PMC10435972_01
(A) Multiple low-density shadows and hypermetabolism in multiple parts of the pelvis with no significant imaging in the parathyroid gland on PET/CT examination. (B) Nuclear cells on bone marrow smear: Focal or fused distribution with deep staining of cytoplasm and nucleus (x1,000, Wright-Giemsa). (C) Thick collagen fiber capsule of the lesion (x100, hematoxylin-eosin), focal distribution of water-like transparent cells, with few stroma (x400, hematoxylin-eosin stain).
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Positron emission tomography-computed tomography (PET-CT) also showed elevated metabolism in the pelvis, suspected hematological neoplasms, and bone marrow metastatic carcinoma ( Figure 1A ). Many abnormal cells that were difficult to distinguish from multiple myeloma and metastatic carcinoma were found in the bone marrow smear ( Figure 1B ). Histopathological examination confirmed the diagnosis of parathyroid adenoma ( Figure 1C ).
A large homogeneous mass (4.1 x 2.6 cm) with distinguishable boundaries in the lower pole of the left thyroid gland (A), a hypoechoic nodule (0.4 x 0.2 cm) with unclear boundaries in the middle of the right thyroid gland (B).
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Doppler color ultrasound showed a thyroid mass (left, 4.1 x 2.6 cm) ( Figure 2A ) and suspected parathyroid adenoma, thyroid, and isthmus nodular goiter (right, 0.4 x 0.2 cm) ( Figure 2B ).
Dynamic monitoring of PTH (A) and serum calcium and phosphorus (B) levels preoperatively and postoperatively.
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The patient recovered well postoperatively, serum calcium (2.67 mmol/L), serum phosphorus (0.64 mmol/L) and PTH (4.49 pg/L) also significantly decreased on second day after surgery ( Figure 3 ).