세스타미비스캔에서 섭취가 관찰되지 않은 부갑상선암 1예

초록

Parathyroid carcinoma is rare, comprising only 0.1% to 5% of all patients with primary hyperparathyroidism. It present with severe hypercalcemia, bone disease, palpable neck mass, renal involvement. Sestamibi scanning is useful in the localization of primary hyperparathyroidsm, but it's sensitivity in parathyroid carcinoma have been unknown. A few case of parathyroid carcinoma were reported. but there have been no magnetic resonance imaging(MRI) of bone and parathyroid. So, we report a parathyroid carcinoma with brown tumor that pre-operation localization was done by MRI A 37-years-old woman admitted to the hospital due to pain on the left elbow. MRI of elbow showed multi-septated mass with heterogenous T2 signal intensity. The excisional biopsy of ulnar showed increased number of osteoclast. And then She was transferred to endocrinology department. The patient complained weakness, nausea, and 3 cm sized neck mass was examined. Elevated serum calcium and parathyroid hormone(PTH) concentration allowed the diagnosis of hyperparathyroidism. But, there was no abnormal uptake in 99mTc-sestamibi scan. Neck MRI showed 3.0 cm sized mass in the posterior side of left thyroid. Postoperative histological diagnosis was parathyroid carcinoma with focal invasion to thyroid parenchyma. After operation, the patients was treated with vitamin D and calcium because of hungry bone syndrome. The intact PTH level decreased and calcium level return to normal range.