World Journal of Endocrine Surgery

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VOLUME 12 , ISSUE 1 ( January-April, 2020 ) > List of Articles

CASE REPORT

Ectopic Precarinal Space Parathyroid Carcinoma: A Rare Entity with a Diagnostic Dilemma

Rakesh Bobba, PS Venkatesh Rao, Shilpa Rudradevaru, Ravi S Shetty, Nagamalesh Udigala Madappa, Pramila Kalra

Citation Information : Bobba R, Rao PV, Rudradevaru S, Shetty RS, Madappa NU, Kalra P. Ectopic Precarinal Space Parathyroid Carcinoma: A Rare Entity with a Diagnostic Dilemma. World J Endoc Surg 2020; 12 (1):23-26.

DOI: 10.5005/jp-journals-10002-1267

License: CC BY-NC 4.0

Published Online: 20-08-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Parathyroid carcinomas are rare tumors that arise in the normally located or an ectopic gland. Here, we present a case of a 36-year-old female patient who presented with a history of generalized bone pain, associated with multiple fractures and with elevated serum calcium, parathyroid hormone (PTH) levels, and low vitamin D levels. Biochemical evaluation suggested primary hyperparathyroidism. Initial technetium-99m sestamibi scan and choline 11 scans were misleading and surgical exploration of the neck and superior mediastinum revealed three small parathyroid glands, right superior and inferior, and left superior, all unremarkable on biopsy. Initial surgery failed to alleviate the symptoms. An ectopic parathyroid adenoma was localized in the precarinal space on a gallium 68 DOTANOC PET scan. Repeat surgery by sternotomy, transpericardial approach, and exploration of the mediastinum with intraoperative PTH monitoring was successful in identification and complete excision of parathyroid carcinoma. Operative management of patients with persistent hyperparathyroidism is difficult despite the new advances in radiological imaging. Patients are better managed with a combined approach of biochemical tests, imaging, and intraoperative parathyroid hormone monitoring.


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