11/100. Brown tumor of the maxilla associated with primary hyperparathyroidism.Brown tumors represent the terminal stage of the remodeling processes during primary or secondary hyperparathyroidism. During the last three decades primary hyperparathyroidism has been recognized much more commonly and the increase has generally been attributed to the routine determination of calcium by new automated methods and the advent of new and more objective parathyroid hormone radioimmunoassay techniques. early diagnosis and successful treatment of the disease have made clinical evidence of bone disease uncommon. While, the mandible is the most frequently involved bone in the head and neck region, maxillary involvement is extremely rare. A case of brown tumor on the maxilla associated with primary hyperparathyroidism is reported. This patient presented multiple skeletal lesions, which are uncommonly seen nowadays. The diagnosis was suggested by the clinical history and confirmed by biochemical, radiological and histopathological determinations. Excision of a parathyroid adenoma normalized the metabolic status. Excision of the maxillary mass led both histopathological confirmation of the disease and early masticator rehabilitation.- - - - - - - - - - ranking = 1keywords = mandible (Clic here for more details about this article) |
12/100. Somatic mutations of the MEN1 gene and microsatellite instability in a case of tertiary hyperparathyroidism occurring during high phosphate therapy for acquired, hypophosphatemic osteomalacia.Somatic mutations of the men type 1 (MEN1) gene were recently shown to be responsible for tumorigenesis in 13-26% of sporadic, nonfamilial primary hyperparathyroidism. However, it is unknown whether these mutations are also involved in tumorigenesis of parathyroid glands occurring during high phosphate therapy for hypophosphatemic rickets or osteomalacia. A male patient with adult-onset, hypophosphatemic osteomalacia had been treated with 1alpha-OHD3 and oral phosphate for 13 yr when tertiary hyperparathyroidism developed. After total resection of four enlarged parathyroid glands and autotransplantation of a hyperplastic gland, the patient has continued to do well for the last 2 yr. sequence analysis of the coding exons of MEN1 gene revealed a 36-bp deletion with a 2-bp insertion (exon 2) in the right upper parathyroid gland accompanied with loss of heterozygosity at 11q13 locus and a heterozygous mutation of 2-bp deletion (AG) in exon 10 in the right lower gland, in which microsatellite instability was also found. No MEN1 gene mutation was detected in the other two hyperplastic parathyroid glands or in the peripheral blood. These findings indicate that MEN1 gene mutations contributed to tumorigenesis of the right upper parathyroid gland in this case of phosphate-induced tertiary hyperparathyroidism. Very recently a bone tumor was found in the right femoral neck, and the tumor (chondroblastoma) was resected.- - - - - - - - - - ranking = 0.026791938686998keywords = lower (Clic here for more details about this article) |
13/100. A case of ectopic parathyroid gland hyperplasia in the pyriform sinus.Variability in the location of parathyroid glands is well recognized. There are usually 4 parathyroid glands located in the area of the thyroid gland, but embryologically, they may be found anywhere from the angle of the jaw to the pericardium. We report a case of an ectopic parathyroid gland in the pyriform sinus. It appeared as a tumorous lesion in the pyriform sinus owing to progress of secondary hyperparathyroidism.- - - - - - - - - - ranking = 0.49545428346421keywords = jaw (Clic here for more details about this article) |
14/100. An ectopic mediastinal parathyroid adenoma accurately located by a single-day imaging protocol of Tc-99m pertechnetate-MIBI subtraction scintigraphy and MIBI-SPECT-computed tomographic image fusion.PURPOSE: Because ectopic parathyroid adenoma (PA) is a frequent cause of failed initial surgery, an imaging approach with accurate preoperative localization is recommended by some authors in patients with primary hyperparathyroidism (HPT). methods: The authors describe a 52-year-old woman in whom primary HPT was diagnosed incidentally during a screening program for osteoporosis. The peculiarity of this case is that the patient was examined before operation in a single-day multimodal imaging protocol based on the combination of high-resolution cervical ultrasound, planar Tc-99m pertechnetate-MIBI scans, and an MIBI-SPECT-computed tomographic (CT) image fusion study. An ectopic PA was accurately located in the upper middle mediastinum, close to the lower margin of the sternal notch. RESULTS: Guided by the MIBI-SPECT-CT fusion images, the surgeon performed a limited median sternotomy and easily removed the PA that was revealed before operation. To confirm the completeness of resection, a bilateral neck exploration was performed through the same incision, with identification of three normally sized parathyroid glands. CONCLUSIONS: Our experience suggests the utility of multimodality imaging procedures for the accurate preoperative localization of PAs, particularly when they are present in ectopic mediastinal locations. Such procedures, including the MIBI-SPECT-CT image fusion study, can be performed in a single day.- - - - - - - - - - ranking = 0.026791938686998keywords = lower (Clic here for more details about this article) |
15/100. Radioguided parathyroidectomy for reexploration of primary hyperparathyroidism-- a case report.BACKGROUND: We report a case of radioguided parathyroidectomy using a hand-held gamma probe for the reexploration of primary hyperparathyroidism. CASE REPORT: The patient was a 66-year-old Japanese woman. She had previously undergone surgical exploration for primary hyperparathyroidism due to a left inferior parathyroid tumor detected by 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy. However, the pathological diagnosis of the resected tumor was adenomatous goiter. 99mTc-MIBI scintigraphy was performed again and revealed an abnormal uptake close to the right lower lobe of the thyroid. However, venous sampling for PTH measurements did not support this finding. Sestamibi was injected and the radioactivity was measured pre- and intraoperatively with a hand-held gamma probe. With the patient under general anesthesia, the tumor, which was adjacent to the right recurrent laryngeal nerve, was resected, but it contained only a low level of radioactivity ex vivo, indicating that it was not a parathyroid tumor. A hand-held gamma probe accurately located the radioactive parathyroid tumor in the right lower neck. The resected tumor measured 15 x 6 mm and weighed 331 mg. The pathological diagnosis was parathyroid adenoma. CONCLUSIONS: Radioguided parathyroidectomy is useful to localize parathyroid tumors not only in primary hyperparathyroidism at the initial neck exploration but also for reexploration.- - - - - - - - - - ranking = 0.053583877373996keywords = lower (Clic here for more details about this article) |
