Cammarata Francesco, Yakushkina Al'ona, Pennacchi Luca, Carsana Luca, Zerbi Pietro, Montecamozzo Giulio, Danelli Piergiorgio
Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy.
Department of General Surgery, Ospedale di Saronno, Saronno VA, Italy.
J Surg Case Rep. 2021 Jul 23;2021(7):rjab308. doi: 10.1093/jscr/rjab308. eCollection 2021 Jul.
Parathyroid lipoadenoma is a very rare cause of primary hyperparathyroidism. Preoperative imaging techniques often fail to detect such lesions, and even during surgery they can be misinterpreted just as fat tissue. A 62-year-old woman clinically monitored for primary hyperparathyroidism, with hypertension and a left nephrectomy for hydrouretheronephrosis caused by recurrent kidney stones. A neck ultrasound showed a nodule consistent with left parathyroid of 9 × 5 mm, which was not confirmed on single-photon-emission computed tomography/computed tomography (CT) scan. On surgery, a voluminous lesion with adipose appearance and texture was removed. Frozen sections and intraoperative parathyroid hormone (PTH) confirmed such lesion to be a parathyroid lipoadenoma. Parathyroid lipoadenomas are difficult to localize preoperatively. Sometimes they can be seen by ultrasound scan as hyperechoich lesion, but scintigraphy and CT often fail to identify them. Only the awareness of such lesions and the use of intraoperative PTH can avoid unnecessary extensive cervical exploration.
甲状旁腺脂肪瘤是原发性甲状旁腺功能亢进症非常罕见的病因。术前成像技术常常无法检测到此类病变，甚至在手术过程中它们也可能被误认作脂肪组织。一名62岁女性因原发性甲状旁腺功能亢进症接受临床监测，患有高血压，曾因复发性肾结石导致肾盂积水行左肾切除术。颈部超声显示一个9×5毫米的与左侧甲状旁腺相符的结节，但单光子发射计算机断层扫描/计算机断层扫描（CT）未证实。手术中，切除了一个外观和质地似脂肪的巨大病变。冰冻切片和术中甲状旁腺激素（PTH）证实该病变为甲状旁腺脂肪瘤。甲状旁腺脂肪瘤术前难以定位。有时超声扫描可将其视为高回声病变，但闪烁扫描和CT常常无法识别它们。只有认识到此类病变并使用术中PTH，才能避免不必要的广泛颈部探查。
