Water-clear cell adenoma of the mediastinal parathyroid gland

Abstract

Water-clear cell adenoma of the parathyroid gland is a rare neoplasm that consists of cells with abundant clear-pink cytoplasm. There have only been 19 cases reported in the English literature. Here we report a case of water-clear cell adenoma of the mediastinal parathyroid gland. A 70-year-old male patient presented to the hospital with back pain and a mediastinal mass 6 cm in size was detected. After excision and microscopic evaluation, uniform, large clear cells with fine cytoplasmic vacuolization, without nuclear atypia, and arranged in solid and acinar patterns were revealed. The cells formed nests that were separated by fine fibrovascular septae and stained positively with anti-parathyroid hormone. To the best of our knowledge, this has not been previously reported in this location. In the differential diagnosis of clear cell lesions of the mediastinum, water-clear cell parathyroid adenoma should be considered.

Brief review of parathyroid adenoma; problems caused by water clear cells

“…In another study, an A with a diameter of 6×2.5×2.cm was presented, but preoperative Ca and PTH values were not available in this study (8). When WCCA was searched on the favorite search engine, 35 titles were seen.…”

“…A small proportion of cases may be associated with hereditary multiple endocrine neoplasia. External radiation exposure of the head and neck region during childhood and long-term lithium use also in the etiology of PA is thought to take place (1,8).…”

“…PC is a malignant neoplasia that develops from parathyroid parenchymal cells (1,8). These tumors are extremely rare and account for less than 1% of primary HPT cases.…”

Institutional characterisation of water clear cell parathyroid adenoma: a rare entity often unrecognised by TC-99m-sestamibi scintigraphy

“…After reviewing the PubMed/MEDLINE search engine and conducting separate searches using standard web browsers for journals not indexed in these databases, we found available and readable descriptions of 24 WCCAs up until November 2020. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] These cases, including our six cases reported herein, are briefly summarised in Table 3 along with some baseline clinical characteristics. From the current literature, it seems evident that the majority of WCCA cases published are large tumours arising predominantly in female patients exhibiting classical features of PHPT.…”

“…1 Around 90 cases of PLA have been previously described as causative of primary hyperparathyroidism (PHPT) in the literature, 2,3 but significantly fewer WCCAs have been reported, making the latter entity the most unusual histological variant in terms of parathyroid neoplasia. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Moreover, rare descriptions of a predominant water clear cell morphology in PHPT patients with four-gland disease also exist, entitled water clear cell hyperplasia (WCCH). 24 Although previously quite frequently described, this latter entity is now declining in incidence.…”