Reséndiz-Colosia JA, Rodríguez-Cuevas SA, Barroso-Bravo S, Gallegos-Hernández JF, Hernández-San Juan M, Gómez-Acosta F

Language: Spanish
References: 15
Page: 419-423
PDF size: 116.55 Kb.

ABSTRACT

Background: Thyroid nodules in patients with primary hyperparathyroidism are frequent, but synchronous association of parathyroid carcinoma and papillary thyroid carcinoma is an uncommon event.
Clinical case: We report the case of a 42-year-old patient who presented with a tumor in the mandible and a nodule in the anterior side of the neck dependent on the right lobe of the thyroid. Aspiration biopsy of the lesion in the oral cavity reported a giant-cell lesion. Severe hypercalcemia (16.5 mg/dl), hypophosphatemia (1.8 mg/dl), alkaline phosphatase elevation three times the upper normal limit, and severe elevation of serum parathyroid hormone were detected. During surgery we located a tumor of the inferior right parathyroid gland with firm adherence to another nodule of the right lobe of the thyroid gland. Total thyroidectomy was carried out en bloc with the parathyroid lesion and dissection of the central level (level VI). Histological report confirmed parathyroid carcinoma and papillary carcinoma of the thyroid. After surgery, we corroborated normalization of biochemical values and a progressive spontaneous regression of mandibular tumor.
Conclusions: Brown tumors are histologically and radiologically indistinguishable from other giant cell-containing lesions. Definitive diagnosis is possible only by comparative evaluation of clinical, radiological, and biochemical findings. Parathyroid carcinoma represents a diagnostic challenge; nonetheless, to conclude with clinical suspicion of a malignant tumor after or during surgery is the first step toward achieving appropriate disease control.

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