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Duman S, Sarıgül A, Erdoğdu E, Özkan B, Demir A, Kara M, Toker SA. Video-Assisted Thoracoscopic Surgery Is a Safe and Feasible Technique for Mediastinal Parathyroid Lesions. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38639341 DOI: 10.1089/lap.2024.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Introduction: Hyperfunctional ectopic parathyroid glands in the mediastinum pose a challenge to diagnosis and require optimal surgical management. Video-assisted thoracoscopic surgery (VATS) has emerged as a promising minimally invasive approach, offering potential benefits in terms of both patient comfort and oncological principles. This study aimed to evaluate the effectiveness and safety of VATS for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum. Methods: Among the 538 patients with mediastinal tumors who underwent thoracoscopic surgery at Istanbul University (2008-2021), 11 exhibited hyperfunctional ectopic parathyroid glands. The localization of the glands was performed using various diagnostic techniques, including neck ultrasound, sestamibi scan, CT (computerized tomography), and SPECT (Single-photon emission computed tomography). VATS (Video-assisted thoracoscopic surgery) was used to remove ectopic parathyroid glands in all 11 patients, with no need for conversion to open surgery. Results: The pathological results showed that VATS successfully removed the ectopic glands in all 11 patients. Serum parathyroid hormone (PTH) levels were monitored intraoperatively, and frozen sections were used to confirm the presence of parathyroid adenomas in all cases. Postoperative analysis showed that PTH levels dropped by at least 50% within 10-15 minutes after adenoma removal. Conclusion: VATS is a safe and effective method for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum with a low risk of complications.
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Affiliation(s)
- Salih Duman
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Arda Sarıgül
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Eren Erdoğdu
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Berker Özkan
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Adalet Demir
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Murat Kara
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - S Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
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Karla Veronica C, Mariana CT, Adriana Graciela PR, Gabino CP, Francina Valezka BM. Thoracoscopic treatment of mediastinal ectopic parathyroid adenomas: a Latinamerica experience case series and literature review. J Cardiothorac Surg 2024; 19:177. [PMID: 38575949 PMCID: PMC10996178 DOI: 10.1186/s13019-024-02694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 03/24/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Hyperparathyroidism (HPT) is a disease caused by hypersecretion of one or more parathyroid glands, it can be associated with ectopic mediastinal parathyroid glands (MEPA) in 2% of cases. The use of video-assisted thoracoscopic surgery (VATS) for the surgical resection of these glands is a safe, cost-effective, and low morbidity option for patients with MEPA. We report a case series of patients with this disease managed with VATS, the first in Mexico and Latinamerica. METHODS From 2008 to 2022, a retrospective study involving patients with MEPA and treated by VATS approach was performed in a tertiary hospital in Mexico city. Relevant biochemical and clinical variables such as imaging studies, pre and postoperative laboratory results, surgical strategy, outcomes and pathological analysis were analyzed. RESULTS Four cases of mediastinal parathyroid adenomas causing HPT were included. All patients were female with a median age of 52.5 years-old (range 46-59 years), half of the patients had primary HPT and the others tertiary HPT after kidney transplant. 75% of cases had a MEPA in the medium mediastinum, all had a preoperative positive SPECT-CT 99mTc Sestamibi scan. Mean preoperative PTH was 621.3pg/mL (182-1382pg/mL). All patients successfully underwent parathyroidectomy with a VATS approach, no deaths were reported. CONCLUSIONS VATS is a minimally invasive surgery that provides adequate access to mediastinal located glands, optimal visualization of mediastinal structures and has a high resection success rate with less complications and morbidity than open approaches.
