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Distant subcutaneous recurrence of a parathyroid carcinoma: abnormal uptakes in the 99mTc-sestamibi scan and 18F-FDG PET/CT imaging

The Korean Journal of Internal Medicine 2014년 29권 3호 p.383 ~ p.387

김상수(Kim Sang-Soo) - Pusan National University School of Medicine Department of Internal Medicine
전윤경(Jeon Yun-Kyung) - Pusan National University School of Medicine Department of Internal Medicine
이수형(Lee Soo-Hyung) - Pusan National University School of Medicine Department of Internal Medicine
김보현(Kim Bo-Hyun) - Pusan National University School of Medicine Department of Internal Medicine
김성장(Kim Seong-Jang) - Pusan National University School of Medicine Department of Nuclear Medicine
김용기(Kim Yong-Ki) - Pusan National University School of Medicine Department of Internal Medicine
김인주(Kim In-Ju) - Pusan National University School of Medicine Department of Internal Medicine

Abstract

We report a rare case of distant subcutaneous parathyroid carcinoma recurrence. A 50?year-old woman was referred to our hospital because of sustained hypercalcemia despite surgical removal of a parathyroid carcinoma. A focal uptake in the upper mediastinal area was detected in a 99mTc-sestamibi scan, and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) imaging demonstrated a subcutaneous mass. She underwent tumor resection, and the pathological findings were consistent with a parathyroid carcinoma. The postoperative serum parathyroid hormone (PTH) level remained within normal limits. However, a new palpable solitary mass was identified in the upper portion of the left breast 1 year postoperatively. Both a 99mTc?sestamibi scan and 18F-FDG PET/CT imaging revealed an abnormal lesion in the upper breast, and subsequent pathology reports confirmed parathyroid carcinoma metastasis. Serum PTH and calcium levels fell within normal ranges after tumor resection. Two subcutaneous recurrent lesions appeared likely due to tumor seeding during the previous endoscopic operation at a local hospital.