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Reprint requests: Fernando Martínez Regueira, PhD, Department of General Surgery, Clinica Universidad de Navarra, Av Pio XII, n 36, Pamplona, Spain 31008.
A 62-year-old woman presented with slight hypophosphatemia (2.4 mg/dL; normal range, 2.5–4.7) and mild
hypercalcemia (10.5 mg/dL; normal range, 8.1–10.4) in the preoperative assessment
of surgery for morbid obesity (body mass index of 44 kg/m2). Bone densitometry showed severe lumbar osteoporosis, and parathyroid hormone (PTH)
levels were 188 pg/mL (reference range, 12–72). Within this frame work, the most probable
diagnosis was primary hyperparathyroidism caused by a solitary adenoma. However, neither
cervical ultrasonography or scintigraphy with 99mTc-MIBI showed a parathyroid adenoma. C-11 methionine positron emission tomography/computed
tomography (Met-PET/CT) showed 1 focal high uptake (SUVmax = 5.5) located in contact with the left posterior wall of cervical esophagus (Fig 1). Endoscopic ultrasonography confirmed the presence of a 3.5-cm, oval-shaped nodule
in contact with the posterior surface of the esophagus but not infiltrating esophageal
wall.
Fig 1Methionine–positron emission tomography/computed tomography showing an uptake (SUV
5,5) located in contact with the posterior wall of the esophagus at the level of the
thyroid cartilage.
