![]() The pathologist did not confirm the specimen to be a parathyroid lesion. The second specimen revealed near total necrotic material. Therefore, the second specimen that was excised from mass-like fibrotic tissues was sent for pathological evaluation. Frozen biopsy revealed fibrotic tissue with necrosis. ![]() Because there was severe fibrosis and an inflamed mass, it was difficult to confirm the parathyroid lesion hence, a part of the specimen was sent for pathological examination intraoperatively. The patient underwent left-focused parathyroidectomy. (A) An isoechoic mass with well demarcated clear border before FNAB (blue arrow) (B) enlargement of a heterogeneous hyperechoic mass mixed with intracapsular hematoma 4 days after FNAB (blue arrow) the patient had developed swelling and neck pain accompanied by odynophagia (C) 10 days after the FNAB, enlargement of the heterogeneous hyperechoic mass mixed with intracapsular hematoma remained (blue arrow). Functional single-photon emission computed tomography using 99mTc-sestamibi (SPECT MIBI), performed for localization before surgery, revealed a non-uptaken lesion measuring 2.5 cm in the left neck between the thyroid gland and the esophagus.įigure 1 Ultrasound of neck (case 1). He presented to an outpatient radiology clinic, where ultrasound evaluation revealed enlargement of the original mass (2.9 cm × 2.1 cm) that was mixed with an intracapsular hematoma in the left neck ( Figure 1B,C). Four days after FNAB, the patient developed swelling and neck pain accompanied by odynophagia. There were no immediate complications, and the patient did not complain of any discomfort. FNAB of the extrathyroidal mass was performed the slide was assessed to be nondiagnostic by a pathologist due to blood mixed cytology. Ultrasound evaluation revealed a left extrathyroidal neck mass measuring 2.6 cm × 1.6 cm, which was suspected to be a parathyroid adenoma ( Figure 1A). During consultation with the Endocrine Department, hypercalcemia and elevated parathyroid hormone (PTH) levels were confirmed. We present the following cases in accordance with the CARE reporting checklist (available at ).Ī 58-year-old man who was undergoing osteoporosis treatment visited Severance Hospital for treatment. In two cases presented here, hemorrhage due to the use of FNAB for the diagnosis of hyperparathyroidism led to spontaneous remission a parathyroid adenoma, which was confirmed on preoperative imaging and postoperative histological analysis. Moreover, FNAB for diagnostic purposes in patients with hyperparathyroidism is controversial. There have been few reports of PHPT remission caused by hemorrhage of a parathyroid adenoma after fine needle aspiration biopsy (FNAB). In more than half of PHPT cases, permanent improvement has been noted after spontaneous remission however, in some PHPT cases, that the spontaneous remission was temporary ( 4, 5). ![]() However, in few published cases, autoinfraction in the lesion led to spontaneous remission of hyperparathyroidism ( 2, 3). The optimal treatment for PHPT is the surgical removal of the lesion. Primary hyperparathyroidism (PHPT) is the third most common endocrine disease, and most patients with PHPT have an adenoma ( 1). Keywords: Hyperparathyroidism fine-needle aspiration biopsy (FNAB) spontaneous remission case report Caution is needed while performing FNAB for diagnosis of hyperparathyroidism and during decision making regarding whether to observe the patient or perform surgery after spontaneous remission due to bleeding or infarction. The first patient maintained a normal level of PTH for 6 years, and the second patient received kidney transplantation 6 years after surgery, and the normal level of PTH was confirmed for 13 years. In the second patient receiving hemodialysis treatment for end-stage renal disease, hyperparathyroidism spontaneously resolved after FNAB and the parathyroid hormone (PTH) levels normalized after surgery. The first patient diagnosed with primary hyperparathyroidism (PHPT) had neck pain and severe swelling 4 days after FNAB, and spontaneous remission due to intracapsular hemorrhage was confirmed after surgery. The remission was confirmed after surgical removal and pathological review of the adenoma. Here we have reported two cases of hyperparathyroidism in which spontaneous remission occurred due to the use of FNAB for diagnosis. And spontaneous remission of hyperparathyroidism caused by bleeding or infarction of the adenoma rarely occurs. Diagnostic use of fine-needle aspiration biopsy (FNAB) for histological confirmation in patients with hyperparathyroidism is controversial. Policy of Dealing with Allegations of Research MisconductĪbstract: Hyperparathyroidism is not a rare disease if a parathyroid adenoma is confirmed, the treatment of choice is the surgical resection.Policy of Screening for Plagiarism Process.
0 Comments
Leave a Reply. |