Pulmonary Embolism and Subclavian Vein Thrombosis
in a Patient with Parathyroid Carcinoma: Case Report
and Review of Literature
Worapaka Manosroi MD*,
Komson Wannasai MD**, Mattabhorn Phimphilai MD*
Affiliation :
* Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
** Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Parathyroid carcinoma is a rare etiology of primary hyperparathyroidism responsible for 0.4 to 5.2% of all
primary hyperparathyroidism cases. The overt hyperparathyroid bone or renal disease with palpable neck mass, as well as
severe hypercalcemia with extremely high parathyroid hormone, are clinical parameters raising the suspicion for parathyroid
carcinoma. However, a definite diagnosis can be confirmed only by examining the histopathology of the tumor. The curative
treatment solely depends on an en bloc surgical approach. Therefore, preoperative clinical diagnosis of carcinoma is
essential for optimal surgical planning. The present study reported asymptomatic subclavian vein thrombosis and pulmonary
embolism in parathyroid carcinoma, suggesting paraneoplastic syndrome of hypercoagulability in this cancer type. The
presence of this paraneoplastic syndrome in a case of overt clinical hyperparathyroidism in addition to a palpable neck
mass indicated the diagnosis of carcinoma preoperatively in the present patient, which led to an en bloc surgical plan. Since
this paraneoplastic syndrome can be asymptomatic, the exploration of this syndrome by a commonly used imaging technique
for parathyroid tumor localization, computerized tomography, would enable a preoperative diagnosis of cancer, especially
in an equivocal situation.
Keywords : Parathyroid carcinoma, Pulmonary embolism, Venous thromboembolism, Paraneoplastic syndrome, Hypercalcemia
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