Parathyroid adenoma combined with a rib tumor as the primary disease: A case report

Abstract

Background: Parathyroid adenoma is a benign parathyroid tumor, with serum parathyroid hormone and calcium ion concentrations as the typical basis for diagnosis. Its clinical manifestations are complex and changeable; thus it is easily missed or misdiagnosed. Approximately 85% of patients with parathyroid adenoma develop primary hyperparathyroidism, and abnormalities in bones, kidneys and other organs can occur. Brown tumors are rare.

Case summary: We report a rare case of fibrocystic osteitis associated with a parathyroid adenoma, which was discovered by chance due to a rib tumor. Abnormally elevated serum parathyroid hormone and calcium ion were found before surgery. We suspected primary hyperparathyroidism, and color Doppler ultrasound suggested the presence of a thyroid mass. With informed consent by the patient and her family, we first removed the rib tumor, and one week later, resection of the parathyroid adenoma and thyroid mass was performed on both sides, and the patient recovered well after surgery.

Conclusion: In the case of parathyroid adenoma combined with brown tumor, the bone cyst will gradually decrease in size with time without treatment. If not, surgery should be performed as soon as possible.

Keywords: Brown tumor; Case report; Operation; Parathyroid adenoma; Primary hyperparathyroidism; Rib; Treatment.

Figure 1

Chest X-ray and computed tomography before surgery.

Figure 2

Ultrasound image of the thyroid.

Figure 3

Chest X-ray after surgery.

Figure 4

Pathological results of the rib tumor. A solid section of the cut surface, bleeding and bloody fluid are seen in the cyst cavity, fibrous tissue hyperplasia around the cystic cavity, reactive hyperplasia of bone-like tissue and trabecular bone in the deep cystic cavity, solid part of the area containing hemosiderin deposition, and multinucleated giant cell reaction.

Figure 5

Pathological results of the parathyroid adenoma. Left lower parathyroid gland combined with HE morphology and immunohistochemistry results diagnosis: parathyroid adenoma. Immunohistochemical results: CgA part (+), PTH (+), Ki67 (marker of proliferation Ki-67) approximately 1% (+), TG (-), and TTF-1 (thyroid transcription factor 1) (-).