PMC9668461_01
Radionuclide parathyroid scintigraphy with 99mTc-sestamibi scan demonstrates focal abnormal persistent uptake inferior to the right thyroid lobe and extending into the mediastinum (arrow).
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Radionuclide parathyroid study with 99mTc-sestamibi scintigraphy scan was done at another facility after discharge, and it demonstrated focal abnormal persistent uptake inferior to the right thyroid lobe and extending into the mediastinum, correlating to the site of the previously diagnosed right paratracheal mass lesion (Figure 1).
(a) Gross pathological appearance of giant parathyroid adenoma, which weighed 42 grams, featuring intact capsule, cystic areas, and foci of congestion. Bar represents 1 cm. (b) Cut section of the giant parathyroid adenoma featuring tan surface, areas of congestion or hemorrhage, and multiple cystic spaces that were filled with clear fluid. Bar represents 1 cm.
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It weighed 42 grams and measured 6.2 x 4.7 x 2.3 centimeters (Figure 2(a)). On cut section, it showed a rubbery light tan brown surface with areas of hemorrhage, and formation of multiple small cysts ranging from 2-11 millimeters in size (Figure 2(b)).
(a) Photomicrograph featuring thin fibrous capsule (arrows) and clusters and nests of chief epithelial cells with clear cytoplasm and rounded monotonous nuclei. The stroma shows vascularized connective tissue (H&E X 40). (b) Photomicrograph featuring tumor nests within fibrotic stroma (double headed arrows) with adjacent cystic areas (asterisk) surrounded by clusters of tumor cells. The cysts are filled with granular secretions. No necrotic tissue is present (H&E X 40). (c) Histological section of parathyroid adenoma featuring clusters and nests of benign epithelial cells with uniform rounded nuclei and water clear cytoplasm. The stroma contains few fat cells (arrows) (H&E X 200). (d) Histological section of parathyroid adenoma featuring clusters and nests of benign epithelial chief cells (arrows) with uniform rounded nuclei and water clear cytoplasm (H&E X 400).
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Many cystic spaces of variable sizes are noted, some contained eosinophilic material and others were empty; all were surrounded by sheets or clusters of clear cells (Figures 3(a)-(d)).