[Cervico-mediastinal hematoma secondary to extracapsular hemorrhage of parathyroid carcinoma. Clinical case and review of the literature].
Extracapsular parathyroid haemorrhage is a rare but ominous occurrence, which may cause cervico-mediastinal haematoma and a severe calcaemia imbalance. We identified only 23 cases reported in the literature and these were always secondary to adenoma, hyperplasia or cysts, and never to carcinoma. We describe a case of a 56-year-old man who was admitted to our Institute because of the sudden development of an anterior neck swelling, together with dysphagia, dyspnoea and hoarseness. Physical examination revealed a large ecchymosis extending from the anterior neck to the upper chest, while the early symptoms had disappeared. Laboratory studies, ultrasonography and 99mtTC-Sestamibi scintiscan demonstrated the presence of primary parathyroidism due to a right inferior parathyroid neoplasm. At operation, the parathyroid was excised en bloc with the right thyroid lobe because they were joined together by an extensive fibrous reaction. Histological examination showed a well-differentiated parathyroid carcinoma with evidence of recent haemorrhage. To the best of our knowledge this is the first case of extracapsular haemorrhage due to a parathyroid carcinoma. In summary, although parathyroid haemorrhage is a rare condition, it should always be suspected when a painful mass or diffuse swelling suddenly occurs in the anterior neck, with or without ecchymosis, especially when serum calcium and phosphorus are abnormal.
Erdas
Enrico
E
Dipartimento di Scienze Chirurgiche e Trapianti d'Organo, Sezione di Chirurgia Generale II, Università degli Studi di Cagliari, Via Ospedale, 46, 09124 Cagliari.
Licheri
Sergio
S
Lai
Maria Letizia
ML
Pisano
Giuseppe
G
Pomata
Mariano
M
Daniele
Giovanni Maria
GM
D002291:Carcinoma, Papillary / Q000150:complications*; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000209:etiology*; D008875:Middle Aged; D009333:Neck; D010282:Parathyroid Neoplasms / Q000150:complications*