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      Imaging features and surgical management of giant parathyroid adenoma with autoinfarction

      case-report

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          Abstract

          Autoinfarction of a parathyroid adenoma can have an atypical clinicoradiologic features that can mimic an inflammatory process or malignancy. In addition, the associated fibrosis makes surgical resection more challenging than for regular parathyroid adenomas. The implications of these findings are that while autoinfarction of parathyroid adenomas is a rare phenomenon, this entity should be considered when there are heterogeneous and cystic components on imaging in patients without hypercalcemia. Ultimately, histopathology is necessary for definitive diagnosis.

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          Do giant parathyroid adenomas represent a distinct clinical entity?

          Philip Spanheimer, Andrew Stoltze, James Howe … (2013)
          The size of abnormal parathyroid glands in patients with primary hyperparathyroidism (PHPT) is highly variable, but the clinical significance of giant glands is unknown.
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            Parathyroid carcinoma.

            Jay Goswamy, Mary Lei, Ricard Simo (2016)
            This article highlights recent advances in our understanding of the incidence, epidemiology, clinical presentation, evaluation, diagnosis, treatment, and prognosis of parathyroid carcinoma.
            Article 0 comments Cited 24 times – based on 0 reviews     Review now
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              Atypical parathyroid adenoma: clinical and anatomical pathologic features

              Alessandro Galani, Riccardo Morandi, Mira Dimko … (2021)
              Background Primary hyperparathyroidism is an endocrine pathology that affects calcium metabolism. Patients with primary hyperparathyroidism have high concentrations of serum calcium or high concentrations of parathyroid hormone, or incorrect parathyroid hormone levels for serum calcium values. Primary hyperparathyroidism is due to the presence of an adenoma/single-gland disease in 80–85%. Multiple gland disease or hyperplasia accounts for 10–15% of cases of primary hyperparathyroidism. Atypical parathyroid adenoma and parathyroid carcinoma are both responsible for about 1.2–1.3% and 1% or less of primary hyperparathyroidism, respectively. Methods We performed a retrospective cohort study and enrolled 117 patients with primary hyperparathyroidism undergoing minimally invasive parathyroidectomy. Histological and immunohistochemical examination showed that 107 patients (91.5%) were diagnosed with typical adenoma (group A), while 10 patients (8.5%) were diagnosed with atypical parathyroid adenoma (group B). None of the patients were affected by parathyroid carcinoma. Results Significant statistical differences were found in histological and immunohistochemical parameters as pseudocapsular invasion (p   1/10 high-power fields (HPFs) (p   4% (p <  0.001), galectin-3 + (p = 0.002), and protein gene product (PGP) 9.5 + (p = 0.038). Conclusions Atypical parathyroid adenoma is a tumor that has characteristics both of typical adenoma and parathyroid carcinoma. The diagnosis is reached by excluding with strict methods the presence of malignancy criteria. Atypical parathyroid adenoma compared to typical adenoma showed significant clinical, hematochemical, histological, and immunohistochemical differences. We did not find any disease relapse in the 10 patients with atypical parathyroid adenoma during 60 months of follow-up time.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Imaging Sci
                Journal ID (iso-abbrev): J Clin Imaging Sci
                Journal ID (publisher-id): JCIS
                Title: Journal of Clinical Imaging Science
                Publisher: Scientific Scholar
                ISSN (Print): 2156-7514
                ISSN (Electronic): 2156-5597
                Publication date (Electronic): 26 March 2024
                Publication date Collection: 2024
                Volume: 14
                Electronic Location Identifier: 9
                Affiliations
                [1 ]Department of Radiology, U Chicago , Chicago, United States
                [2 ]Department of Pathology, U Chicago , Chicago, United States
                [3 ]Department of Pathology, The University of Chicago , Chicago, United States
                [4 ]Department of Surgery, U Chicago, Pritzker School of Medicine , Chicago, United States.
                Author notes
                [* ] Corresponding author: Daniel Thomas Ginat, Department of Radiology, University of Chicago, Pritzker School of Medicine, Chicago, United States. dtg1@ 123456uchicago.edu
                Article
                Publisher ID: 10.25259/JCIS_133_2023
                DOI: 10.25259/JCIS_133_2023
                PMC ID: 11021105
                PubMed ID: 38628608
                SO-VID: 72e60a58-dbe2-4b64-ad52-2b0d1cf83dd9
                Copyright © © 2024 Published by Scientific Scholar on behalf of Journal of Clinical Imaging Science
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 17 December 2023
                Date accepted : 19 January 2024
                Funding
                Financial support and sponsorship
                Nil.
                Categories
                Subject: Case Report
                Subject: Neuroradiology/Head and Neck Imaging

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: imaging,surgery,giant parathyroid adenoma,autoinfarction
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: imaging, surgery, giant parathyroid adenoma, autoinfarction

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