Cancer of an ectopic parathyroid gland: from diagnosis to treatment (clinical case)

Cover Page

Cite item

Full Text

Abstract

The article presents a clinical case of a prolonged course of gastrointestinal ulcer disease, followed by dysphagia. During the examination, severe hyperparathyroidism was revealed, which subsequently prompted a diagnostic search for a parathyroid adenoma, which is the cause of hyperathyroidism in 80–85% of cases. With instrumental methods of research, the cause of the main complaint is dysphagia, a formation in the posterior upper mediastinum up to 5 cm, compressing the esophagus. With transoesophageal aspiration biopsy (EUS-TYPE). The cytological picture is similar to the thyroid epithelium with part of the oncocytic differentiation. In an immunological study, lavage for parathyroid hormone showed high expression. Scintigraphy with Tc-99m pertechnetate revealed the exact topic of the formation of the parathyroid gland in the posterior mediastinum – an atypical location. Surgical treatment was performed in the amount of thoracoscopic removal of the mediastinal tumor. The radical nature of the surgical intervention was confirmed by laboratory. Serum PTH levels decreased significantly. Upon receipt of the morphological conclusion, reliable data on malignant damage to the parathyroid gland were obtained. Subsequent treatment of the patient consisted in the correction of severe hypercalcemia in the postoperative period by prescribing denosumab, which led to the stabilization of the patient’s condition.

About the authors

Arif K. Allakhverdiev

Moscow Clinical Scientific and Practical Center; Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: a.allakhverdiev@mknc.ru
ORCID iD: 0000-0001-8378-2738

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Nataliya A. Malkina

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru
ORCID iD: 0000-0001-6090-7809

Cand. Sci. (Med.)

Russian Federation, Moscow

Karina K. Noskova

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru
ORCID iD: 0000-0001-5734-0995

Cand. Sci. (Med.)

Russian Federation, Moscow

Vyacheslav N. Grinevich

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru
ORCID iD: 0000-0003-1908-2256

D. Sci. (Med.)

Russian Federation, Moscow

Ilia Yu. Feidorov

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru
ORCID iD: 0000-0001-8369-5116

