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CASE 15

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A 25 year-old female with parathyroid tumor. The patient had previous history of primary hyperparathyroidism. In 2001 she had surgery with resection of a nodule in the right side, which was diagnosed as hyperplastic, however, during the post-operative she developed severe hyperparathyroidism. In August 2002, she had another surgery with resection of left side nodules together with the right thyroid lobe. The pathology report at this time was hyperplasia of parathyroid in three glands and normal thyroid. In June 2003 she presents again with clinical symptoms of hyperparathyroidism and two nodules are removed from the subcutaneous tissue of her neck, one at the level of the supra-sternal scar from previous surgery, and the other is smaller and adjacent to the first, both diagnosed as hyperplastic. The main question is on the benign or malignant nature of these tumors.

Please reply to: Dr. Leopoldo Santamaría (Panama)

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DIAGNOSIS

Parathyromatosis in hyperparathyroidism.

Recurrent hyperparathyroidism after parathyroidectomy may present a difficult diagnostic problem. A rare etiology is parathyromatosis (multiple nodules of hyperfunctioning parathyroid tissue scattered through the neck and mediastinum) due to spillage of otherwise benign parathyroid tissue during surgery. We present a case of recurrent hyperparathyroidism and parathyromatosis due to tissue spillage during surgical removal of probable double adenomas, a rare cause of primary hyperparathyroidism. Thus, parathyromatosis must be included in the differential diagnosis of recurrent or persistent hyperparathyroidism, distinguished from parathyroid carcinoma by histologic criteria. The surgeon must be careful of parathyroid spillage during surgery, even of benign tumors of the parathyroids.

REFERENCES

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2. Baloch ZW, Fraker D, LiVolsi VA. Parathyromatosis as cause of recurrent secondary hyperparathyroidism: a cytologic diagnosis. Diagn Cytopathol. 2001 Dec;25(6):403-5. PMID: 11747238 [PubMed - indexed for MEDLINE]

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6. Kollmorgen CF, Aust MR, Ferreiro JA, McCarthy JT, van Heerden JA. Parathyromatosis: a rare yet important cause of persistent or recurrent hyperparathyroidism. Surgery. 1994 Jul;116(1):111-5. PMID: 8023257

7. Sokol MS, Kavolius J, Schaaf M, D'Avis J. Recurrent hyperparathyroidism from benign neoplastic seeding: a review with recommendations for management. Surgery. 1993 Apr;113(4):456-61. Review. PMID: 8456402

8. Fitko R, Roth SI, Hines JR, Roxe DM, Cahill E. Parathyromatosis in hyperparathyroidism. Hum Pathol. 1990 Feb;21(2):234-7. PMID: 2307452

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