Letter to the Editor
Mediastinal parathyroid lipoadenoma as cause of primary hyperparathyroidism
Lipoadenoma paratiroideo mediastínico como causa de hiperparatiroidismo primario
Álvaro Vidal-Suárez
, María del Mar Roca-Rodríguez, Isabel Torres-Barea
Corresponding author
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Cádiz, Spain
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Both the anteroposterior (A) and posteroanterior (B) scintigraphy shows an increased right paramediastinal density. In the SPECT-CT images, a mass is observed that coincides with said uptake in the coronal section (<span class="elsevierStyleSmallCaps">C</span>) and the sagittal section (D). Increased uptake in the thyroid bed, compatible with multinodular goitre, and physiological uptake in the salivary glands can also be observed.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The parathyroid gland is made up of chief cells and oxyphilic cells, surrounded by stroma, the main component of which is adipose tissue, which accounts for 25% of the parathyroid content in adults. In parathyroid adenomas, prominent parathyroid cellularity can be seen, with a significant decrease in the stroma. Parathyroid lipoadenoma is a rare variant of parathyroid adenoma, characterized by hyperfunctioning parathyroid cells in an abundant fatty stroma<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 76-year-old woman with a history of arterial hypertension and a previous diagnosis of non-toxic multinodular goitre without follow-up. During an outpatient study for weakness and incipient cognitive disorders, severe hypercalcemia of 18.3<span class="elsevierStyleHsp" style=""></span>mg/dL and a creatinine levels of 2.3<span class="elsevierStyleHsp" style=""></span>mg/dL were detected, for which she was admitted for treatment and study. Previous laboratory tests showed a progressive increase in calcium levels for at least 6 years, which had not been studied, with levels in the previous year of 15<span class="elsevierStyleHsp" style=""></span>mg/dL.</p><p id="par0015" class="elsevierStylePara elsevierViewall">During admission, she showed parathyroid hormone (PTH) levels of 2,310.7<span class="elsevierStyleHsp" style=""></span>pg/mL (VN: 15–68), 25-OH-vitamin D of 12<span class="elsevierStyleHsp" style=""></span>ng/mL (VN: 30–100) and TSH of 0.12<span class="elsevierStyleHsp" style=""></span>μIU/mL (VN: 0.35–4.94), with normal FT4. Cervical ultrasound revealed multinodular goitre, with a dominant nodule of 27<span class="elsevierStyleHsp" style=""></span>mm. The biopsy of the dominant nodule for cytological study was compatible with nodular hyperplasia. The spinal X-ray showed a L4–L5 fracture, with bone densitometry compatible with osteoporosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The chest X-ray showed a significant increase in right paratracheal density, which corresponded in the 99mTc-sestamibi SPECT scintigraphy with a heterogeneous uptake of the radiotracer (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The cervicothoracic CT revealed a right paratracheal mass with well-defined borders, with solid and fat densities, and dimensions of 5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>cm, without other lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A biopsy of the mass was performed, obtaining a whitish-brownish sample consisting of adipose tissue and tissue with benign characteristics, with a low proliferative index (Ki67 of 1%), confirming its parathyroid origin with immunohistochemical techniques (positive for the expression of panCK, PAX8 and chromogranin, and negative for PLAP, TTF1 and thyroglobulin). All compatible with parathyroid lipoadenoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Before surgical treatment, calcaemia levels of 10−11<span class="elsevierStyleHsp" style=""></span>mg/dL were achieved with cinacalcet 30<span class="elsevierStyleHsp" style=""></span>mg/day. The patient underwent a total thyroidectomy and resection of the mediastinal mass. Intraoperative PTH was determined with evidence of progressive reduction (baseline: 609.8<span class="elsevierStyleHsp" style=""></span>pg/mL; 5′: 240<span class="elsevierStyleHsp" style=""></span>pg/mL; 10′: 155.6<span class="elsevierStyleHsp" style=""></span>pg/mL; 20′: 132.6<span class="elsevierStyleHsp" style=""></span>pg/mL). The mediastinal surgical specimen, 91<span class="elsevierStyleHsp" style=""></span>g and 9<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3.5<span class="elsevierStyleHsp" style=""></span>cm, had a nodular appearance with a smooth and yellowish surface, covered by a fibrous capsule. The definitive histological study confirmed thyroid nodular hyperplasia and mediastinal parathyroid lipoadenoma.</p><p id="par0035" class="elsevierStylePara elsevierViewall">At hospital discharge the patient's calcaemia was 9.34<span class="elsevierStyleHsp" style=""></span>mg/dL and she received outpatient treatment with LT4 and calcium and vitamin D supplements. Five months after surgery, she had a calcaemia of 9.6<span class="elsevierStyleHsp" style=""></span>mg/dl, PTH 43.3<span class="elsevierStyleHsp" style=""></span>pg/mL and vitamin D of 42.3<span class="elsevierStyleHsp" style=""></span>ng/mL, remaining asymptomatic.