16/100. Quantitative ultrasound of the hand phalanges and calcaneus revealed skeletal abnormalities due to primary hyperparathyroidism: a case report.Primary hyperparathyroidism (PHPT) is a common disease causing bone loss in elderly patients. We report a case study of a 36-year-old woman with PHPT. Quantitative ultrasound (QUS) assessment of the phalanges and calcaneus revealed significantly lower than normal values for age. This observation was confirmed by measuring bone mineral density in different skeletal sites using dual-energy X-ray absorptiometry (DXA). Subsequent parathyroid adenoma surgery normalized calcium metabolism, resulting in a progressive increase of BMD and ultrasound (US) parameters. This report has shown an ability of peripheral QUS examinations (phalanges and calcaneus) in early detection of bone alterations caused by PHPT in a young woman. Skeletal changes after surgery could be evaluated by QUS in a similar manner to that used in DXA.- - - - - - - - - - ranking = 0.026791938686998keywords = lower (Clic here for more details about this article) |
17/100. 'Suppressed' double adenoma--a rare pitfall in minimally invasive parathyroidectomy.Since the introduction of a quick intraoperative parathyroid hormone (QPTH) assay, complete removal of hyperfunctioning parathyroid tissue can be proven during surgery. We report on a scintigraphically and biochemically documented patient with persistent primary hyperparathyroidism (PHPT) caused by suppressed hyperfunctioning parathyroid tissue. A left lower enlarged parathyroid gland was resected by minimally invasive open parathyroidectomy. QPTH measurements confirmed complete resection of hyperfunctioning tissue and histology showed a tumorous enlarged left lower parathyroid gland. The patient was normocalcemic until 1 month after surgery, when serum calcium increased again. A MIBI scan 6 months after surgery showed no evidence of hyperfunctioning parathyroid tissue. After an increase of PTH, a third MIBI scan another 3 months later was performed. Increased tracer uptake behind the lower pole of the right thyroid lobe was seen and confirmed by ultrasonography. Another tumorous enlarged parathyroid gland was removed. These findings support the hypothesis that smaller yet abnormal parathyroid glands can be suppressed and may become hypersecretory if left in situ after surgical removal of the larger gland.- - - - - - - - - - ranking = 0.080375816060993keywords = lower (Clic here for more details about this article) |
18/100. Primary hyperparathyroidism in an elderly woman: surgical reversibility of profound mental state problems due to mild hypercalcaemia.BACKGROUND: Clinical case of primary hyperparathyroidism in an 89 year old woman causing profound neuropsychiatric symptoms associated with relatively mild increases in serum calcium levels. OBJECTIVES: To demonstrate that lowering of serum calcium levels by medical treatment (biphosphonate), provided a scientific basis from which to treat a very elderly woman with neuropsychiatric symptoms with definitive surgery. METHOD: Case report. RESULTS: The use of biphosphonate therapy led to marked but temporary improvements in her mental state. CONCLUSION: A trial of reducing serum calcium levels with biphosphonate appears to be indicated in elderly patients with mild primary hyperparathyroidism and neuropsychiatric disorders.- - - - - - - - - - ranking = 0.026791938686998keywords = lower (Clic here for more details about this article) |
19/100. Bone and In-111 octreotide imaging in oncogenic osteomalacia: a case report.osteoporosis associated with aging is considered the most common cause of bone mineral loss. osteomalacia, abnormal bone loss with excess osteoid formation, is another cause. A 46-year-old man was examined for chronic hip and lower extremity pain that had not been relieved by nonsteroidal anti-inflammatory drugs or steroids. A bone scan revealed multiple foci of activity. The serum calcium level was normal, but phosphorus values were low. These results did not correspond with the indications for typical hyperparathyroid disease, so another cause was sought. An In-111 octreotide scan showed a focus in the right humeral head. At surgery, a phosphaturic tumor of mesenchymal origin was partially resected. Oncogenic osteomalacia is related to secretion of a phosphaturic material from a fibroblast growth factor.- - - - - - - - - - ranking = 0.026791938686998keywords = lower (Clic here for more details about this article) |
20/100. Neurofibromatosis type 1, hyperparathyroidism, and osteosarcoma: interplay?Neurofibromatosis type 1 (NF 1) is a syndrome with a predisposition for benign and malignant tumor development. Of the malignant neoplasms, osteogenic sarcomas are rare but have been described. There are some reports of patients with neurofibromatosis type 1 with a parathyroid adenoma and hyperparathyroidism. Also, there are studies that imply that the parathyroid hormone plays a role in the regulation and modulation of oseogenic sarcomas in vitro. We report about a 50-year-old female suffering from neurofibromatosis type 1, with a 3-year documented history of untreated hyperparathyroidism and a parathyroid adenoma. The patient developed a mandibular osteogenic sarcoma. To our knowledge, this is the first reported case occurring in the mandible. The unusual tumor site for a patient with neurofibromatosis type 1, the conjugation with hyperparathyroidism and the rapid growth of an osteogenic sarcoma are intriguing.- - - - - - - - - - ranking = 1keywords = mandible (Clic here for more details about this article) |
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