Sagliker syndrome: A case report of a rare manifestation of uncontrolled secondary hyperparathyroidism in chronic renal failure

Figure 1 A 24-year-old woman had obvious facial deformity with difficultly chewing and swallowing. A: Normal appearance four years prior; B and C: Frontal and side photos, respectively, of the craniofacial deformity before parathyroidectomy; D: Increasing width of dentition with alveolar bone neoplasia; E and F: Frontal and side photos of craniofacial deformity with partial relief 4 mo after parathyroidectomy.

Figure 2 Non-contrast computed tomography showed skull and maxillofacial bone changes. A: There was a marked heterogeneous widening of the skull with sclerotic and lytic changes; B, C, and D: The distinct overgrowth of the maxilla and mandible bone was profoundly affected by diffuse bone abnormalities; E: Osteolysis, osteofibrosis, osteoporosis, and sclerosis coexisted in the scapula, humerus, sternum, and vertebra; F: A volume rendering 3D reconstruction of the craniomaxillofacial structures.

Figure 3 Nuclear examinations before the operation. A: ^99mTc-methylene diphosphonate bone scintigraphy indicated increased radiotracer in the bilateral parietal, maxilla, and mandible. The signal was strongest on the right side of the mandible area; B: ^99mTc-sestamibi single-photon emission computed tomography/computed tomography showed only one hyperplastic parathyroid gland on the left side.

Figure 4 Histopathological examination of secondary hyperparathyroidism, mandibular biopsy, and papillary thyroid cancer. A: Four parathyroid glands were confirmed by colloidal gold-based immunoassays during the operation; B and C: Histochemistry of the hyperplastic parathyroid gland by microscopy at 200× and 400×; D: Immunohistochemistry of the hyperplastic parathyroid gland by microscopy at 400×; E: Bone trabeculae could be seen in the fibroblast background with multinucleated megakaryocytes; F: Histochemistry of the papillary thyroid carcinoma by microscopy at 400×.