PMC9193965_01
Computed tomography (CT) scan and 99m-Technetium sestamibi scanning of the patient. (A) Transverse view of the CT scanning showed a mixed density mass with uneven enhancement in the posterior mediastinum. The maximum cross-section size was about 3.3x1.9 cm.; (B) Coronal view of the CT scanning; (C) Sagittal view of the CT scanning; (D). Three-dimensional reconstruction in sagittal view of the CT scanning; (E) The 15th minute static imaging: the left thyroid lobe was more prominent, whereas the uptake of imaging agent in the right thyroid lobe was decreased; In addition, localized abnormal uptake of imaging agent under the right thyroid lobe was found (as shown by the red arrow). (F) The two-hour delayed imaging: the uptake of thyroid imaging was lower than that before, the abnormal imaging agent concentration under the right thyroid lobe was clearly displayed (as shown by the red arrow).
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F1
Computed tomography scan showed posterior superior mediastinal was occupied with a cystic solid tumor whose maximum cross-section size was about 3.3 x 1.9 cm (Figure 1A-1D). The patient underwent 99mTechnetium sestamibi scanning, indicating a mass with increased uptake of imaging agent in the posterior mediastinum (Figure 1E-1F).
Histology and immunohistochemistry of parathyroid adenoma. (A). Hematoxylin and eosin staining. (B) Positivity for parathyroid hormone. (C) About 2% of positivity for Ki-67 staining. (D) Negativity for thyroid transcription factor 1 (TTF-1). Magnification x200.
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F2
Postoperative pathology confirmed parathyroid adenoma (Figure 2).
The PTH, serum calcium, and Vitamin D level changed perioperatively. Grey area was the normal range PTH (15-65 pg/mL), serum calcium (2.00-2.60 mmol/L), and Vitamin D level (>=30 ng/mL) defined at our center. The PTH level decreased immediately after the operation but went up at the early follow-up (A), while the postoperative blood calcium level was lower than the upper limit of normal value (B). After vitamin D levels were normalized with vitamin D supplementation (C), the PTH level went back to normal level at the one year of follow-up. Pre-Mon 1: one month prior to surgery. Post-Day 1: one day after surgery. Post-Mon 1.5, Post-Mon 4, and Post-Mon 12: 1.5, 4, and 12 months after surgery.
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F3
One year after the operation, serum PTH, calcium, and vitamin D levels returned to normal (Figure 3).
The timeline of clinical interventions of this patient.
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F4