A case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonography

Abstract Background With advances in diagnostic imaging such as ultrasonography (US), computed tomography (CT), and 99mTc-MIBI-sestamibi (MIBI) scintigraphy, localized diagnosis of hyperparathyroidism (pHPT) has become possible with considerable accuracy. However, even with the use of these imaging...

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Main Authors: Nobuyuki Takemoto, Ai Koyanagi, Masanori Yasuda, Yuya Yamamoto, Hiroshi Yamamoto
Format: Article
Language:English
Published: SpringerOpen 2020-04-01
Series:The Ultrasound Journal
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13089-020-00164-9
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spelling doaj-fa57a1aa7c0b45c191f5acc6375633702020-11-25T02:13:02ZengSpringerOpenThe Ultrasound Journal2524-89872020-04-011211610.1186/s13089-020-00164-9A case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonographyNobuyuki Takemoto0Ai Koyanagi1Masanori Yasuda2Yuya Yamamoto3Hiroshi Yamamoto4Department of Breast & Endocrine Surgery, Japan Medical Alliance East Saitama General HospitalResearch and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Sant Boi de LlobregatDepartment of Pathology, Saitama Medical University International Medical CenterDepartment of Endocrine Internal Medicine, Japan Medical Alliance East Saitama General HospitalGeriatric Health Service Facility (COSMOS), Japan Medical Alliance Yokohama Stroke and Brain CenterAbstract Background With advances in diagnostic imaging such as ultrasonography (US), computed tomography (CT), and 99mTc-MIBI-sestamibi (MIBI) scintigraphy, localized diagnosis of hyperparathyroidism (pHPT) has become possible with considerable accuracy. However, even with the use of these imaging techniques, since intrathyroid parathyroid tumors exist as a mass within the thyroid, it is often difficult to distinguish from thyroid masses. Although there have been various reports on US images of intraparathyroid tumors, we experienced a case with US images that were distinct from previous reports. Herein we present a case of an intrathyroid parathyroid adenoma (IPA) that was difficult to diagnose, with a main focus on US images. Case presentation A 53-year-old man with a diagnosis of hyperparathyroidism was referred to our department in December 2018. Ultrasonography revealed a tumor that was located in the inferior pole of the right lobe of the thyroid gland and no parathyroid mass was observed. The tumor had an irregular round shape and showed heterogeneous hyperechogenicity with a defined margin, but within it, there were a few irregular and hypoechogenic area with unclear margins, while the tumor had a mosaic appearance at first glance. Although 99mTc-MIBI scintigraphy showed accumulation at the same location in delayed phase, it was difficult to determine the presence of a parathyroid tumor on the image. The patient underwent an operation on April 2019 and the tumor could not be identified on both naked eye and palpation. We used US intraoperatively to define the location and resected the tumor. A parathyroid adenoma was diagnosed by frozen section and the final diagnosis was an intrathyroid parathyroid adenoma. Conclusion We experienced an IPA presenting an US image that was atypical and has previously not been reported. IPA has no established US image to confirm the diagnosis and even with the use of other imaging techniques, a definitive diagnosis often cannot be established. Thus, our recommendation based on the current situation is that operation with intraoperative diagnosis using frozen section should be conducted if hypercalcemia and high I-PTH are observed and when localization sites in MIBI and US coincide.http://link.springer.com/article/10.1186/s13089-020-00164-9Intrathyroid parathyroid adenomaUltrasonography99mTc-MIBIDifficult-to-diagnose
collection DOAJ
language English
format Article
sources DOAJ
author Nobuyuki Takemoto
Ai Koyanagi
Masanori Yasuda
Yuya Yamamoto
Hiroshi Yamamoto
spellingShingle Nobuyuki Takemoto
Ai Koyanagi
Masanori Yasuda
Yuya Yamamoto
Hiroshi Yamamoto
A case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonography
The Ultrasound Journal
Intrathyroid parathyroid adenoma
Ultrasonography
99mTc-MIBI
Difficult-to-diagnose
author_facet Nobuyuki Takemoto
Ai Koyanagi
Masanori Yasuda
Yuya Yamamoto
Hiroshi Yamamoto
author_sort Nobuyuki Takemoto
title A case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonography
title_short A case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonography
title_full A case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonography
title_fullStr A case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonography
title_full_unstemmed A case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonography
title_sort case of intrathyroid parathyroid tumor that was difficult to diagnose by ultrasonography
publisher SpringerOpen
series The Ultrasound Journal
issn 2524-8987
publishDate 2020-04-01
description Abstract Background With advances in diagnostic imaging such as ultrasonography (US), computed tomography (CT), and 99mTc-MIBI-sestamibi (MIBI) scintigraphy, localized diagnosis of hyperparathyroidism (pHPT) has become possible with considerable accuracy. However, even with the use of these imaging techniques, since intrathyroid parathyroid tumors exist as a mass within the thyroid, it is often difficult to distinguish from thyroid masses. Although there have been various reports on US images of intraparathyroid tumors, we experienced a case with US images that were distinct from previous reports. Herein we present a case of an intrathyroid parathyroid adenoma (IPA) that was difficult to diagnose, with a main focus on US images. Case presentation A 53-year-old man with a diagnosis of hyperparathyroidism was referred to our department in December 2018. Ultrasonography revealed a tumor that was located in the inferior pole of the right lobe of the thyroid gland and no parathyroid mass was observed. The tumor had an irregular round shape and showed heterogeneous hyperechogenicity with a defined margin, but within it, there were a few irregular and hypoechogenic area with unclear margins, while the tumor had a mosaic appearance at first glance. Although 99mTc-MIBI scintigraphy showed accumulation at the same location in delayed phase, it was difficult to determine the presence of a parathyroid tumor on the image. The patient underwent an operation on April 2019 and the tumor could not be identified on both naked eye and palpation. We used US intraoperatively to define the location and resected the tumor. A parathyroid adenoma was diagnosed by frozen section and the final diagnosis was an intrathyroid parathyroid adenoma. Conclusion We experienced an IPA presenting an US image that was atypical and has previously not been reported. IPA has no established US image to confirm the diagnosis and even with the use of other imaging techniques, a definitive diagnosis often cannot be established. Thus, our recommendation based on the current situation is that operation with intraoperative diagnosis using frozen section should be conducted if hypercalcemia and high I-PTH are observed and when localization sites in MIBI and US coincide.
topic Intrathyroid parathyroid adenoma
Ultrasonography
99mTc-MIBI
Difficult-to-diagnose
url http://link.springer.com/article/10.1186/s13089-020-00164-9
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