Parathyroid glands are four small-sized glands, located behind the upper and lower poles of the thyroid gland. The two superior glands are usually located at the posterolateral aspect of the upper pole of the thyroid whereas the inferior glands are found frequently near the lower thyroid pole. However, parathyroid glands can be found in ectopic positions in 6%-16% of normal adults. [1] These ectopic positions include intrathyroidal, [1,2] carotid sheath, [1] retroesophageal sites, mediastinal sites, and thymus. [1][2][3] Compared to the superior parathyroid glands the inferior glands demonstrate a greater degree of variability in location since they might stopover anywhere along the thyrothymic tract as they descend with the thymus gland from the angle of the mandible down to the pericardium during embryogenesis. [4] Parathyroid adenomas can be found in various ectopic positions including the carotid sheath. We report a 52-year-old Libyan woman who presented with neck mass and a fragility fracture. Her serum Calcium was elevated (14.3 mg/dl), as well as her parathyroid hormone (1202 pg/ml). Technetium-99m-sestamibi scan showed a large localized parathyroid adenoma at the upper lateral left aspect of the neck just below the left submandibular gland. The patient underwent surgical resection, and the histopathology confirmed the diagnosis of parathyroid adenoma.The rarity of the ectopic parathyroid adenoma in the carotid sheath led to a delayed diagnosis of this case. Therefore, ectopic parathyroid adenoma should be considered in the differential diagnosis of masses that arise from the carotid sheath.
Background: Pancreatic neuroendocrine tumors (NETs) are rare; representing less than 10% of all primary pancreatic tumors. The minority of these tumors are functional producing a clinical syndrome according to the hormone secreted. ACTH production by pancreatic NETs is rare and even rarer, it occurs from liver metastasis later in the course of the disease. Case Report: We report a case of a 30-year-old Libyan man who presented with Cushing's syndrome due to ectopic ACTH production from liver metastases of a pancreatic NET. The pancreatic NET was diagnosed 7 years previously when it was considered a nonfunctional at the time of diagnosis; the tumor was resected completely then. In the current presentation there was no evidence of the primary tumor but multiple liver metastases were present. Conclusions: This report highlights the fact that initially non-functional pancreatic NETs may present later with a functional hormonal syndrome either from the primary tumor itself or from its metastatic secondary tumors elsewhere.
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