11/852. Parathyroid carcinoma in a child. Parathyroid carcinoma is a rare cause of hypercalcemia in children but should be considered in a child presenting with an extremely elevated serum calcium level. The authors report the fifth case of parathyroid carcinoma in a child less than 16 years of age. ( info) |
| A rare case of ganglioneuromatous polyposis of the colon found in association with mucinous adenocarcinoma and primary hyperparathyroidism caused by a parathyroid adenoma in a 77-year-old woman is described. We discuss the clinical implications of this finding and review the literature. ( info) |
13/852. A peculiar factor viii-related antigen staining of an oxyphilic cell nodule within an intrathyroidal parathyroid adenoma. A case of intrathyroidal parathyroid adenoma, which was found in the lower portion of the right thyroid lobe, is presented. The nodule in this lesion was composed of oxyphilic cells. In order to verify a possible vascular invasion, immunohistochemical study with factor viii-related antigen/von willebrand factor, which is known to be synthesized by the endothelial cells and stored in weibel-palade bodies, and ulex europaeus lectin 1 were applied. It was interesting to find positivity for factor viii-related antigen and ulex europaeus lectin I strictly confined in the nodule of oxyphil cells, which are known to have large numbers of mitochondria. This led to investigating similar immunoreactions in different lesions of oxyphilic cells with several other markers. The possible cross-reaction between weibel-palade bodies and mitochondria deserves further detailed research. ( info) |
14/852. Parathyroid cysts. Parathyroid cysts are relatively uncommon. They may be non-functioning or associated with primary hyperparathyroidism. Three patients are presented, including one with a large mediastinal parathyroid cyst, and these cases illustrate the range of pathological and clinical features. ( info) |
15/852. technetium-99m pertechnetate uptake in ectopic parathyroid adenoma. A 37-year-old male with a persistent increased parathyroid hormone level, after subtotal thyroidectomy and parathyroidectomy, was referred for scintigraphic localization of a possible ectopic parathyroid adenoma. Tc-99m pertechnetate and Tc-99m MIBI scintigraphy were performed on separate days. There was marked uptake of both tracers in the mediastinum, which at surgery was confirmed to be an extrathyroidal parathyroid adenoma. Hypervascularity was suggested as a possible explanation for rare cases of pertechnetate avid parathyroid adenomas. And Tc-99m MIBI scintigraphy proved to be a successful imaging procedure for ectopic parathyroid tissue. ( info) |
| A malignant insulinoma (LOHG-I), a carcinoid of the lung (LOHG-L), a parathyroid adenoma (LOHG-NSA), and a fibroma (LOHG-F) were obtained from a patient with multiple endocrine neoplasia type 1 (MEN1). Long-term cultures were established. Essential neurobiological properties of the cell lines were proven immunocytochemically and by electron microscopy. Molecular analysis of the germline dna showed a 4 bp deletion in exon 3 of the MEN1 gene. Cytogenetic and CGH analyses of the tumors/tumor cell lines revealed diploidy and balanced and unbalanced structural aberrations different for each tumor. chromosomes 6q21, 11q and 17q were most frequently involved in clonal structural aberrations. ( info) |
17/852. Inappropriate elevation of intact PTH in the presence of normocalcemia after successful surgery for primary hyperparathyroidism. We describe here a patient with primary hyperparathyroidism who had high serum intact PTH levels for over 16 months after parathyroidectomy without signs of recurrence or persistence of the disease. The patient was a 48-year-old female who appeared well nourished (body mass index, 23.7). She was received subtotal gastrectomy as treatment for a duodenal ulcer at 44 years and 5 months old and had reached menopaused at 46 years of age. hypercalcemia and a high serum intact PTH level were pointed out three months before admission to our institute. A bone densitometric study revealed that the bone mass of the lumbar spine was extremely reduced (0.636 g/cm2, Z score, -2.17) preoperatively and had not increased 29.5 months after parathyroidal adenomectomy (0.656 g/cm2, Z score, -1.97). hyperparathyroidism, menopause and gastrectomy may have together contributed to the reduced bone mass. The postoperative persistently increased PTH levels in our patient suggest that the remaining parathyroid glands could have been altered during hypercalcemia, causing an increase in the set-point of PTH secretion by serum calcium or a decrease in the renal responsiveness to PTH during the disease. ( info) |
| A 49 year-old Japanese woman had subjected enlargement of a cervical tumor, and also suffered two bone fractures in 2 years. The cervical tumor had enlarged further in the month prior to admission, becoming warm and tender. Endocrinological examination revealed that the serum intact PTH concentration was remarkably high at 400 pg/mL despite the low serum calcium concentration, and that the serum vitamin Ds concentration was decreased. Bone roentgenograms revealed severe osteolytic changes compatible with osteitis fibrosa cystica and a pathologic fracture of the humerus. Under a diagnosis of primary hyperparathyroidism, parathyroidectomy was performed, followed by fixation surgery for the pathologic fracture. Histologically, the cervical tumor was a parathyroid chief-cell adenoma with massive necrosis, and the bone pathology by iliac bone biopsy revealed the existence of osteomalacia. She was treated with calcium, vitamins D and K2 and calcitonin after the surgery. This case is a rare condition manifesting hypocalcemia with catastrophic osteoporosis under the coexistence of spontaneous infarction of parathyroid adenoma with osteomalacia, suggesting that the clinical features of hyperparathyroidism are modified by both the autoparathyroidiectomy and the existence of osteomalacia due to vitamin d deficiency. ( info) |
19/852. Familial isolated hyperparathyroidism caused by single adenoma: a distinct entity different from multiple endocrine neoplasia. Familial hyperparathyroidism (FHPT) is a hereditary disease where hyperparathyroidism (HPT) is transmitted in an autosomal dominant fashion. FHPT consists of a variety of diseases such as multiple endocrine neoplasia type1 (MEN 1) and type2 (MEN 2), familial isolated hyperparathyroidism (FIHPT) with single adenoma and with multiple adenomas (or hyperplasia), and FHPT with jaw-tumor (FHPT-JT). Isolation of the genes responsible for MEN1, and 2, i.e. MEN1 and RET, respectively, makes it possible to examine the relations among disorders constituting FHPT. We studied germ-line mutations in these 2 genes in a family of FHPT with single parathyroid adenoma. The disorder in this family was proved to be an entity different from MEN1 because no germ-line mutations in MEN1 gene were found in the affected members. The loss of heterozygosity (LOH) at MEN1 gene and PYGM were not found in the abnormal parathyroid in this family, supporting the above conclusion. No mutations in exons 10, and 11 of RET proto-oncogene was found in germ-line dna of the affected member of the family, suggesting no relation to MEN2A. Linkage study excluded the possibility of FHPT-JT syndrome. PRAD1 was not overexpressed in the parathyroid tumors in this family. The relation of this disorder to FIHPT with multiple enlarged parathyroid glands remains to be clarified. A search for the gene(s) predisposing to FIHPT is needed. ( info) |
20/852. Intraoperative radio-guided identification of parathyroid adenomas with the gamma probe: initial experiences in a community hospital. Previous radiological imaging studies for identification of parathyroid adenomas have generally been unreliable. Currently, preoperative administration of Tc-99m sestamibi improves detection of parathyroid adenomas. Combining preoperative administration of sestamibi radionuclide with the gamma probe intraoperatively can successfully identify the exact location of parathyroid adenomas in a community hospital setting and facilitate a safe and efficient operation. A team approach, including surgeon, radiologist, and technologist, is recommended to facilitate mastery of the learning curve. ( info) |