Presentation
Six months history of a dry cough with nocturnal dyspnoea.
Patient Data
Widening of the upper mediastinum on the AP view with anterior displacement of the trachea and oesophagus on the lateral view due to a posterior/superior mediastinal mass.
The CT images demonstrate a well-defined ovoid hypodense mass within the posterosuperior mediastinum at T2-T3 level with peripheral enhancement following IV contrast, compressing and displacing the trachea and oesophagus anteriorly. No regional lymphadenopathy was noted. No pulmonary lesion was seen on lung window.
The thyroid gland appears small in size (atrophied), inhomogeneous on postcontrast images (patient treated for hypothyroidism).
Case Discussion
The patient went on to have a total resection of the lesion and the histopathological study confirmed the diagnosis of a cystic parathyroid adenoma.
Microscopically the parathyroid parenchyma was composed of an encapsulated benign tumoural proliferation of epithelial nature with a peripheral rim of compressed normal parathyroid tissue. This tumoural proliferation was composed mainly of chief cells with clear cytoplasm, round nuclei. The stroma was reduced to its vascular component endocrinoid-type.
The preoperative calcium concentration was at 12.5 mg/dl and PTH level at 171 pg/ml with an immediate postoperative drop of calcium and PTH level.
On imaging the differential diagnosis should include:
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