.2018.18.4.236

Abstract

Secondary hyperparathyroidism (SHPTH) occurs commonly in patients with end-stage renal disease (ESRD). Uncontrolled SHPTH is associated with complications of calcium deposition including calciphylaxis and elevated rates of cardiovascular morbidity. Current treatment recommendations for medically refractory disease include total parathyroidectomy, often with autotransplantation (TPTH+AT) of minced parathyroid gland. Surgical intervention is associated with a reduction in cardiovascular mortality. We report a case of a 56-year-old man with ESRD who developed SHPTH and underwent TPTH+AT of parathyroid tissue into the right brachioradialis muscle. Over the course of 7 years he developed a mass at the site of the autotransplanted gland as well as recurrent refractory hyperparathyroidism with increased forearm uptake noted on sestamibi scan. After excision of this mass, pathology demonstrated hyperplasia of the minced gland fragments which were embedded within a mass of fibroadipose tissue rather than the muscle tissue it was originally transplanted in.

Keyword

Secondary hyperparathyroidism; Autologous Transplantation; Parathyroid Neoplasms

MeSH Terms

Autografts
Calciphylaxis
Calcium
Forearm
Humans
Hyperparathyroidism
Hyperparathyroidism, Secondary
Hyperplasia
Kidney Failure, Chronic
Lipoma*
Middle Aged
Mortality
Parathyroid Glands
Parathyroid Neoplasms
Parathyroidectomy*
Pathology
Transplantation, Autologous
Calcium

Figure

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  Fig. 1 Sestamibi scan with increased uptake of the transplanted glandular tissue in the right forearm.

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  Fig. 2 Auto-transplanted parathyroid tissue mass resected from right forearm.

Reference

1. Hedgeman E, Lipworth L, Lowe K, Saran R, Do T, Fryzek J. International burden of chronic kidney disease and secondary hyperparathyroidism: a systematic review of the literature and available data. Int J Nephrol. 2015; 2015:184321.

2. Liu ME, Qiu NC, Zha SL, Du ZP, Wang YF, Wang Q, et al. To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for secondary hyperparathyroidism in chronic renal failure: a systematic review and meta-analysis. Int J Surg. 2017; 44:353–362.

3. Anderson K Jr, Ruel E, Adam MA, Thomas S, Youngwirth L, Stang MT, et al. Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes. Am J Surg. 2017; 214:914–919.

4. Li JG, Xiao ZS, Hu XJ, Li Y, Zhang X, Zhang SZ, et al. Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients. Medicine (Baltimore). 2017; 96:e9050.

5. Tominaga Y, Matsuoka S, Uno N, Tsuzuki T, Hiramitsu T, Goto N, et al. Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients. World J Surg. 2010; 34:1312–1317.