PMC8361545_01
Scintigraphy study of planar parathyroid in anterior cervical projection in two phases (with acquisition of an early phase image at 20 "and two late-phase images at 60" and "120") after the administration of 740 MBq of 99mTc-sestamibi in which an overactive focus is observed superimposed on the lower pole of the inferior right parathyroid gland with a slightly slowed lavage compatible with hyperfunctioning parathyroid tissue (a, b). CT coronal view showing proximal tibial metaphysis, the white arrow points to a radiolucent mass (brown tumor) that breaks the cortical of the left tibia (c). The sagittal CT view shows the Brown tumor as an exophytic mass invading soft tissue of the right tibia (d). MRI shows the brown tumor as a lesion with low T1; the white arrow points to a mildly hyperintense patchy area, suggesting intralesional hemorrhage (e).
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Considering that her SHPT was caused by a hyperplasia parathyroid, a parathyroid scintigraphy with 99mTc-sestamibi was performed (Figure 1(a) and (b)). The X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) scans revealed multiple eccentric osteolytic and expansible trabeculated lesions in both tibias and patellae (Figure 1(c):(e)).
CD68 immunostaining was performed (20x), using this marking for giant cells, the tendency to form dense lobes or groups separated by areas with lower density is appreciated from a panoramic point of view (a). In greater detail, oval cells and occasional more elongated cells are observed between the multinucleated cells in the center of the image (H-E., 400x) (b). In p63 immunostaining, nuclear staining is seen in elongated oval cells (400x) (c). In the CD68 immunostaining showed marking of the osteoclastic cells of the accompanying macrophages (400x) (d).
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Histopathological tissue examination revealed the presence of diffusely shaped giant cells (Figure 2(a):(d)).