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Affiliation(s)
| | - Chavez-Tostado Mariana
- Department of Human Reproduction, University of Guadalajara, Health Sciences University Center, Guadalajara, Mexico.
| | - Peña-Rivera Adriana Graciela
- Department of Human Reproduction, University of Guadalajara, Health Sciences University Center, Guadalajara, Mexico
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Tay YZ, Balasubbiah N, Awang RR, Retna Pandian BD, Sathiamurthy N. A Surgical Management of Mediastinal Parathyroid Adenoma: A Regional Experience in Malaysia. Cureus 2024; 16:e56792. [PMID: 38650780 PMCID: PMC11034996 DOI: 10.7759/cureus.56792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
Primary hyperparathyroidism (PHPT) usually presents with symptoms of hypercalcemia which is due to excessive secretion of parathyroid hormone (PTH). Surgical removal of the secreting tumor either adenoma or hyperplasia remains the mainstay of treatment. Around 2% to 25% of the lesions are located in the mediastinum. We reviewed our institution's surgical treatment and approach to mediastinal parathyroid adenoma (MPA). We retrospectively reviewed the demography, comorbidities, clinical presentation, surgical approach, and outcome for patients in our institution who underwent surgery for MPA from September 2019 until August 2023. All patients with MPA who underwent surgery were included in the review. The surgical approaches used were both video-assisted thoracoscopic surgery (VATS) and median sternotomy. There were three patients with PHPT due to MPA who underwent surgery. Out of the three patients, two were female. The mean age was 48.6 years old, ranging from 16 to 66 years old. All of them presented with PHPT with a raised mean serum calcium level of 3.52 mmol/L (range: 2.84-4.38 mmol/L) and a mean PTH or intact PTH (iPTH) level of 274.6 pmol/L (range: 8.87-695 pmol/L). Ultrasound of the neck was performed for all the patients before further investigations were done to look for the ectopic parathyroid gland. Computed tomography (CT) of the thorax showed mediastinal parathyroid mass in all the patients with an average size of 2.4 x 2.1 x 2.3cm (range: 1.3-3.8cm), which showed uptake in 99mTc-hexakis-2-methoxyisobuthylisonitrile (Tc99m-MIBI) scintigraphy. VATS was performed for two cases and an upper partial sternotomy was performed for one patient. Postoperatively, iPTH and serum calcium levels were reduced significantly for all patients. There were no post-operative complications in our study. Comprehensive diagnostic imaging and surgical planning are important for the localization of MPA. In our review, all cases were promptly diagnosed and underwent surgery without complication.
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Affiliation(s)
- Yen Zhir Tay
- General Surgery, Thoracic Surgery Unit, Kuala Lumpur Hospital, Kuala Lumpur, MYS
| | | | - Raflis Ruzairee Awang
- General Surgery, Breast and Endocrine Surgery Unit, Kuala Lumpur Hospital, Kuala Lumpur, MYS
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Sahu A, Zameer MM, Rao S, D’Cruz A. Sestamibi-guided thoracoscopic excision of functional mediastinal parathyroid adenoma in a child: A case report and review of literature. J Minim Access Surg 2024; 20:102-104. [PMID: 37282424 PMCID: PMC10898640 DOI: 10.4103/jmas.jmas_190_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 03/19/2023] Open
Abstract
Primary hyperparathyroidism secondary to ectopic parathyroid (in anterior mediastinum) is rare in children. We report the case of a 12-year-old girl with a history of multiple fractures, renal calculi and limb deformities. She was diagnosed with hyperparathyroidism secondary to an intrathymic parathyroid adenoma. Sestamibi scan showed a lesion in the anterior mediastinum. A biochemical evaluation revealed hypercalcaemia, elevated alkaline phosphatase and parathormone levels. The lesion was marked with radioisotope and confirmed intraoperatively using a gamma camera. The child underwent thoracoscopic left thymectomy with the adenoma. Immediate decrease in calcium and parathyroid hormone values were noted intraoperatively and serial monitoring showed a downward trend. On follow-up, the child is doing well. Ectopic parathyroid adenoma is very rare. CT with radioisotope scans is helpful in diagnosis. Thoracoscopic excision of ectopic adenoma is safe in children.
