PMC4746839_01
(a and b) 18F-fluorodeoxyglucose positron emission tomography/computed tomography revealed tracer uptake in a 6 cm x 4 cm mass in the left paratracheal region with an extension to the superior mediastinum. (Standard uptake value 4.3) no other significant uptakes were seen
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F1
An 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) scan was additionally done which confirmed the isolated uptake standard uptake value: 4.3 in the left paratracheal region [Figure 1a and b].
25 mCi of 99mTc-SestaMIBI was given intravenously followed by the acquisition of early and delayed images of the neck and upper thorax and/or mediastinum. The initial early image is obtained at 15 min after the injection, and delayed imaging is obtained at 1, 2 and 4 h after the injection. The scan demonstrated a persistent retention of the SestaMIBI tracer in the left inferior parathyroid gland at 4 h
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F2
The left paratracheal mass lesion was localized to the left inferior parathyroid gland using Tc99m SestaMIBI scintigraphy, which demonstrated a persistent retention of the sestamibi tracer in the left inferior parathyroid gland [Figure 2].
Intraoperative photograph showing the focused neck exploration. (a) The left recurrent laryngeal nerve splayed over the left giant parathyroid adenoma. (b) The left parathyroid adenoma dissected off the nerve and delivered in the neck. (c) Operative bed following the tumor removal. (d) Specimen photograph of the giant parathyroid adenoma
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F3
The patient underwent an uneventful resection of the tumor-bearing left inferior parathyroid gland through a focused trans-cervical approach after carefully safeguarding the left recurrent laryngeal nerve [Figure 3a-d].
(a and b) H and E, x20 section shows tumor cells which are large with moderate eosinophilic granular cytoplasm, fine nuclei and tiny nucleoli, oncocytic type of cell clusters are seen, with areas of hemorrhage, no capsular or vascular invasion are seen, the findings are suggestive of a diagnosis of parathyroid adenoma
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F4
The final histopathology confirmed the diagnosis of a giant parathyroid adenoma [Figure 4] and the patient is on regular follow-up.