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When a Pathological Forearm Fracture Led to Explore the Neck: About a Case

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Abstract

The majority of patients with parathyroid carcinoma (PC) have significant clinical signs and simultaneous symptoms related to the unregulated hypersecretion of parathyroid hormone (PTH) by the tumor. The aim of this case was to report a patient presenting an isolated bone fracture leading to the diagnosis of PC. A 20-years-old female patient presenting a fracture of both bones of the forearm following a fall from her own height. Imageries showed diffuse bone demineralization. Biology revealed malignant hypercalcemia at 4.1 mmol/L and PTH at 1331 pg/mL. Bone densitometry showed severe osteoporosis with a femoral and lumbar T-score < − 3DS. Imageries showed a right parathyroid mass of 32 mm. An one-piece excision of the pathological gland, right thyroid lobectomy and ipsilateral central lymph node dissection were performed. Postoperatively, the patient presented a hungry bone syndrome with severe hypocalcemia and required substitutive treatment. PTH on day 1 was normal. Pathology analysis found a PC with Ki67 at 3%, lymph node removal was negative. Complete one-piece surgical excision is the only potentially curative treatment for PC. Preoperative suspicion and intraoperative recognition of malignant features is important in order to propose an appropriate compartmental surgery, which can provide the lowest possible recurrence rate.

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Authors and Affiliations

  1. Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital Nancy Brabois, Rue du Morvan, 54511, Vandoeuvre-Les-Nancy, Grand Est, France

    Cyrille Buisset, Claire Nominé-Criqui & Laurent Brunaud

  2. Department of Endocrinology, University Hospital Nancy Brabois, Rue du Morvan, 54511, Vandoeuvre-Les-Nancy, Grand Est, France

    Léa Demarquet

  3. Department of Rhumatology, University Hospital Nancy Brabois, Rue du Morvan, 54511, Vandoeuvre-Les-Nancy, Grand Est, France

    Marie Raynal

  4. Department of Pathology, University Hospital Nancy Brabois, Rue du Morvan, 54511, Vandoeuvre-Les-Nancy, Grand Est, France

    Hélène Busby

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  1. Cyrille Buisset
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  2. Léa Demarquet
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  3. Marie Raynal
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  5. Claire Nominé-Criqui
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  6. Laurent Brunaud
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All authors should have made substantial contributions to all of: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

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Correspondence to Cyrille Buisset.

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Buisset, C., Demarquet, L., Raynal, M. et al. When a Pathological Forearm Fracture Led to Explore the Neck: About a Case. Head and Neck Pathol 14, 828–832 (2020). https://doi.org/10.1007/s12105-019-01085-3

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  • DOI: https://doi.org/10.1007/s12105-019-01085-3

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