Radiological and Anatomical Findings in
Parathyroid Carcinoma: A Case Report
Masoume Soleymaninejad1, Zabihollah Gholizadeh2, Vida Garousi3 and Ahmad Farrokhi4*
1Ayatollah Mousavi hospital, Aniography center, Zanjan University of Medical Sciences, Iran
2BSc of operating room, Shafa hospital, Iran
3Medical student, Zanjan University of medical sciences, Iran
4Department of Anatomical Sciences, Zanjan University of Medical Sciences, Iran
Submission: March 05, 2018; Published: March 19, 2018
*Corresponding author: Ahmad Farrokhi, Department of Anatomical Sciences, Zanjan University of Medical Sciences, Iran, Tel: 00989178172415; Email: firstname.lastname@example.org
How to cite this article: Ibrahim A Ai, Hisham M Abdel Rahim, Babiker Almobasher, Rihab M Badi, Abdarahiem Alborai, Abdelmohisen Hussein. Kamal M
Awad,Reference Range of Hemoglobin A1c in Khartoum State. Anatomy Physiol Biochem Int J: 2018; 4(4): 555645. DOI: 10.19080/APBIJ.2018.04.555645.
Parathyroid Carcinoma is a rare cause of primary hyperparathyroidism often resulting in severe hypocalcaemia. Diagnosis of parathyroid carcinoma requires radiological Investigations. We presented the case of a 52 year old lady, with a past history of abdominal pain, frequent vomiting, curettage and a large swelling on the neck there. The novelty of this study was abnormally large of parathyroid tumour that led doctors to suspect thyroid cancer. In benign hyperparathyroidism, experienced surgeons will successfully detect the tumours during their exploration; but imaging plays an important role when the carcinoma is suspected as a differential diagnosis of parathyroid adenoma and hyperplasia due to clinical manifestations.
Parathyroid glands are four tiny glands behind the thyroid gland. The size of each of these glands is 5-7×3-4×0.5-2mm and weight of each these glands is 30-50mg . These glands are involved in calcium homeostasis and metabolism of phosphate. Overactive of these glands, can cause hyperparathyroidism as a result of the increase in PTH hormone. Also, hyperparathyroidism can cause adenoma, hyperplasia and carcinoma . Parathyroid carcinoma is created in 1-3% of cases of hyperparathyroidism . Parathyroid carcinoma is a rare disorder with a difficult clinical diagnosis and high mortality [3-6]. The etiology of the disorder is largely unknown . Reports indicate that the average age of onset of the disease is 48 years and the incidence is equal in men and women . Although some sources have reported incidence in women is twice that of men . Diagnosis of this rare endocrine disorderis carried out through biochemical, histological, molecular biology and radiological tests. Radiological evaluation by CT scan, MRI, ultrasonography, scintigraphy and TC99-msestamibi carried out. Since parathyroid tumors require surgery to reduce the risk and treatment with parathyroidectomy action is done, the diagnosis of cancer is very important [4,8]. Therefore, this study aimed to diagnosis faster and more accurate parathyroid carcinoma to reduce side-effects for the patient.
We presented the case of a 52 year old lady, with a past history of abdominal pain, frequent vomiting, curettage and a large swelling on the neck there. Early diagnosis was hyperparathyroidism. A hard palpable right neck mass approximately 6.5 to 5.5cm diameter was discovered on first examinations.
The anterior view of the neck and chest was performed,
almost at 20, 30, 60, 70, 90 and 100 minutes after IV
administration of 15mCi TC99-msestamibi (Figure 1). There
was a homogeneous radiotracer accumulation in the below
right lobe, which extends to the substernal areas corresponding
to palpable nodule, which was holding the radiotracer out the
study. Early diagnosis of the nuclear physician was parathyroid
adenoma, parathyroid hyperplasia, thyroid adenoma, thyroid
carcinoma and parathyroid carcinoma.
To reduce the risk of mortality and morbidity,
parathyroidectomy (Figure 2) surgery was performed and right
lobe of the thyroid and parathyroid glands were removed (Figure
3). Observations and measurements after parathyroidectomy
have shown a nodule 5.5×4.5×2.5cm dimension. After bringing
the sample to pathology unit, the pathologist was diagnosed
Parathyroid carcinoma is a rare malignancy that occurs in
1-2%  or 1-3%  of patients with hyperparathyroidism.
Among the most important risk factors for this disease is
a palpable mass in the neck with a size of more than 3cm 
which causes anatomical changes in the parathyroid glands.
Radiological techniques such as Technetium TC 99-msestamibi
can have an important role in the clinical diagnosis of the disease
and Show anatomical changes in the glands. Some surgeons
believe that imaging techniques are not useful for surgery . In
terms of treatment, early treatment for parathyroid carcinoma is
complete removal of the gland through surgery for all tumours
. However, in the last century, parathyroidectomy was the
most common method for direct visualization of the parathyroid
glands in patients with hyperparathyroidism but recently,
preoperative localization methods which have fewer side effects
are being replaced . Of course, to remove the tumour detected
in the patient reported in this study parathyroidectomy is used.
In this patient, according to the image of TC 99-msestamibi,
change in normal anatomical sizes which is one of the main risk
factors for parathyroid carcinoma was observed. The novelty of
this study was abnormally large of parathyroid tumour that led
doctors to suspect thyroid cancer. According to a painful mass
in the neck, the early radiological detection and pathological
secondary diagnosis, the patient reported was suffering from
parathyroid carcinoma. Therefore, it is recommended to
surgeons that if they see carcinoma risk factors and also tumour
metastases to the liver area, lymph nodes and lungs, complete
radiological and pathological tests before surgery. Because onethird
of parathyroid carcinoma metastasis seen that reliability
indices to prove the rare disease  and Imaging is also useful
for detecting metastases or recurrent diseases.