Journal of

Case Reports and Images in Surgery

 
     
Case Report
 
Large retropharyngeal undescended inferior parathyroid adenoma masquerading as part of retropharyngeal goitre
Agata M. Plonczak1, Aimee N. DiMarco1, Roberto Dina2, Pawan Pusalkar3, F. Fausto Palazzo1
1Department of Thyroid & Endocrine Surgery, Hammersmith Hospital, Imperial College Hospitals NHS Trust, London, UK
2Department of Histopathology, Hammersmith Hospital, Imperial College Hospitals NHS Trust, London, UK
3Department of Endocrinology, West Hertfordshire Hospitals NHS Trust, Watford, UK

Article ID: 100050Z12AP2017
doi: 10.5348/Z12-2017-50-CR-15

Address correspondence to:
Agata Marta Plonczak
Flat 26 Cranston Court
W127FE, London

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How to cite this article
Plonczak AM, DiMarco AN, Dina R, Pusalkar P, Palazzo FF. Large retropharyngeal undescended inferior parathyroid adenoma masquerading as part of retropharyngeal goitre. J Case Rep Images Surg 2017;3:57–60.


ABSTRACT

Introduction: Primary hyperparathyroidism is the third most common endocrine disorder with an incidence of 3 per 1000 in Europe. An increased prevalence coexistent parathyroid and thyroid disease has been described. A combination of a huge goitre with a scan negative undescended retropharyngeal inferior parathyroid adenoma is presented, which is unusual and currently absent from published literature.
Case Report: A 71-year-old female with asymptomatic primary hyperparathyroidism and compressive symptoms from a very large toxic multinodular goitre is presented. Localization studies failed to identify a parathyroid adenoma. Computed tomography scan showed the left thyroid lobe to be larger with a significant retropharyngeal component, extrathoracic tracheal compromise and minor retrosternal extension. A combined total thyroidectomy and parathyroidectomy via a cervical approach was performed. During mobilization of the highly developed superior pole of the left thyroid lobe, a separate retropharyngeal structure was identified. This structure, measuring up to 63 mm, was recognized as a very large adenoma of what we interpret as a non-descended left inferior parathyroid gland. Histology showed a multinodular goitre with an incidentally found 0.2 mm papillary thyroid carcinoma and hyperplasia of all three parathyroid glands, including the very large (21 g) non-descended left inferior gland.
Conclusion: We believe this case to be unique in published literature given the huge goitre, unusual nature of the parathyroid disease and coincidentally found microcarcinoma. The primary value of this case lies in the illustration of the difficulties of parathyroid localization in the presence of a large goitre.

Keywords: Hyperparathyroidism, Parathyroid, Parathyroidectomy, Thyroid cancer, Thyroid carcinoma, Thyroid surgery


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Author Contributions
Agata M. Plonczak – Substantial contribution to conception and design, Drafting the article, Revising critically for intellectual content, Final approval of the version to be published
Aimee N. DiMarco – Substantial contribution to conception and design, Revising the article critically for intellectual content, Final approval of the version to be published
Roberto Dina – Substantial contribution to conception and design, Acquisition of data, Revising the article critically for intellectual content, Final approval of the version to be published
Pawan Pusalkar – Substantial contribution to conception and design, Revising the article critically for intellectual content, Final approval of the version to be published
F. Fausto Palazzo – Substantial contribution to conception and design, Revising the article critically for intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Agata M. Plonczak et al. This article is distributed of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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