11 March 2021: Articles
A Woman with a 27-Year History of Hyperparathyroidism and Hypercalcemia Who Was Diagnosed with Low-Grade Parathyroid Carcinoma
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Monika Kaszczewska A* , Michał Popow A , Witold Chudziński A , Joanna Kaszczewska B , Magdalena Bogdańska B , Joanna Podgórska B , Agnieszka Czarniecka B , Zbigniew Gałązka ADOI: 10.12659/AJCR.930301
Am J Case Rep 2021; 22:e930301
Table 1. Summary of the important points in the diagnostic and treatment period.
| Year | Interventions/tests/diagnosis |
|---|---|
| 1989–1992 | ESWL procedures due to symptomatic nephrolithiasis |
| 1992 | Diagnosis of hypercalcemia secondary to primary hyperparathyroidism (adenoma of right lower parathyroid gland) |
| 1993 | Right lower parathyroidectomy and partial resection of thyroid gland due to nodular lesions |
| 2006 | Symptomatic hyperparathyroidism - prathyroidectomy of a recurrent lesion in the area of previously removed right lower parathyroid gland, focal parathyromatosis |
| 2006–2010 | Acceleration of the hyperparathyroidism and growth of adenomatous lesions – 3 surgeries. Non-specifically increased Ki-67 proliferation index (6%) in histopathological examination of parathyroid adenomas |
| 2010, 2013, 2014 | Surgical treatment due to adenomatous parathyroid lesions in the right side of the neck |
| 2014 | Exclusion of the mutation of RET protooncogene, negative staining against parafibromin, advanced stage of nephrocalcinosis in right kidney and lower pole of left kidney, bell-shaped thorax in imaging examination, right sided parathyromatosisSurgical treatment: resection of pathological parathyroid tissue as well as parathyromatosis located in muscles and adipose tissue because of hypercalcaemic crisisFarmacological treatment: calcimimetics – cinacalcet together with zoledronic acid and calcitonin and next denosumab |
| November 2015 | Operation of another recurrent lesion, located between the right jugular vein and right common carotid artery. Diagnosis of the parathyroid cancer. Treatment with denosumab and vitamin D |
| January 2016 | Pharmacological treatment of severe hypercalcaemia. Exclusion of the germinal mutation of gene CDC73 |
| May 2016 | Another hypercalcaemic crisis resistant to pharmacological management and emergency surgical (resection of 26mm diameter tumor infiltrating the sternum manubrium) and pharmacological treatment (high doses of zoledronic acid and cinacalcet). Developing the pulmonary embolism |
| September 2016 | Operation of another four lesions: three in the cervical area and one located retroclavicularly. Discovery of a somatic mutation CDC73/HRPT2 |
| 2017–2019 | Parathyroidectomy, 33 courses of radiotherapy (fractional dose 2 Gy, total radiation dose 66 Gy on neck and mediastinum region) complicated and additional pharmacological treatment (cinacalcet and denosumab) |