PMC9872260_01
(a) shows diffuse facial swelling over the left cheek. (b) shows swelling of the left side of the palate(arrow)
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F1
A 29-year-old female came to the ENT department with complaints of swelling over her left cheek for the past 6 months (figure 1a) which was insidious in onset, progressively increasing in size, and associated with intermittent pain. On intraoral examination- there was a soft tissue swelling involving the left half of the hard palate and extending up to the soft palate (Figure 1b).
(a) Computed Tomography scan (axial section) showing left maxillary sinus mass(arrow) (b,c) CT Coronal and sagittal section with the extension of mass into palate(arrow) (d) 3D bony reconstruction of left maxilla revealing the mass (e) Computed tomography of neck demonstrating enlarged parathyroid mass
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F2
Contrast Enhanced Computed Tomographic (CECT) Scan of the Nose and Para Nasal Sinus (PNS) with 3D reconstruction (figure 2a,b,c,d) was done which revealed an osteolytic, expansile mass of approximately 6.4x5.3x7.3cm in left maxillary sinus eroding the maxillary sinus walls compressing the neighboring structures without any obvious invasion into them. The patient was then posted for a CECT scan of the neck which revealed an ovoid lesion in the right trachea-oesophageal groove along the posteroinferior aspect of the right thyroid lobe likely a parathyroid lesion (figure 2e).
(a) Parathyroid mass identified at the inferior pole of the thyroid. (b) excised parathyroid specimen. (c) Histopathology showing chief cell hyperplasia suggesting parathyroid adenoma
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F3
Intra-operatively, an enlarged right inferior parathyroid gland (figure 3a) was encountered. It was carefully separated from the thyroid gland and removed in toto. (figure 3b) Intraoperative intact parathyroid hormone level was assessed within 10 minutes post excision which dropped significantly from 297.7 pg/mL (preoperatively) to 9.7 pg/mL (reference range 15-65 pg/mL). Diagnosis of a parathyroid adenoma was concluded on histopathological examination (figure 3c).
(a) Post-operative D7 (b) On 11 months follow-up visit with decreased palatal mass and decreased facial swelling
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F4
Post-excision there was a significant reduction in the size of Brown's tumor thus providing symptomatic relief to the patient (figure 4a,b).