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Affiliation(s)
- Avilash Sahu
- Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India
| | - M. M. Zameer
- Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India
| | - Sanjay Rao
- Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India
| | - Ashley D’Cruz
- Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India
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Sayed S, Das A, Turner B, Wadhwa VS, Pathak KA. Role of four-dimensional computer tomography (4D-CT) in non-localising and discordant first-line imaging in primary hyperparathyroidism. Ann R Coll Surg Engl 2023; 105:739-746. [PMID: 36748800 PMCID: PMC10618046 DOI: 10.1308/rcsann.2022.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Accurate preoperative localisation of parathyroid adenoma is imperative for the success of minimally invasive parathyroidectomy (MIP). OBJECTIVE Our study aimed to evaluate the role of four-dimensional computer tomography (4D-CT) scan as an imaging modality in patients with failed and discordant localisation reported in the first-line imaging modalities (ultrasonography and 99mTc-MIBI-SPECT/CT). METHODS This is a prospective cohort study performed at a university teaching centre from March 2013 to July 2021. All patients with primary hyperparathyroidism who had failed localisation by ultrasonography and 99mTc-MIBI-SPECT/CT (SpCT), or discordance between them, had 4D-CT performed in this study. RESULTS One hundred and two sporadic cases of pHPT with failed/discordant first-line imaging had 4D-CT imaging prior to parathyroidectomy. In 102 patients, 105 parathyroid adenomas were reported on histopathology. 4D-CT was able to localise 78% of them to the correct side and 64% to the correct quadrant in 102 patients, as compared with US (correct side 21%, correct quadrant 16%) and 99mTc-MIBI-SPECT/CT (correct side 36%, correct quadrant 31%). 4D-CT had a sensitivity, precision, accuracy and F1 score for correct quadrant localisation as 79%, 81%, 66% and 80%; and for correct side localisation as 82%, 98%, 80% and 89%, respectively. 4D-CT was able to identify three ectopic adenomas (two in superior mediastinum and one in the oesophageal wall) which were not detected on US or SpCT. CONCLUSION 4D-CT was found to be sensitive and accurate in preoperative localising of the diseased parathyroid glands after failed/discordant US and SpCT. This led to more patients being offered MIP as the primary surgery and improved operative outcomes.
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Affiliation(s)
- S Sayed
- CancerCare Manitoba, Winnipeg, Canada
| | - A Das
- Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - B Turner
- CancerCare Manitoba, Winnipeg, Canada
| | - V S Wadhwa
- Cedars Sinai Medical Center, Los Angeles, USA
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Bao Y, Kang G, Wu X, Li J, Huang Y, Wang Y. Mediastinal parathyroid carcinoma: a case report and review of the literature. BMC Endocr Disord 2023; 23:130. [PMID: 37280629 DOI: 10.1186/s12902-023-01363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/04/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is an uncommon cause of primary hyperparathyroidism (PHPT) and particularly rare in the mediastinum. Herein, we present a case of mediastinal PC and conduct a related literature review. CASE PRESENTATION We described a case of a 50-year-old female patient with PHPT due to mediastinal PC. She was initially admitted to a local hospital in her hometown with hypercalcemia and high blood concentrations of PTH (parathyroid hormone). The patient underwent neck parathyroidectomy and pathological examination suggested parathyroid adenoma. Although the overproduction of serum calcium and PTH declined after the surgery, calcium and PTH increased again one month later, so the patient was transferred to our hospital. A 99mTc-sestamibi scan revealed an ectopic finding in the mediastinum, which was also indicated on the CT image. After removing the mediastinal mass, the metabolism of calcium and PTH quickly reverted to normal and the pathologic features of the mass were consistent with PC. By reviewing the related literature, we noticed that only scattered reports were published before 1982, and those were not included in the present review due to their differences with current radiological examination and treatment methods. After excluding outdated studies, we summarized and analyzed 20 reports of isolated mediastinal PC and concluded that. Parathyroidectomy remains the only curative treatment for the disease. Furthermore, the success of treatment directly depends on accurate preoperative localization. CONCLUSION With this study, we emphasize the importance of accurate preoperative diagnosis of mediastinal PC and improve clinicians' understanding of the disease.
