The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 5 1635-1636
Copyright © 2006 by The Endocrine Society
Giant Mediastinal Cystic Parathyroid Adenoma
Makoto Kammori,
Takeshi Fukami,
Toshihisa Ogawa,
Ei-ichi Tsuji,
Kaiyo Takubo,
Jun Nakajima and
Michio Kaminishi
Division of Metabolic Care Unit and Endocrine Surgery (M.Kamm., T.O., E.-i.T., M.Kami.), Department of Surgery, and Division of Thoracic Surgery (T.F., J.N.), Department of Cardiothoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; and Tissue Research Group (K.T.), Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
Address all correspondence and requests for reprints to: Makoto Kammori, Division of Metabolic Care Unit and Endocrine Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. E-mail: kanmori-dis{at}umin.ac.jp.
A 59-yr-old man presented with episodes of increasingly severe left arm bone pain due to "brown tumor." Ten years previously, a right chest mass had been detected by chest radiography. Since that time, the patient had noticed progressive fatigue and arm muscle weakness. Physical examination showed no abnormality. Posteroanterior chest radiography showed a mass in the right hilar region. Computed tomography of the chest showed a large anterior mediastinal cystic mass with a hypodense area extending into the right hemithorax (Fig. 1A
). A [99mTc] sestamibi parathyroid scan of the neck and thorax showed uptake of tracer in what appeared to be a giant parathyroid tumor (Fig. 1B). Biochemical investigations confirmed that the patient was euthyroid, but significant hypercalcemia (11.4 mg/dl) was evident, with an elevated intact PTH level of 420 pg/ml. Bone density was also found to be reduced (0.913 g/cm2 by body mass index, –2.3 by T-score, and –1.5 by Z-score) (1, 2, 3, 4, 5). Therefore, we performed a unilateral neck and posterolateral thoracotomy exploration, which revealed a giant 12 x 7 x 1.7-cm right-sided cystic-type parathyroid adenoma weighing 116 g (Fig. 2, A and B), which was subsequently resected. The tumor was confirmed histopathologically to be of parathyroid origin with multiple bunched cysts (Fig. 2C). Two months after surgery, the patient was free of clinical symptoms and was normocalcemic with a normal intact PTH level. After 10 months of follow-up, the patient remains disease free. To our knowledge, this giant cystic-type parathyroid adenoma is the largest to have been reported.
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FIG. 1. A, Computed tomogram of the chest showing a 12 x 6.5 x 5.5-cm anterior mediastinal cystic mass with a hypodense area. B, Scintigraphic images demonstrating clearly more focal, washout-delay uptake in the right parathyroid (arrows) compared with low-grade uptake in the bilateral thyroid. Cervical images 120 min after iv injection of [99mTc] sestamibi.
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FIG. 2. A, The resected giant 12 x 7 x 1.7-cm right-sided cystic-type parathyroid adenoma weighing 116 g with mediastinal lymph nodes. B, Several cysts, hematoma, and adenoma (arrows) are observed in a cut section. C, Parathyroid adenoma (A) is seen adjacent to the cyst wall (C). D, Small islands of parathyroid tissue are evident in the fibrocystic wall.
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Received January 19, 2006.
Accepted February 17, 2006.
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References
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- Kuzucu A, Soysal O, Savli H 2002 Giant mediastinal parathyroid adenoma presenting with a hyperparathyroid crisis and leading to postoperative hungry bone syndrome. Eur J Surg 168:747–749[Medline]
- Bergenfelz A, Valdemarsson S, Ahren B 1994 Functional recovery of the parathyroid glands after surgery for primary hyperparathyroidism. Surgery 116:827–836[Medline]
- Power C, Kavanagh D, Hill ADK, O’Higgins N, McDermott E 2005 Unusual presentation of a giant parathyroid adenoma: report of a case. Surg Today 35:235–237[Medline]
- Rao DS, Honasoge M, Divine GW, Phillips ER, Lee MW, Ansari MR, Talpos GB, Parfitt AM 2000 Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab 85:1054–1063[Abstract/Free Full Text]
- Hedback G, Oden A, Tisell LE 1995 Parathyroid adenoma weight and the risk of death after treatment for primary hyperthyroidism. Surgery 117:134–139[CrossRef][Medline]
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