ABSTRACT
Tatton-Brown-Rahman syndrome (TBRS) is a rare overgrowth syndrome first described in 2014.1 This report describes a 17-year-old male with TBRS who presented with primary hyperparathyroidism (PH) and was found to have sestamibi positive imaging. The patient underwent a bilateral neck exploration where an ectopic parathyroid gland was localized and removed. The patient had no surgical complications, and his follow up visit showed normalization of parathyroid hormone and calcium levels. This report represents the importance of obtaining multiple imaging modalities during preoperative preparation for a parathyroidectomy in patients with TBRS. It also demonstrates the need for further publications of anatomic anomalies associated with PH in patients with TBRS in the future.
Subject(s)
Hyperparathyroidism, Primary , Male , Humans , Adolescent , Hyperparathyroidism, Primary/complications , Hyperparathyroidism, Primary/diagnosis , Hyperparathyroidism, Primary/surgery , Parathyroid Hormone , Parathyroidectomy/methods , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Parathyroid Glands/diagnostic imaging , Parathyroid Glands/surgeryABSTRACT
Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer in the United States following basal cell carcinoma. The majority are successfully cured by surgical excision or Mohs microsurgery. A subset of cSCCs are more aggressive and likely to recur locally, spread to regional lymph nodes or even distantly, and can even result in death. High-risk features of cSCC including perineural invasion of nerve >0.1 mm in diameter and invasion beyond the subcutaneous fat are not routinely reported by Mohs microsurgery. Facial cSCC commonly involves branches of the facial nerve (VII) or trigeminal nerve (V). Clinical symptoms associated with cranial nerve VII and V involvement include pain, paresthesia of the face and tongue, facial paralysis. Assessment of nerve involvement by magnetic resonance imaging (MRI) is the most optimal imaging modality. Here, we present a case where Mohs microsurgery was performed on a facial cSCC 1.5 years prior to the development of facial paresis. We aim to highlight the interesting perineural path resulting in facial paralysis and associated symptomatology, the importance of MRI, and to remind clinicians of important high-risk features of cSCC.