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Affiliation(s)
- Yan Bao
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
- Present address: Department of Endocrinology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, Hubei, 430060, China.
| | - Ganjun Kang
- Departments of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoyan Wu
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jing Li
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yan Huang
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ye Wang
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Bondje S, Kaplan F, Palazzo F, Barwick T. Resection of an elusive parathyroid adenoma in the aortopulmonary window. BMJ Case Rep 2023; 16:e250380. [PMID: 36759046 PMCID: PMC9923292 DOI: 10.1136/bcr-2022-250380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia and is caused by a single parathyroid adenoma in the neck in 85% or more of patients. National Institute for Health and Care Excellence (NICE) guidelines published in May 2019 advise that preoperative imaging is offered prior to parathyroid surgery for PHPT if it will inform surgical approach. If imaging, typically a neck ultrasound and a second modality that may use ionising radiation, does not identify the adenoma or is discordant, it is advised that surgery is performed by a surgeon with expertise in the management of unlocalised parathyroid disease.The cure rate in such cases is over 96%. Occasionally, however, PHPT cure can be challenging.A woman in her late 40s presented with bilateral renal calculi and was found to have PHPT. Following false positive imaging and three non-curative surgical procedures, removal of a supernumerary ectopic parathyroid adenoma in the aortopulmonary window via sternotomy achieved definitive cure.
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Affiliation(s)
| | - Felicity Kaplan
- Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Fausto Palazzo
- Thyroid and Endocrine Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Tara Barwick
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, Imperial College Healthcare NHS Trust, London, UK
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Makey IA, Geldmaker LE, Casler JD, El-Sayed Ahmed MM, Jacob S, Thomas M. Localization and surgical approach to mediastinal parathyroid glands. J Cardiothorac Surg 2022; 17:299. [PMID: 36476282 PMCID: PMC9730602 DOI: 10.1186/s13019-022-02052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hyperactive parathyroid glands (PTGs) are in the mediastinum 4.3% of the time. Historically, localization and resection of these glands can be challenging. METHODS We searched all operative notes involving a thoracic surgeon and a preoperative diagnosis of hyperparathyroidism from 2001 to 2019. RESULTS Eighty-five cases were reviewed, of which 63 were included. Only 14 patients (22%) had de novo hyperparathyroid operations. Seventeen patients (27%) had single-photon emission computed tomography with computed tomography fusion (SPECT-CT) as the only preoperative localization test (excluding chest radiography and ultrasound), and all were resected successfully. The initial surgical approach was transcervical for 16 (27%) patients, however only 7 remained transcervical. 4 (6%) patients had an exploration in which the target lesion was resected but it was not parathyroid tissue. CONCLUSION Most patients presenting with mediastinal PTG have had prior HPT surgery. The trend toward more focused HPT surgery may mean more de novo mediastinal PTG resections. An unambiguous functional and anatomic localization test, such as a spect-ct scan, is the best predictor of a successful resection. Ambiguous or discordant scans should be approached cautiously, and additional confirmatory tests are recommended. For suspected PTG located in the thymus, the thoracic surgeon should choose the most familiar approach to achieve complete thymectomy.
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Affiliation(s)
- Ian A. Makey
- grid.417467.70000 0004 0443 9942Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 USA
| | - Laura E. Geldmaker
- grid.417467.70000 0004 0443 9942Graduate Research Education Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL USA
| | - John D. Casler
- grid.417467.70000 0004 0443 9942Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Clinic, Jacksonville, FL USA
| | - Magdy M. El-Sayed Ahmed
- grid.417467.70000 0004 0443 9942Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 USA
| | - Samuel Jacob
- grid.417467.70000 0004 0443 9942Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 USA
| | - Mathew Thomas
- grid.417467.70000 0004 0443 9942Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 USA
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Liu L, Zhang JQ, Wang GG, Zhao K, Guo C, Huang C, Li SQ, Chen YY. Surgical Treatment of Ectopic Mediastinal Parathyroid Tumors: A 23-Year Clinical Data Study in a Single Center. J INVEST SURG 2022; 35:1747-1753. [PMID: 35914896 DOI: 10.1080/08941939.2022.2106392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background. Ectopic mediastinal parathyroid glands are parathyroid glands located completely below the clavicle. At present, most literature reports on ectopic mediastinal parathyroid tumors (EMPT) are case reports or small case sequences.Methods. This study conducted a retrospective analysis of ectopic mediastinal parathyroid tumors cases treated over the past 23 years, summarizing and analyzing general conditions, preoperative positioning, postoperative pathology, intraoperative conditions, and long-term follow-up results.Results. This study enrolled 28 patients. Among them, 27 patients underwent preoperative localization diagnosis using 99mTc-sestamibi scan (MIBI) in conjunction with chest computed tomography (CT), including 26 cases of the anterior superior mediastinum and 2 cases of middle mediastinum. Postoperative pathology revealed 23 cases of parathyroid adenoma, 4 cases of parathyroid hyperplasia, and 1 case of parathyroid cyst. In this study, 12 patients underwent video-assisted thoracoscopic surgery (VATS) and thoracotomy approaches. Using Mann-Whitney U test, we discovered that VATS approach group is significantly superior in surgical time (P = 0.039) and intraoperative bleeding (P < 0.001). Within one week of surgery, 26 patients with primary hyperparathyroidism (PHPT) experienced a significant decrease in blood parathyroid hormone (PTH) (P < 0.001) and blood calcium (P < 0.001), and all achieved long-term remission.Conclusions. EMPT is most frequently performed in the anterior superior mediastinum. EMPT is predominantly parathyroid tumors, and most of them are associated with PHPT. MIBI and chest CT combination can be used for preoperative lesion localization (positive rate 96.15%). VATS can be used as a better surgical approach. PHPT patients before surgery can achieve long-term symptom relief with surgical treatment.
