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CLINICAL IMAGES
Year : 2013  |  Volume : 138  |  Issue : 1  |  Page : 150-151

Unusual localization of parathyroid carcinoma in anterior chest wall


1 Department of Endocrinology and Metabolism, Fortis Hospitals, Bannerghatta Road, (Opp IIM-B), Bangalore 560 076, India
2 Department of Nuclear Medicine, Health Care Global Hospitals, Bangalore 560 076, India

Date of Web Publication6-Aug-2013

Correspondence Address:
C V Harinarayan
Department of Endocrinology and Metabolism, Fortis Hospitals, Bannerghatta Road, (Opp IIM-B), Bangalore 560 076
India
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Source of Support: None, Conflict of Interest: None


PMID: 24056572

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How to cite this article:
Harinarayan C V, Prashant G R. Unusual localization of parathyroid carcinoma in anterior chest wall. Indian J Med Res 2013;138:150-1

How to cite this URL:
Harinarayan C V, Prashant G R. Unusual localization of parathyroid carcinoma in anterior chest wall. Indian J Med Res [serial online] 2013 [cited 2020 Jun 5];138:150-1. Available from: http://www.ijmr.org.in/text.asp?2013/138/1/150/116210

A 36-year old male presented to Endocrinology OPD, Fortis Hospitals, Bangalore, India, with low serum 25-hydroxy vitamin D levels, normal calcium and parathyroid hormone (PTH) levels [Figure 1] a year after endoscopic excision of left inferior parathyroid adenoma. With calcium and vitamin D supplementation he developed hypercalcaemia. After stopping supplementation, he presented with hypercalcaemia and high PTH levels. Routine nuclear scanning (MIBI scan) did not reveal any increased uptake in the region of neck or ectopic sites for parathyroid gland. Ga68 DOTANOC whole body PETCT scan revealed two well defined lesions in the right upper anterior chest wall [Figure 2] a, b. Histology confirmed it to be parathyroid carcinoma [Figure 3]. Post-operatively serum biochemistry was normalized. The unusual location of parathyroid gland is probably due to migration of right parathyroid gland down to the anterior chest wall during previous endoscopic surgery which has gone for migtogenic change [1] . Clinical presentation of adenoma on one side and later occurrence of carcinoma on the other gland is rare [2] .
Figure 1: Graphical representation of serum calcium (normal 8.5 to 10.5 mg/dl); 25(OH) vitamin D (normal >32 ng/ml) and intact parathyroid hormone (normal 32 to 75 pg/ml) in the patient from the time of presentation till post-operative period.

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Figure 2: a. Ga68 Dotanocwhole body PETCT scan. Two well defined smoothly marginated slightly lobulated soft tissue lesions in the right upper anterior chest wall just above the level of jugular notch to the right of midline which are Ga68 Dotanocavid (arrow).
Figure 2: b: Fused PET CT image. There are two well defined smoothly marginated slightly lobulated soft tissue dense lesions measuring 1.6 x 1.5 cm and 1.2 x 1.2 cm in the right upper anterior chest wall just above the level of jugular notch (arrows).


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Figure 3: Histology of the excised lesion (x10 and x40) (weight 5 g) showing cells arranged in trabeculae and nests separated by fibrovascular septae. The cells show moderate to abundant granular cytoplasm, large vesicular nuclei and prominent nucleoli with little mitosis and no necrosis (arrows).

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   Acknowledgment Top


The authors acknowledge Dr M.G. Bhat, Minimal access surgeon and Drs Shantha Krishnamurthy and Kshithija Kulkarni for their kind support in this case.

 
   References Top

1.Goldfarb M, O'Neal P, Shih JL, Hartzband P, Connolly J, Hasselgren PO. Synchronous parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma in a patient with severe and long-standing hyperparathyroidism. Endocr Pract 2009; 15 : 463-8.  Back to cited text no. 1
[PUBMED]    
2.Shapiro DM, Recant W, Hemmati M, Mazzone T, Evans RH. Synchronous occurrence of parathyroid carcinoma and adenoma in an elderly woman. Surgery 1989; 106 : 929-33.  Back to cited text no. 2
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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