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Case Reports
. 2014 May 16;2(5):151-6.
doi: 10.12998/wjcc.v2.i5.151.

Parathyroid carcinoma in pregnancy

Maja Baretić  1 , Hrvojka Tomić Brzac  1 , Margareta Dobrenić  1 , Antonia Jakovčević  1
Affiliations
Case Reports

Parathyroid carcinoma in pregnancy

Maja Baretić et al. World J Clin Cases. .

Abstract

A 24-year-old female patient with parathyroid carcinoma, the rarest endocrine malignancy, had two pregnancies. In the first pregnancy, she had severe nausea and fatigue. Hypercalcemia and hyperparathyroidism were diagnosed in the postpartum period. Hyperemesis gravidarum masked a diagnosis of hypercalcemia. Neck ultrasound and Tc-99m sestamibi found an enlarged lower right parathyroid gland. The gland was surgically removed, and an initial pathology report described atypical adenoma. Shortly afterward, she became pregnant again. During the second pregnancy, her calcium level was frequently controlled but was always in the normal range. Normocalcemia is explained by the specific physiology of pregnancy accompanied by hemodilution, hypoalbuminemia and maternal hypercalciuria (mediated by increased glomerular filtration). During lactation, calcium levels rose, and a new neck ultrasound showed a solitary mass in the area of prior surgery and an enlarged pretracheal lymph node. Fine needle aspiration of the solitary mass and node showed parathyroid carcinoma cells. The tumor mass was resected en bloc with the contiguous tissues and surrounding lymph nodes (pathology report; parathyroid carcinoma with metastases). Over the next five years, four consecutive surgeries were performed to remove malignant parathyroid tissue, lymph nodes and local metastases. Following the surgical procedures, no hypocalcemia was observed. More serious hypercalcemia recurred; the calcium level was difficult to control with a combination of pamidronate, cinacalcet and loop diuretic. No elements of multiple endocrine neoplasia were present.

Keywords: Hypercalcemia; Hyperemesis gravidarum; Hyperparathyroidism; Parathyroid carcinoma; Pregnancy.

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Figures

Figure 1
Figure 1
Doppler ultrasound of parathyroid gland showing well-defined hypoechoic mass with color signals of few surrounding vascular structures and Tc-99m sestamibi planar scan with pinhole collimator, 10 min post injection.
Figure 2
Figure 2
Pathology image of atypical adenoma. A: No significant remodeling of stroma cells or polymorphism, tumor cells are monotonous, small cells with focal cytological atypia without mitotic figures; B: Pathology image of atypical adenoma with tumour cells infiltrating thick fibrous capsule.
Figure 3
Figure 3
Doppler ultrasound of parathyroid carcinoma: small solitary mass in the area of previous surgery.
Figure 4
Figure 4
Pathology image of parathyroid carcinoma. A: Mitotic cells; B: Infiltrating skeletal muscle.
Figure 5
Figure 5
Positron emission tomography/low-dose X-ray computed tomography (positron emission tomography/low-dose computed tomography) with F-18 FDG. Focal accumulation is observed in enlarged lymph nodes of the right axillary region and diffuse uptake is observed in the right breast.
See this image and copyright information in PMC

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