Water-Clear Cell Adenoma of Parathyroid Gland: A Case Report and Literature Review

Abstract

Parathyroid adenoma of water-clear cell type is an extremely rare neoplasm, and only very few cases have been reported to date.  Here we report a case of water-clear cell adenoma of the parathyroid in a 59-year old female patient who presented with hypercalcemia and high parathyroid hormone (PTH) level.  Sestamibi scan showed a possible parathyroid adenoma involving the right superior parathyroid gland.  The surgically excised specimen weighed 13.3 grams and contained a cystic hemorrhagic mass measuring 1 x 1 x 0.8 cm.  Histologically, the tumor mass was surrounded by a thin fibrous capsule with a compressed thin rim of normal parathyroid tissue.  High power examination revealed the tumor to be composed of cells with vacuolated cytoplasm, and with minimal nuclear pleomorphism.  Immunohistochemical analysis demonstrated positive staining for PTH and chromogranin.  Histological examination of the right inferior parathyroid gland showed unremarkable parathyroid tissue.  Post-operatively, the patient’s serum calcium level returned to normal.  These findings support the diagnosis of water-clear cell adenoma of the parathyroid gland.  In this report, we also reviewed related literature and compared our case with similar cases reported before.