Parathyroid adenoma

Case contributed by Dr Hein Els

Presentation

Palpable nodule on the right side of neck. Previous left thyroid lobectomy for a benign condition.

Patient Data

Age: 70
Gender: Male
Ultrasound

Circumscribed  echogenic nodule posterior to and separate from the right lobe of the thyroid. The lesion has internal Doppler, but is not hypervascular. No calcification.  No adenopathy in the remainder of the neck.

CT

Circumscribed mixed density nodule posterior to the right lobe of the thyroid. A thin tissue plane separates the lesion from adjacent vasculature, muscles and the right lobe of the thyroid. No calcification or cystic component. Mixed enhancement pattern. 

Pathology

Large nodule: parathyroid adenoma with no atypia or malignancy.

Immunohistochemistry: thyroglobulin negative; synaptophysin and chromogranin positive.

Smaller tissue sample: thyroid tissue with features of multinodular goitre. No malignancy.

Images courtesy of Dr. Reenee Munbodh

Case Discussion

Imaging most compatible with a parathyroid adenoma. The differential of an enlarged lymph node, an eccentric thyroid nodule, or a nerve sheath tumor were considered unlikely. 

Lab results concordant with imaging suspicion of a parathyroid adenoma. The serum calcium and parathyroid hormone levels were raised.

With thanks to Drs. D van der Merwe & A. Macdonald.

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Case information

rID: 46638
Case created: 11th Jul 2016
Last edited: 15th Sep 2016
System: Head & Neck
Inclusion in quiz mode: Included

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