EP97 – Water-clear Cell Double Parathyroid Adenoma

      Vincent, Aurora1; Goyal, Rajen2; Patel, Uresh3; Robin, Jeffrey4; Vetto, Susan4; Sniezek, Joseph4 1 Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA 2 CellNetix Pathology, Seattle, WA 3 Seattle Radiology, Seattle, WA 4 Head and Neck Surgery, Swedish Medical Center, Seattle, WA   Background: Parathyroid adenoma is the most common cause of primary hyperparathyroidism, accounting for 85% of cases1-2.  Double-adenomas are a controversial source of hyperparathyroidism, with their true  incidence reported anywhere from 0-11% in the literature3.  A water-clear cell adenoma is an extremely rare variant of parathyroid adenomas, with only 21 cases reported in the literature. Objective: To present a rare case of a water-clear cell double parathyroid adenoma with review of radiologic imaging, surgical management, pathologic characteristics, and clinical implications. Method: Herein, we present a case of a water-clear cell double parathyroid adenoma in a 67 year old female.  We describe patient work-up with various imaging modalities including ultrasound, sestamibi scan, and 4D CT scan.  We also describe the surgical and post-operative management of the patient, pathologic findings, and the associated clinical implications. Results: The patient presented with primary hyperparathyroidism, a non-localizing sestamibi scan, and a non-localizing formal ultrasound.  Surgeon-performed in-office ultrasound was also non-specific.  4D CT revealed two large, bilateral masses, posterior to the thyroid gland, consistent with parathyroid adenomas.  The patient underwent parathyroidectomy revealing two superior water-clear cell parathyroid adenomas measuring 3.5cm and 5.5cm in greatest dimension, respectfully, with histologically normal inferior parathyroid glands.  The surgery proceeded without complications, and the patient recovered without issues. Discussion and Conclusion: Overall, water-clear cell parathyroid adenomas are exceedingly rare, with water-clear cell double-adenomas being even less common.  Their clinical characterization continues to develop as more cases are reported.   References:
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