Presentation
Palpable nodule on the right side of neck. Previous left thyroid lobectomy for a benign condition.
Patient Data
A well circumscribed echogenic nodule posterior to and separate from the right lobe of the thyroid. The lesion has internal Doppler, but is not hypervascular. No calcification. No adenopathy in the remainder of the neck.
A well circumscribed mixed density nodule posterior to the right lobe of the thyroid. A thin tissue plane separates the lesion from adjacent vasculature, muscles and the right lobe of the thyroid. No calcification or cystic component. Mixed enhancement pattern.
Large nodule: parathyroid adenoma with no atypia or malignancy.
Immunohistochemistry: thyroglobulin negative; synaptophysin and chromogranin positive.
Smaller tissue sample: thyroid tissue with features of multinodular goiter. No malignancy.
Images courtesy of Dr. Reenee Munbodh
Case Discussion
Imaging most compatible with a parathyroid adenoma. The differential of an enlarged lymph node, an eccentric thyroid nodule, or a nerve sheath tumor were considered unlikely.
Lab results concordant with imaging suspicion of a parathyroid adenoma. The serum calcium and parathyroid hormone levels were raised.
With thanks to Drs. D van der Merwe & A. Macdonald.
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