Undescended parathyroid adenoma

Abstract

Undescended parathyroid adenomas are rare, representing 0.08% of all parathyroid adenomas; however, they make up 7% of the underlying cause of failed cervical exploration in patients with persistent primary hyperparathyroidism. A 43-year-old woman with no significant medical or family history presented with fatigue and was diagnosed with primary hyperparathyroidism; however, preoperative imaging including sestamibi scan and ultrasound was unable to identify the hyperfunctioning gland. She underwent a neck exploration and hemithyroidectomy and partial parathyroidectomy with failure of resolution of her disease. Subsequent work up including a CT of the neck demonstrated a 1.9 cm mass adjacent to the left submandibular gland. This was removed with postoperative normalisation of the patient's serum calcium and parathyroid hormone levels.

Figure 1

CT of the neck with contrast obtained after first neck exploration, on which a 1.9 cm hyperintensity was noted near the left submandibular gland (arrow), (A) transverse and (B) coronal.

Figure 2

(A) Planned incision following localisation of mass with ultrasound. (B) Dissection demonstrating 2 cm mass immediately deep to the platysma (patient's head is to the left in the image). (C) Specimen following removal, 1.9×1.2×1.0 cm and weighing 1.01 g; pathology was consistent with a hypercellular parathyroid adenoma.