Parathyroid Carcinoma Mimicking a Parathyroid Adenoma on [ 18 F]F-Choline-PET With Occult Metastases.

Bregenzer, Carola M; Trepp, Roman; Dammann, Florian; Kaderli, Reto M; Chouchane, Aziz; Seifert, Robert · Clin Nucl Med · 2026

case_report · Level V

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Abstract

An 80-year-old man with hypercalcemia and hyperparathyroidism was suspected of having a parathyroid adenoma, which was localized on [ 18 F]F-choline-PET/CT. Still, after surgical removal of the suspected adenoma with an intraoperative parathyroid hormone decrease of >50%, severe hypercalcemia recurred quickly. A repeated [ 18 F]F-choline-PET/CT raised suspicion of a single contralateral parathyroid adenoma or multiglandular disease. Given the inconclusive findings, a histological reassessment of the suspected parathyroid adenoma showed the presence of a singular vessel invasion, which alerted the diagnosis to parathyroid carcinoma. An additionally performed [ 18 F]FDG-PET/CT revealed a liver lesion and MRI confirmed multiple liver metastases, which could not be seen on [ 18 F]F-choline-PET/CT.

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