Background: Parathyroid carcinoma and parathyromatosis are very rare diseases in patients on hemodialysis. Its pathogenesis, clinical features, preoperative diagnosis, and surgery are challenging. We describe a rare case of recurrent hyperparathyroidism due to synchronous parathyroid carcinoma and parathyromatosis. Case presentation: A 46-year-old Chinese woman was diagnosed with end-stage renal disease and received regular hemodialysis. Four years later, she experienced discomfort due to itching and was diagnosed with drug-resistant secondary hyperparathyroidism. Parathyroidectomy was performed, and her parathyroid hormone (PTH) levels were reduced. The pathology also revealed that the four nodules were parathyroid nodular hyperplasia without evidence of malignancy. Five years after surgery, the right subcutaneous nodule and left inferior nodule were detected by multiple imaging modalities, and the nodules were accompanied by recurrence itching and elevation of PHT. A complete resection of two nodules was performed, and the patient was diagnosed with parathyroid carcinoma and parathyromatosis. At 8 months postsurgery, her PHT and serum calcium levels were stable, and there were no signs of recurrence. Conclusions: This is a rare case of synchronous parathyroid carcinoma and parathyromatosis in a patient with secondary hyperparathyroidism after parathyroidectomy. We suggest meticulous handling of parathyroid hyperplasia to avoid rupture and spillage during surgery, and precise pro-operation location by multiple imaging modalities is crucial for successful parathyroidectomy.

Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary lymph node staging in breast cancer patients, and its application has prevented unnecessary axillary lymph node dissection (ALND) in early-stage breast cancer in the past decades. Accurate sentinel lymph nodes (SLNs) localization helps improve the success rate of SLNB. The dual-tracer technique (radiocolloid plus blue dye) for SLN mapping significantly improves the identification rate compared to single tracer methods. The most widely adopted radiocolloid is 99mTc-SC, and methylene blue is widely used in visual mapping. However, previous studies have found that the identification rate of SLN imaging varies significantly, which may be closely related to the preparation process and the operator's experience.Standardization of the SLN mapping protocol is crucial for maximizing the identification rate and minimizing false-negative results. This article provides a detailed process using 99mTc - SC combined with methylene blue for SLN mapping in early-stage breast cancer, including procedures for the preparation of 99mTc-SC, injection, SLN image acquisition, methylene blue mapping and intraoperative localization.

Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary lymph node staging in breast cancer patients, and its application has prevented unnecessary axillary lymph node dissection (ALND) in early-stage breast cancer in the past decades. Accurate sentinel lymph nodes (SLNs) localization helps improve the success rate of SLNB. The dual-tracer technique (radiocolloid plus blue dye) for SLN mapping significantly improves the identification rate compared to single tracer methods. The most widely adopted radiocolloid is 99mTc-SC, and methylene blue is widely used in visual mapping. However, previous studies have found that the identification rate of SLN imaging varies significantly, which may be closely related to the preparation process and the operator's experience.Standardization of the SLN mapping protocol is crucial for maximizing the identification rate and minimizing false-negative results. This article provides a detailed process using 99mTc - SC combined with methylene blue for SLN mapping in early-stage breast cancer, including procedures for the preparation of 99mTc-SC, injection, SLN image acquisition, methylene blue mapping and intraoperative localization.