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Affiliation(s)
- Lei Liu
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Jia-Qi Zhang
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Gui-Ge Wang
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Ke Zhao
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Chao Guo
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Shan-Qing Li
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Ye-Ye Chen
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
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Prevertebral cervical approach to posterior mediastinum parathyroid adenomas. Surg Endosc 2022; 36:6319-6325. [PMID: 35608699 DOI: 10.1007/s00464-022-09279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND About 4 years ago, we described the pure endoscopic cervical approach to posterior mediastinum parathyroid adenomas, which we called the "prevertebral cervical approach". At that time, we had operated on three patients and did not have enough quality videos to demonstrate this approach. After broadening our experience, we present our results and show this technique through a video. METHODS From June 2015 to January 2021, information on patients undergoing the prevertebral cervical approach was obtained from a specific prospective database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. The step by step technique is described for both right- and left-sided adenomas, by means of a short video clip. RESULTS Ten patients were operated on using this technique. Seven adenomas were right-sided and three were left-sided. The mean surgical time was 33 ± 7 min. There were neither intraoperative nor major postoperative complications. Seven patients presented with a slight subcutaneous emphysema, which did not cause complaints. All patients were discharged the day after surgery, except for one patient with a previous open neck removal of four glands due to secondary hyperparathyroidism, which required calcium replacement. Calcium and parathyroid hormone levels were normalised in the other nine patients after surgery. One patient experienced a transient recurrent laryngeal nerve injury which was spontaneously resolved within 1 month. No permanent recurrent laryngeal nerve injury was found. The postoperative cosmetic outcomes were excellent. CONCLUSION In our experience, the pure cervical endoscopic approach has shown a high feasibility and short operation time, with excellent postoperative results regarding patient comfort, length of stay and disease cure. This approach also offers a very reasonable procedure cost, and may result in a less aggressive surgical option when compared with thoracic approaches.
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Primary hyperparathyroidism due to mediastinal parathyroid lesions. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:55-59. [PMID: 34552645 PMCID: PMC8442087 DOI: 10.5114/kitp.2021.105189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/16/2021] [Indexed: 12/05/2022]
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Lombardi R, Muccio CF, D'Auria V, D'Agostino V, Genovese S, Monaci A, La Selva P, Castaldo A, Pesce I, Bencivenga A. The role of unhenanced CT in a ruptured parathyroid adenoma: A case report. Radiol Case Rep 2021; 16:2382-2387. [PMID: 34257766 PMCID: PMC8260755 DOI: 10.1016/j.radcr.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022] Open
Abstract
Acute bleeding is a rare and potentially life-threatening complication of a Parathyroid Adenoma described in just a few cases in literature. We describe the case of a healthy 53-years-old female patient without prior history of parathyroid pathology who presented with acute onset of neck and mediastinal hemorrhage. Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) combined with laboratory tests led to the diagnosis of a bleeding Parathyroid adenoma. This case is presented to sensitize both Radiologists and Clinicians about this rare presentation that should be put into differential diagnosis of acute neck swelling and pain.
