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SAT205 (99)Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum

Disclosure: D.V. Reddy: None. S. Paidipally: None. V. kyatham: None. S. Palle: None. C. Bhandiwad: None. Background: Parathyroid carcinoma (PC) is a very rare and indolent endocrine malignancy occurring a decade earlier than parathyroid adenoma. It can present as recurrent pancreatitis, anemia, and...

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Autores principales: Sheker Reddy, Danda Vijay, Paidipally, Srinivasrao, Kyatham, Vivek, Palle, Sharmila, Bhandiwad, Chandrashekhar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10554271/
http://dx.doi.org/10.1210/jendso/bvad114.502
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author Sheker Reddy, Danda Vijay
Paidipally, Srinivasrao
Kyatham, Vivek
Palle, Sharmila
Bhandiwad, Chandrashekhar
author_facet Sheker Reddy, Danda Vijay
Paidipally, Srinivasrao
Kyatham, Vivek
Palle, Sharmila
Bhandiwad, Chandrashekhar
author_sort Sheker Reddy, Danda Vijay
collection PubMed
description Disclosure: D.V. Reddy: None. S. Paidipally: None. V. kyatham: None. S. Palle: None. C. Bhandiwad: None. Background: Parathyroid carcinoma (PC) is a very rare and indolent endocrine malignancy occurring a decade earlier than parathyroid adenoma. It can present as recurrent pancreatitis, anemia, and peptic ulcers. Serum calcium >14mg/dl, 3-10 times ULN of PTH, and concomitant renal and bone involvement should arise suspicion for PC. PC is diagnosed only through histopathology in the majority. It can also present during a prolonged follow-up, either by local recurrences or distant metastases. Clinical Case: A 27 year old female presented with hypercalcemic crises (as pancreatitis). At admission serum calcium and PTH were grossly elevated; 15.1 mg/dl (8.5-10 mg/dl) and 363 pg/ml (10-55 pg/ml) respectively. Abdominal CT revealed acute pancreatitis with medullary nephrocalcinosis. Ultrasonography of the neck revealed a colloid cyst in the right lobe of thyroid.(99)Tc m-sestamibi /SPECT-CT revealed no uptake. CT neck and chest showed a 13 mm X 13 mm well-defined round nodular lesion in the left apico-posterior segments of the lung. 18F-FDG PET/CT revealed uptake in the lesion with an SUV max of 10, suggestive of a metabolically active solitary pulmonary nodule. She had a similar presentation 8 years back and was diagnosed to have parathyroid adenoma for which she underwent resection. Serum PTH and calcium levels normalized postoperatively and also on follow-up till 3 years. Differentials include-recurrent ectopic parathyroid adenoma, parathyromatosis, and metastatic parathyroid carcinoma. After managing hypercalcemia medically, the patient underwent video-assisted thoracoscopic surgery with left lung wedge resection. Postoperatively serum calcium and PTH normalized. Histopathology revealed a grey-white nodule of 1.4X1.5X1.2 cm with sections, showing a well-defined lesion composed of lobules and nests of tumor cells separated by thin-walled vascular sinusoids. Tumor cells were polygonal with well-defined margins, moderate granular cytoplasm, and vesicular nuclei showing prominent nucleoli with a mitotic activity of 9/hpf. Immunohistochemistry revealed staining with PanCK, GATA3, and S100 with focal PAX 8 activity in the periphery. MIB index was 18%.IHC was suggestive of a neuroendocrine tumor consistent with metastatic parathyroid carcinoma. Whole exome sequencing did not reveal any pathogenic variants. Conclusion: Though (99)Tc MIBI is useful in localizing PC, there are reports of false negative MIBI in documented cases of PC, which has been ascribed to the defective transport to the interior of the malignant cells. This demonstrates the importance of a multimodality imaging approach in such cases. (99)Tc MIBI may miss certain cases of PC substantiating the importance of 18F-FDG PET/CT in diagnosis as well as follow-up. Reference: Evangelista L et al. FDG-PET/CT and parathyroid carcinoma: Review of literature and illustrative case series. World J Clin Oncol 2011; 2(10): 348-354. Presentation: Saturday, June 17, 2023
