Intrahepatic ectopic atypical parathyroid tumor causing primary hyperparathyroidism: a case report

Primary hyperparathyroidism (PHPT) most commonly arises from cervical parathyroid pathology, with ectopic disease representing a rare entity. We report a case of PHPT diagnosed during fracture workup in a female patient who manifested persistent hypercalcemia and elevated parathyroid hormone (PTH) despite two prior cervical explorations. Cross-sectional and functional imaging, including PET/CT, localized a PTH-secreting hepatic lesion, which was confirmed by ultrasound-guided biopsy. Laparoscopic resection of the intrahepatic tumor resulted in prompt biochemical normalization. Histopathology confirmed an intrahepatic ectopic atypical parathyroid adenoma. This case underscores that refractory PHPT with persistent biochemical derangements following conventional cervical surgery should prompt consideration of rare ectopic parathyroid neoplasms with atypical histologic features.