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Primary hyperparathyroidism due to atypical vertically long cystic adenoma.
Kawashima, Sachiko-Tsukamoto; Usui, Takeshi; Ueda, Yohei; Kobayashi, Maiko-Kakita; Tsuiki, Mika; Tanase-Nakao, Kanako; Nanba, Kazutaka; Tagami, Tetsuya; Naruse, Mitsuhide; Watanabe, Yoshiki; Asato, Ryo; Kato, Sumiko; Shimatsu, Akira.
Afiliação
  • Kawashima ST; Department of Endocrinology and Metabolism , National Hospital Organization Kyoto Medical Center , Kyoto , Japan ; Department of Diabetes , Endocrinology and Metabolism, Tango Central Hospital , Kyoto , Japan.
  • Usui T; Clinical Research Institute , National Hospital Organization Kyoto Medical Center , 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 , Japan.
  • Ueda Y; Department of Endocrinology and Metabolism , National Hospital Organization Kyoto Medical Center , Kyoto , Japan.
  • Kobayashi MK; Department of Endocrinology and Metabolism , National Hospital Organization Kyoto Medical Center , Kyoto , Japan.
  • Tsuiki M; Department of Endocrinology and Metabolism , National Hospital Organization Kyoto Medical Center , Kyoto , Japan.
  • Tanase-Nakao K; Department of Endocrinology and Metabolism , National Hospital Organization Kyoto Medical Center , Kyoto , Japan.
  • Nanba K; Department of Endocrinology and Metabolism , National Hospital Organization Kyoto Medical Center , Kyoto , Japan.
  • Tagami T; Department of Endocrinology and Metabolism , National Hospital Organization Kyoto Medical Center , Kyoto , Japan.
  • Naruse M; Clinical Research Institute , National Hospital Organization Kyoto Medical Center , 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 , Japan.
  • Watanabe Y; Department of Head and Neck Surgery , National Hospital Organization Kyoto Medical Center , 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 , Japan.
  • Asato R; Department of Head and Neck Surgery , National Hospital Organization Kyoto Medical Center , 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 , Japan.
  • Kato S; Osaka Saiseikai Ibaraki Hospital , Osaka , Japan.
  • Shimatsu A; Clinical Research Institute , National Hospital Organization Kyoto Medical Center , 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 , Japan.
Article em En | MEDLINE | ID: mdl-25379182
UNLABELLED: Parathyroid cystic adenomas are often misdiagnosed as thyroid cysts and routine preoperative diagnostic tools, such as ultrasonography (US) or 99m technetium-sestamibi (99mTc-MIBI) scans, cannot clearly distinguish between these entities. We present a 67-year-old hypercalcemic woman with a cervical cystic lesion who had negative sestamibi scan results. Her laboratory data indicated primary hyperparathyroidism (serum calcium concentration 14.0 mg/dl, phosphate concentration 2.3 mg/dl, and intact parathyroid hormone (PTH) concentration 239 pg/ml). The cervical US and computed tomography scans revealed a large and vertically long cystic mass (12×11×54 mm). A mass was located from the upper end of the left thyroid lobe to the submandibular region and was not clearly distinguishable from the thyroid. For preoperative definitive diagnosis, we carried out a parathyroid fine-needle aspiration (FNA) and PTH assay (PTH-FNA) of liquid aspirated from the cyst. The intact PTH-FNA concentration was 1.28×10(6) pg/ml, and the patient was diagnosed with primary hyperparathyroidism due to a cystic mass. She underwent a left upper parathyroidectomy and her serum calcium and intact PTH concentration immediately decreased to normal levels. This report describes the usefulness of PTH-FNA for localizing and differentiating an atypical functional parathyroid lesion from nonfunctional tissue in primary hyperparathyroidism. LEARNING POINTS: Cystic parathyroid lesions, even in the case of elevated PTH levels, can produce negative results in 99mTc-MIBI scans.Preoperative diagnosis of parathyroid cysts detectable on US is possible by parathyroid FNA and PTH assay (PTH-FNA) of liquid aspirated from the cyst, if malignancy is not suspected. PTH-FNA could be helpful in the differential diagnosis of an equivocal cervical tumor.

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2014 Tipo de documento: Article