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Parathyroid lipoadenomas are a rare variant of parathyroid adenoma with an incidence of 0.5–1.6% in primary hyperparathyroidism<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. A study by Hyrcza et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>, which reviews 66 cases described, establishes that the mean age at diagnosis is 56 (range 20–94 years) and the median tumour size is 2.3<span class="elsevierStyleHsp" style=""></span>cm, significantly higher than adenomas. They are mainly located in the neck, although some ectopic cases have been reported, especially intrathymic and in the mediastinum<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. No cases associated with multiple endocrine neoplasia have been described<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. The case we report suggested a differential diagnosis with parathyroid carcinoma, given the remarkably high levels of calcaemia and PTH, as well as its considerable dimensions, which were ruled out after pathological analysis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Histologically it is characterized by a prominent fatty stroma in a proportion greater than 30% of the parathyroid tissue<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. Within the stroma are intermixed hyperfunctioning parathyroid cells, giving an impression of apparent low cellularity. It contrasts with parathyroid adenoma, which is characterised by parathyroid hypercellularity with very little stroma (<5%). No cases of aggressive behaviour lipoadenomas have been reported and no recurrences have been notified after surgical treatment<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0050" class="elsevierStylePara elsevierViewall">One of the challenges posed by its diagnosis is tumour localization using imaging techniques, due to the high proportion of fat, which reduces diagnostic sensitivity. On ultrasound, these lesions are hyperechogenic, unlike the hypoechogenicity of adenomas. On CT, they can also be confused with lipomas, lymph nodes, or other lipid-rich lesions. SPECT scintigraphy shows a sensitivity of 89–95% for parathyroid adenomas, significantly decreased in parathyroid lipoadenomas due to the lower density of parathyroid cells and excess fat<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. Hyrcza et al. described a sensitivity of 56% for ultrasound, 55% for CT and 57% for 99mTc-sestamibi scintigraphy<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, we report a case of atypical parathyroid lipoadenoma, which presents with severe hypercalcemia, as well as an unusual size and location.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vidal-Suárez Á, Roca-Rodríguez M.M., Torres-Barea I. Lipoadenoma paratiroideo mediastínico como causa de hiperparatiroidismo primario. Med Clin (Barc). 2021;156:365–366.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2356 "Ancho" => 2500 "Tamanyo" => 283682 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">99mTc-sestamibi SPECT-scintigraphy. Both the anteroposterior (A) and posteroanterior (B) scintigraphy shows an increased right paramediastinal density. In the SPECT-CT images, a mass is observed that coincides with said uptake in the coronal section (<span class="elsevierStyleSmallCaps">C</span>) and the sagittal section (D). Increased uptake in the thyroid bed, compatible with multinodular goitre, and physiological uptake in the salivary glands can also be observed.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parathyroid lipoadenomas: a rare cause of primary hyperparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.S. Chow" 1 => "L.A. Erickson" 2 => "H.S. Abu-Lebdeh" 3 => "R.A. Wermers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4158/EP.12.2.131" "Revista" => array:7 [ "tituloSerie" => "Endocr Pract." "fecha" => "2006" "volumen" => "12" "paginaInicial" => "131" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16690459" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0090429518302693" "estado" => "S300" "issn" => "00904295" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parathyroid lipoadenoma: a clinicopathological diagnosis and possible trap for the unaware pathologist" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.D. Hyrcza" 1 => "P. Sargin" 2 => "O. Mete" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12022-015-9404-5" "Revista" => array:6 [ "tituloSerie" => "Endocr Pathol." "fecha" => "2016" "volumen" => "27" "paginaInicial" => "34" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26585863" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parathyroid lipoadenoma: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.J. Turner" 1 => "R.N. Baergen" 2 => "P.K. Pellitteri" 3 => "L.A. Orloff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0194-59989670193-6" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg." "fecha" => "1996" "volumen" => "114" "paginaInicial" => "313" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8637760" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare cause of primary hyperparathyroidism: parathyroid lipoadenoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Özden" 1 => "S. Güreşci" 2 => "B. Saylam" 3 => "G. Dağlar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anl.2018.05.001" "Revista" => array:6 [ "tituloSerie" => "Auris Nasus Larynx." "fecha" => "2018" "volumen" => "45" "paginaInicial" => "1245" "paginaFinal" => "1248" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29778311" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack522218" "titulo" => "Acknowledgements" "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">We wish to thank Dr. María José Añón Requena and Dr. Pedro Muriel Cueto, CMU of Pathological Anatomy of the University Hospital of Puerto Real and Puerta del Mar, respectively, for providing us with key information on the pathological diagnosis. Also, thanks to Dr. Manuel Aguilar Diosdado, Director of the CMU of Endocrinology and Nutrition of the Puerta del Mar University Hospital, for the time spent reviewing this article.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000007/v1_202104020834/S2387020621000929/v1_202104020834/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000007/v1_202104020834/S2387020621000929/v1_202104020834/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621000929?idApp=UINPBA00004N" ]
