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Intrapericardial parathyroid carcinoma: a case report

  • Endocrine Surgery
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Abstract

Purpose

Ectopic parathyroid glands are thought to be the cause of a significant portion of failed primary surgery for hyperparathyroidism. Parathyroid carcinoma (PTCA) is a rare malignant tumor, and ectopic PTCA is a particularly unusual situation. Here, we describe, for the first time, a case of intrapericardial PTCA.

Methods

We describe the case of a 53-year-old female presented with 1-year history of backache, multiple fractures, nephrolithiasis, nausea, vomiting, fatigue, and unexplained myocardial ischemia-like symptoms. Physical examination revealed a barrel chest and sternal tenderness with stable vital signs. Blood tests confirmed hypercalcemia (3.70 mmol/L) and hyperparathyroidism (>1900 pg/ml). 99mTc-sestamibi scan indicated ectopic findings in the mediastinum highly suggestive of parathyroid adenoma.

Results

After more tests, cardiac magnetic resonance imaging (MRI) revealed a mass closely related to the great vessels of the heart. The ectopic tumor in the pericardium was successfully resected through sternotomy, with subsequent histopathological confirmation of PTCA. The metabolism of calcium and phosphorus and the level of PTH returned to normal after surgery.

Conclusion

This unique case reinforces the tremendous variety of possible ectopic locations of parathyroid glands. Although most patients with primary hyperparathyroidism (PHPT) carry a high suspicion of a benign course, the entity of ectopic PTCA also needs to be considered. Accurate preoperative locating diagnosis as well as en bloc tumor resection offers the highest chance of cure in patients with PHPT.

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Authors and Affiliations

  1. Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China

    Yunhui Xin, Teng Zhao, Bojun Wei, Hong Shen, Xing Liu, Jiacheng Wang & Qian Wang

  2. Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China

    Hua Gu

  3. Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China

    Mulan Jin

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  1. Yunhui Xin
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  2. Teng Zhao
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  3. Bojun Wei
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  4. Hua Gu
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  5. Mulan Jin
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  6. Hong Shen
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  8. Jiacheng Wang
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  9. Qian Wang
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Correspondence to Bojun Wei.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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These authors contributed equally: Yunhui Xin, Teng Zhao

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Xin, Y., Zhao, T., Wei, B. et al. Intrapericardial parathyroid carcinoma: a case report. Endocrine 69, 456–460 (2020). https://doi.org/10.1007/s12020-020-02283-8

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  • DOI: https://doi.org/10.1007/s12020-020-02283-8

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