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spelling pubmed-105542712023-10-06 SAT205 (99)Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum Sheker Reddy, Danda Vijay Paidipally, Srinivasrao Kyatham, Vivek Palle, Sharmila Bhandiwad, Chandrashekhar J Endocr Soc Bone And Mineral Metabolism Disclosure: D.V. Reddy: None. S. Paidipally: None. V. kyatham: None. S. Palle: None. C. Bhandiwad: None. Background: Parathyroid carcinoma (PC) is a very rare and indolent endocrine malignancy occurring a decade earlier than parathyroid adenoma. It can present as recurrent pancreatitis, anemia, and peptic ulcers. Serum calcium >14mg/dl, 3-10 times ULN of PTH, and concomitant renal and bone involvement should arise suspicion for PC. PC is diagnosed only through histopathology in the majority. It can also present during a prolonged follow-up, either by local recurrences or distant metastases. Clinical Case: A 27 year old female presented with hypercalcemic crises (as pancreatitis). At admission serum calcium and PTH were grossly elevated; 15.1 mg/dl (8.5-10 mg/dl) and 363 pg/ml (10-55 pg/ml) respectively. Abdominal CT revealed acute pancreatitis with medullary nephrocalcinosis. Ultrasonography of the neck revealed a colloid cyst in the right lobe of thyroid.(99)Tc m-sestamibi /SPECT-CT revealed no uptake. CT neck and chest showed a 13 mm X 13 mm well-defined round nodular lesion in the left apico-posterior segments of the lung. 18F-FDG PET/CT revealed uptake in the lesion with an SUV max of 10, suggestive of a metabolically active solitary pulmonary nodule. She had a similar presentation 8 years back and was diagnosed to have parathyroid adenoma for which she underwent resection. Serum PTH and calcium levels normalized postoperatively and also on follow-up till 3 years. Differentials include-recurrent ectopic parathyroid adenoma, parathyromatosis, and metastatic parathyroid carcinoma. After managing hypercalcemia medically, the patient underwent video-assisted thoracoscopic surgery with left lung wedge resection. Postoperatively serum calcium and PTH normalized. Histopathology revealed a grey-white nodule of 1.4X1.5X1.2 cm with sections, showing a well-defined lesion composed of lobules and nests of tumor cells separated by thin-walled vascular sinusoids. Tumor cells were polygonal with well-defined margins, moderate granular cytoplasm, and vesicular nuclei showing prominent nucleoli with a mitotic activity of 9/hpf. Immunohistochemistry revealed staining with PanCK, GATA3, and S100 with focal PAX 8 activity in the periphery. MIB index was 18%.IHC was suggestive of a neuroendocrine tumor consistent with metastatic parathyroid carcinoma. Whole exome sequencing did not reveal any pathogenic variants. Conclusion: Though (99)Tc MIBI is useful in localizing PC, there are reports of false negative MIBI in documented cases of PC, which has been ascribed to the defective transport to the interior of the malignant cells. This demonstrates the importance of a multimodality imaging approach in such cases. (99)Tc MIBI may miss certain cases of PC substantiating the importance of 18F-FDG PET/CT in diagnosis as well as follow-up. Reference: Evangelista L et al. FDG-PET/CT and parathyroid carcinoma: Review of literature and illustrative case series. World J Clin Oncol 2011; 2(10): 348-354. Presentation: Saturday, June 17, 2023 Oxford University Press 2023-10-05 /pmc/articles/PMC10554271/ http://dx.doi.org/10.1210/jendso/bvad114.502 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Bone And Mineral Metabolism
Sheker Reddy, Danda Vijay
Paidipally, Srinivasrao
Kyatham, Vivek
Palle, Sharmila
Bhandiwad, Chandrashekhar
SAT205 (99)Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum
title SAT205 (99)Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum
title_full SAT205 (99)Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum
title_fullStr SAT205 (99)Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum
title_full_unstemmed SAT205 (99)Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum
title_short SAT205 (99)Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum
title_sort sat205 (99)technitiumm sestamibi negative sporadic metastatic parathyroid carcinoma in a young female-a diagnostic conundrum
topic Bone And Mineral Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10554271/
http://dx.doi.org/10.1210/jendso/bvad114.502
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