case_images: PMC6218753_01
case_images: Ultrasound showing the parathyroid mass.
case_images: CRIS2018-9261749.001.jpg
case_images: PMC6218753_01_CRIS2018-9261749.001.jpg
case_images: fig1
case_images: U/L, and phosphate of 1.06 (0.8-1.4) mmol/L. Ultrasound of the neck showed a complex, predominantly cystic nodule with solid components inferior of the right thyroid lobe measuring 4.1 x 3.6 x 3.1 cm (Figure 1).
case_images: CT scan (a) shows one of the bone lesions that has increased tracer uptake on the (99m)Tc-sestamibi scan (b).
case_images: CRIS2018-9261749.002.jpg
case_images: PMC6218753_01_CRIS2018-9261749.002.jpg
case_images: fig2
case_images: Additionally, two well-defined lucent bone lesions, located in the right clavicle and scapula, showed increased tracer uptake (Figure 2).
case_images: Course of calcium and PTH levels related to the different events.
case_images: CRIS2018-9261749.003.jpg
case_images: PMC6218753_01_CRIS2018-9261749.003.jpg
case_images: fig3
case_images: Laboratory results showed profound hypocalcemia with a corrected calcium level of 1.85 (2.32-2.62) mmol/L, phosphate of 0.61 (0.8-1.4) mmol/L, and a decrease in PTH level to 87.5 (1.4-7.6) pmol/L (Figure 3).
case_images: The specimen showed a largely infarcted enlarged cellular parathyroid gland with cystic change (a, b; hematoxylin and eosin). There was no evidence of invasive growth. There was no loss of expression for parafibromin (c), RB (d), p27 (not shown), and bcl-2 (e). The overall clinicopathological findings were consistent with an infarcted parathyroid adenoma.
case_images: CRIS2018-9261749.004.jpg
case_images: PMC6218753_01_CRIS2018-9261749.004.jpg
case_images: fig4
case_images: The mass was an infarcted enlarged cellular parathyroid gland with cystic degeneration (Figure 4). Given the clinical suspicion for malignancy and underlying infarction, this lesion was further assessed with immunohistochemical biomarkers (Figure 4).