Difficulties of differential diagnostics of primary hyperparathyroidism and sarcoidosis of cervical lymph nodes

Abstract

A case of isolated sarcoidosis of cervical lymph nodes is reported that was first erroneously interpreted as parathyroid adenoma. The patient was a 70 year-old woman presenting with hypercalcemia and elevated blood parathormone level. The ultrasound study showed the presence of a tissue mass measuring 1.5 cm in the projection of the inferior right parathyroid gland. The scintigraphic study with 99mTc MIBI demonstrated the accumulation of the radiopharmacological agent in the tissue mass that was identified as an adenoma of the parathyroid gland. The surgical removal of this neoplasm together with the adjacent lymph nodes resulted in the normalization of the blood calcium and parathormone levels. The histological study revealed sarcoidosis of lymph nodes in the absence of lesions in other organs. A literature review of the problem pertaining to hypercalcemia associated with sarcoidosis of cervical lymph nodes is presented with special reference to the difficulties encountered in differential diagnostics of this condition.