PMC7656022_01
(a) CT of maxillary sinus showing the left maxillary sinus mass. (b) CT thoracic spine is showing mass lesion in the upper thoracic area.
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F1
For 2 months, a 37-year-old male demonstrated a slow-growing lesion involving the dendro-alveolar segment of the left upper maxilla (rounded mass of 4 x 4 cm, nonulcerated with normal oral mucosa) [Figure 1].
(a) MRI thoracic spine T2 sagittal on the left and T1 sagittal on the right. (b) MRI thoracic spine T2 sagittal on the left and T1 sagittal on the right (view more lateral to the left side). (c) MRI thoracic spine T2 sagittal and axial. (d) MRI thoracic spine T1 sagittal pre and post gadolinium-based contrast. (e) MRI thoracic spine T1 with contrast sagittal and axial. (f) MRI spine with contrast T1 with contrast lumbar spine sagittal on the left side and T1 with contrast sagittal cervical spine on the right side.
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F2
There was also an accompanying dorsal thoracic scoliotic deformity convex to the right side [Figure 2].
(a-d) Excisional biopsy shows cellular lesion composed of plump and spindle-shaped cells admixed with numerous multinucleated osteoclast-like giant cells with areas of hemorrhage and hemosiderin-laden macrophages. It was highly suggestive of brown tumor taking in consideration multiple bone involvement.
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F3
The soft and highly vascular T4-T5 tumor clearly compressed the thoracic cord, and infiltrated the para spinal ribs/muscle; tumor was readily debulked. The histopathology confirmed a brown tumor attributed to primary hyperparathyroidism [Figure 3].
(a) Thyroid ultrasound, right lobe of thyroid shows a small solid nodule measuring 4 x 5 mm noted at the lower aspect of the right lobe. Isthmus measures 2.5 mm. (b) Thyroid ultrasound, left lobe of thyroid at the region of the left parathyroid enlarged lobulated hypoechoic area noted measuring 34 x 13 mm with extremely increased vascularity, most likely representing a parathyroid adenoma.
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F4
The patient subsequently required excision of the left upper parathyroid gland, following which calcium levels normalized [Figures 4-6].
NM parathyroid MIBI: Planar images of the neck in anterior projection were obtained 20 min and 2 h after IV administration of the radiotracer demonstrated, large persistent focal activity at the upper pole of the left thyroid lobe. No evidence of ectopic abnormal uptake.
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F5
The patient subsequently required excision of the left upper parathyroid gland, following which calcium levels normalized [Figures 4-6].
X-ray hand shows multiple osteolytic lesions.
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F6
The patient subsequently required excision of the left upper parathyroid gland, following which calcium levels normalized [Figures 4-6].