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Affiliation(s)
- Romilda Lombardi
- Radiology Department, A.O. "San Pio" P.O. "Gaetano Rummo", via Dell'Angelo 1, 82100 Benevento Italy
| | - Carmine Franco Muccio
- Neuroradiology Department, A.O. "San Pio" P.O. "Gaetano Rummo", via Dell'Angelo 1, 82100 Benevento Italy
| | - Valeria D'Auria
- Radiology Department, A.O. "San Pio" P.O. "Gaetano Rummo", via Dell'Angelo 1, 82100 Benevento Italy
| | - Valerio D'Agostino
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I 80131 Naples Italy
| | - Stefano Genovese
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I 80131 Naples Italy
| | - Alessandro Monaci
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I 80131 Naples Italy
| | - Pasquale La Selva
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I 80131 Naples Italy
| | - Anna Castaldo
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I 80131 Naples Italy
| | - Ilaria Pesce
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I 80131 Naples Italy
| | - Alfonso Bencivenga
- Radiology Department, A.O. "San Pio" P.O. "Gaetano Rummo", via Dell'Angelo 1, 82100 Benevento Italy
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Giant Ectopic Retroesophageal Parathyroid Adenoma Excised Via Cervical Incision: a Case Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Seo Y, Song K, Choi HS, Suh J, Kwon A, Chae HW, Kim HS. A case of primary hyperparathyroidism due to an intrathymic ectopic parathyroid adenoma in a 15-year-old boy. Ann Pediatr Endocrinol Metab 2020; 25:187-191. [PMID: 32871656 PMCID: PMC7538304 DOI: 10.6065/apem.1938172.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022] Open
Abstract
Hypercalcemia due to primary hyperparathyroidism (PHPT) is uncommon in children. PHPT is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas account for 6%-16% of all parathyroid adenomas and are rare in children but should be considered in cases that present with hypercalcemia. We report the case of a 15-year-old boy with PHPT due to an intrathymic ectopic parathyroid adenoma. Neck ultrasonography and Tc-99m-sestamibi (MIBI) scanning with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed ectopic parathyroid adenoma in the thymus. Video-assisted thoracoscopic surgery was performed to remove the ectopic parathyroid adenoma. Pathology showed intrathymic ectopic parathyroid adenoma. After surgery, the patient's serum calcium level immediately normalized. Intact parathyroid hormone (iPTH) and alkaline phosphatase levels returned to normal ranges within 3 months. Delayed diagnosis of PHPT can cause end-organ damage; a timely diagnosis is especially critical to preserve bone and renal function. If ectopic parathyroid adenomas are well localized in preoperative imaging evaluation and intraoperative iPTH level decreases after resection, ectopic parathyroidectomy without bilateral neck exploration may be performed to avoid unnecessary morbidity.
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Affiliation(s)
- Youngseok Seo
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungchul Song
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Han Saem Choi
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Junghwan Suh
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea,Address for correspondence: Ho-Seong Kim, MD, PhD Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2069 Fax: +82-2-393-9118 E-mail:
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15
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Vetshev PS, Zhivotov VA, Ablitsov AY, Drozhzhin AY, Sudilovskaya VV. [Combination of toxic multinodular goiter and primary hyperparathyroidism with rare ectopia of parathyroma]. Khirurgiia (Mosk) 2020:89-93. [PMID: 31994506 DOI: 10.17116/hirurgia202001189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A well-known feature of primary hyperparathyroidism (PHPT) is possible ectopic localization of parathyroid adenoma that can significantly complicate diagnostic process. Ectopia in the aortic window is extremely rare and accounts only 1% of ectopic parathyroid adenomas in the mediastinum and 0.24% among all parathyroid adenomas. Combination of multinodular toxic goiter and primary hyperparathyroidism with a rare variant of ectopia makes this observation very valuable from scientific and practical point of view.
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Affiliation(s)
- P S Vetshev
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
| | - V A Zhivotov
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
| | - A Yu Ablitsov
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
| | - A Yu Drozhzhin
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
| | - V V Sudilovskaya
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
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16
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Abstract
Proliferative pathologic lesions of parathyroid glands encompass a spectrum of entities ranging from benign hyperplastic processes to malignant neoplasia. This review article outlines the pathophysiologic classification of parathyroid disorders and describes histologic, immunohistochemical, and molecular features that can be assessed to render accurate diagnoses.
