PDF(Pubmed)
Abstract：
Technetium-99m sestamibi single-photon emission computed tomography/computed tomography (99mTc-sestamibi SPECT/CT) is a mainstay of the pre-operative localization of parathyroid lesions. We report here the case of a 30 year-old woman with a fortuitously discovered 2 cm cervical mass for which a parathyroid origin was originally suspected due to its retro-thyroidal localization and a personal history of nephrolithiasis. Normal serum calcium and parathyroid hormone (PTH) levels excluded primary hyperparathyroidism, raising suspicion of a non-functional parathyroid adenoma, and SPECT/CT imaging showed that the mass was 99mTc-sestamibi-avid. Fine-needle aspiration (FNA) was performed; cytology was non-diagnostic but the needle washout was negative for thyroglobulin, calcitonin and PTH, arguing against a thyroidal or parathyroidal origin of the mass. Core needle biopsy revealed a schwannoma, ostensibly originating from the recurrent laryngeal nerve; upon surgical resection, it was finally found to arise from the esophageal submucosa. This case illustrates the fact that endocrinologists, radiologists, nuclear medicine, head and neck, and other specialists investigating patients with cervical masses should be aware that schwannomas need to be considered in the differential diagnosis of focal 99mTc-sestamibi uptake in the neck region.
摘要：
Technetium-99msestamibi单光子发射计算机断层扫描/计算机断层扫描（99mTc-sestamibiSPECT/CT）是甲状旁腺病变术前定位的主要依据。我们在这里报告了一名30岁妇女的病例，该妇女偶然发现了2厘米的宫颈肿块，由于其甲状腺后定位和个人肾结石病史，最初怀疑是甲状旁腺起源。正常血清钙和甲状旁腺激素（PTH）水平排除原发性甲状旁腺功能亢进，怀疑是无功能的甲状旁腺腺瘤,SPECT/CT显像显示肿块为99mTc-sestamibi-avid。进行细针穿刺（FNA）；细胞学检查是非诊断性的，但甲状腺球蛋白的针头冲洗呈阴性，降钙素和PTH，反对肿块的甲状腺或甲状旁腺起源。核心针活检显示神经鞘瘤,表面上起源于喉返神经；手术切除后，最终发现它是由食管粘膜下层引起的。这个案例说明了内分泌学家，放射科医生,核医学,头部和颈部,和其他研究宫颈肿块患者的专家应该意识到，在颈部局灶性99mTc-sestamibi摄取的鉴别诊断中，需要考虑神经鞘瘤。
