PMC4921183_01
39-year-old female with parathyroid carcinoma. Chest radiograph.
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A chest radiograph (Fig. 1) showed an opacity at the base of the neck, displacing the trachea to the left.
39-year-old female with parathyroid carcinoma. Neck sonogram.
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Neck ultrasound (Fig. 2) revealed a 4.3-cm, complex, predominantly cystic mass below the right thyroid lobe with echogenic, hypervascular internal projections (Fig. 2, A and B). A second, circumscribed isoechoic nodule was also seen within the adjacent right thyroid lobe (Fig. 2C, arrow).
39-year-old female with parathyroid carcinoma. Dual-tracer nuclear parathyroid scan. A. Anterior pertechnetate image. B. Anterior sestamibi image. C. Anterior sestamibi image (pertechnetate subtracted).
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Dual-tracer nuclear parathyroid imaging (Fig. 3) was then performed. The anterior pinhole Technetium-99m-Pertechnetate (72MBq/1.9mCi) image (Fig. 3A) showed focal tracer uptake within the right thyroid lobe, corresponding to the circumscribed thyroid nodule identified on ultrasound. The anterior pinhole technetium-99m-sestamibi (802MBq/21.7mCi) image (Fig. 3B) (injected with the patient lying on the camera bed in the same position as for the thyroid scan) showed focally avid concordant uptake corresponding to the right thyroid lesion. This uptake was confirmed on a pertechnetate-subtracted sestamibi image (Fig. 3C, arrow) and was found to localize to the solid components of the complex cystic neck mass on coregistered single photon emission computed tomography/computed tomography (SPECT/CT) (Fig. 4).
39-year-old female with parathyroid carcinoma. (A) Macrocopic parathyroid specimen and (B) histopathology (haematoxylin and eosin, x100) (arrow).
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Gross pathology (Fig. 5A) revealed a 43x30-mm circumscribed mass with a smooth gray external surface. Specimen histology (Fig. 5B) confirmed a parathyroid neoplasm with a hyaline fibrous capsule, showing minimally pleomorphic cells. The foci of vascular (Fig. 5B, arrow) and capsular invasion were identified, consistent with parathyroid carcinoma.