oncologist

Russian Federation, Moscow

Astanda F. Ketsba

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru

doctor

Russian Federation, Moscow

Elena V. Bystrovskay

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru

D. Sci. (Med.)

Russian Federation, Moscow

Yuliya V. Embutniex

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru

D. Sci. (Med.)

Russian Federation, Moscow

Mariya V. Putova

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru

biologist

Russian Federation, Moscow

Daria A. Synkova

Moscow Clinical Scientific and Practical Center

Email: a.allakhverdiev@mknc.ru

pathologist

Russian Federation, Moscow

References

  1. Дедов И.И., Мельниченко Г.А., Мокрышева Н.Г. и др. Первичный гиперпаратиреоз: клиника, диагностика, дифференциальная диагностика, методы лечения. Проблемы эндокринологии. 2016; 62 (6): 40–77. [Dedov I.I., Melnichenko G.A., Mokrysheva N.G. et al. Primary hyperparathyroidism: the clinical picture, diagnostics, differential diagnostics, and methods of treatment. Problems of endocrinology. 2016; 62 (6): 40–77 (in Russian).]
  2. Бельцевич Д.Г., Воскобойников В.В., Клычева Г.М. и др. Роль прицельной тонкоигольной аспирационной биопсии со смывом на паратгормон в топической диагностике интратиреоидных парааденом при первичном гиперпаратиреозе. Остеопороз и остеопатии. 2017; 20 (3): 108–13. [Beltsevich D.G., Voskoboynikov V.V., Klycheva C.M. et al. Role of parathyroid hormone measurement in fine-needle aspiration biopsy washout in diagnosis and treatment of primary hyperparathyroidism. Osteoporosis and Bone Diseases. 2017; 20 (3): 108–13 (in Russian).]
  3. Михайличенко В.Ю., Каракурсаков Н.Э., Мирошник К.А. Остеобластокластома как клиническая маска первичного гиперпаратиреоза. Злокачественные опухоли. 2017; 7 (1): 26–29. doi: 10.18027/2224-5057-2017-1-26-29 [Mykhaylichenko V.Y., Karakursakov N.E., Miroshnik K.A. Osteoblastoclastoma – a clinical mask of primary hyperparathyroidism. Malignant tumours. 2017; 7 (1): 26–9 (In Russ.)]. doi: 10.18027/2224-5057-2017-1-26-29
  4. Usmani S, Oteifa M, Abu Huda F et al. Ectopic intrathymic parathyroid adenoma demonstrated on Tc-99m Sestamibi SPECT-CT. Gulf J Oncolog 2016; 1 (21): 61–3.
  5. Van Heerden JA, Weiland LH, ReMine WH et al. Cancer of the parathyroid glands. Arch Surg 1979; 114 (4): 475–80.
  6. Achour I, Charfi S, Chaabouni MA et al. Parathyromatosis: An uncommon cause of recurrent hyperparathyroidism. Rev Med Interne 2017; 38 (1): 61–4.
  7. Taillefer R, Boucher Y, Potvin C et al. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med 1992; 33 (10): 1801–7.
  8. Jacob S. Human Anatomy: A Clinically-Orientated Approach. Edinburgh: Elsevier, 2008; p. 181–227.
  9. Chen AJ, Wang TT, Bo SJ et al. Clinical value of intraoperative parathyroid hormone determination in secondary hyperparathyroidism operation. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33 (12): 1168–72 (in Chinese). doi: 10.13201/j.issn.1001-1781.2019.12.013

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. The result of gastrointestinal x-rays using barium suspension.

Download (176KB)
Indexing metadata
3. Fig. 2. The results of endoscopy procedure.

Download (247KB)
Indexing metadata
4. Fig. 3. The result of contrast-enhancement CT.

Download (439KB)
Indexing metadata
5. Fig. 4. Endosonographic picture of the complex cystic-solid mass of the upper mediastinum.

Download (308KB)
Indexing metadata
6. Fig. 5. Cytological picture of the needle biopsy.

Download (265KB)
Indexing metadata
7. Fig. 6. The result of scintigraphy with 99mTc-pertechnetate.

Download (652KB)
Indexing metadata
8. Fig. 7. Intraoperative picture: a – the vagus nerve, b – the defect of the muscular layer of the esophagus, c – the suturing of the muscular layer of the esophagus.

Download (693KB)
Indexing metadata
9. Fig. 8. Parathyroid cancer. A general view of a cystic tumor with a section of thickened wall of the cyst. Hematoxyline-eosine staining, ×25.

Download (699KB)
Indexing metadata
10. Fig. 9. Parathyroid cancer. The tumor consists of the main cells that forming solid, acinar and trabecular structures. Hematoxyline-eosine staining, ×100.

Download (369KB)
Indexing metadata
11. Fig. 10. Parathyroid cancer. Extracapsular tumor invasion into the adjacent fibers. Hematoxyline-eosine staining, ×50.

Download (371KB)
Indexing metadata
12. Fig. 11. Parathyroid cancer. Tumor complexes in the lumen of a small venous vessel. Hematoxyline-eosine staining, ×200.

Download (291KB)
Indexing metadata
13. Fig. 12. Parathyroid cancer. Diffuse parathyroid hormone (PTH) positive membrane-cytoplasmic expression in tumor cells. Immunohistochemical study with PTH antibodies, ×200.

Download (465KB)
Indexing metadata
14. Fig. 13. Parathyroid cancer. Low proliferate activity of the tumor. Immunohistochemical study with Ki-67 antibodies, ×200.

Download (464KB)
Indexing metadata

Copyright (c) 2020 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies