Fig. 1
From: Primary hyperparathyroidism caused by enormous unilateral water-clear cell parathyroid hyperplasia
a Ultrasonography showed a 5.4 cm multilobulated hypoechoic well defined mass, localized in the lower half of the left thyroid lobe and submersible into the sub-clavicular area. The right parathyroid glands were within normal size. b Technetium (99mTc) sestamibi scanning revealed a persistent large area of increased activity corresponding to a left inferior double parathyroid adenoma. c Surgical specimen: A multilobulated parathyroid mass. d Histopathology examination: Water clear-cell parathyroid hyperplasia: Distinct cell membranes demarcating abundant water-clear cytoplasm, ranging from granular to finely vacuolated. Small and normal nuclei, sometimes polar and oriented towards adjacent stroma and blood vessels. d1 Hematoxylin and eosin, magnification 100X. d2 PTH staining, magnification 100X