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Affiliation(s)
- Julie Guilmette
- Department of Pathology, Charles-Lemoyne Hospital, Sherbrooke University Affiliated Health Care Center, 3120 Boulevard Taschereau, Greenfield Park, Quebec J4V 2H1, Canada
| | - Peter M Sadow
- Departments of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114-2696, USA.
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17
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JIMÉNEZ-LÓPEZ MF, GÓMEZ-HERNÁNDEZ MT. Papel de la Cirugía Torácica en la cirugía de paratiroides. REVISTA ORL 2019. [DOI: 10.14201/orl.21593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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18
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Isaacs KE, Belete S, Miller BJ, Di Marco AN, Kirby S, Barwick T, Tolley NS, Anderson JR, Palazzo FF. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. BJS Open 2019; 3:743-749. [PMID: 31832580 PMCID: PMC6887896 DOI: 10.1002/bjs5.50207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Primary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video‐assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem. Methods Information on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications. Results Over a 2‐year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60–160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false‐positive preoperative imaging. Conclusion With appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma.
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Affiliation(s)
- K E Isaacs
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - S Belete
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - B J Miller
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - A N Di Marco
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
| | - S Kirby
- Department of Radiology Imperial College Healthcare NHS Trust London UK
| | - T Barwick
- Department of Anaesthesia Imperial College Healthcare NHS Trust London UK
| | - N S Tolley
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
| | - J R Anderson
- Department of Cardiothoracic Surgery, Hammersmith Hospital Imperial College Healthcare NHS Trust London UK
| | - F F Palazzo
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
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19
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Liu X, Sun L, Shao M, Li P, Liu W, Zhang X, Zhang L, Ma Y, Li W. Primary hyperparathyroidism due to ectopic parathyroid adenoma in an adolescent: a case report and review of the literature. Endocrine 2019; 64:38-42. [PMID: 30805889 DOI: 10.1007/s12020-019-01875-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary hyperparathyroidism (PHPT) is a common endocrine disorder and is usually diagnosed in adults. PHPT due to ectopic parathyroid adenoma in adolescents is rare. METHODS We describe the case of a 15-year-old boy with PHPT due to ectopic parathyroid adenoma. A review of the literature of PHPT in adolescents was performed, focusing on etiology, clinical presentation, preoperative localization methods, pathology, and treatment. RESULTS The patient was successfully treated with surgery and was followed up for 5 years with no signs or symptoms of hyperparathyroidism. By reviewing the literature, only seven cases of PHPT associated with ectopic parathyroid lesions in adolescents have been reported. Parathyroidectomy is the only known curative treatment. Accurate preoperative localization of the target lesion is critical. CONCLUSIONS This study should raise awareness of the diagnosis and treatment of PHPT due to ectopic parathyroid adenoma/carcinoma in adolescents.
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Affiliation(s)
- Xiangli Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lei Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Mingrui Shao
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - PeiWen Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wenke Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xinyu Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lin Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yingjun Ma
- Department of Thoracic Surgery, Meihekou City Central Hospital, Meihekou, Jilin Province, China
| | - Wenya Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
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20
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Thoracoscopic removal of ectopic mediastinal parathyroid adenoma causing hyperparathyroidism: a rare entity. Wideochir Inne Tech Maloinwazyjne 2018; 13:546-550. [PMID: 30524629 PMCID: PMC6280090 DOI: 10.5114/wiitm.2018.75896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/03/2018] [Indexed: 11/29/2022] Open
Abstract
Ectopic mediastinal parathyroid adenomas are uncommon. Here, we report the successful thoracoscopic removal of a mediastinal parathyroid adenoma from a patient with hypercalcemia. A 58-year-old female patient was referred to our department with persistent hypercalcemia. Serum calcium and phosphorus levels were 13.2 mg/dl and 2.5 mg/dl respectively, while the intact parathormone level was 798.9 pg/ml. Parathyroid computed tomography revealed a solid and well-defined mass at the anterior mediastinum close to the distal aorta. Once the contrast was enhanced, our pre-diagnosis was ectopic parathyroid adenoma. The mass was detected at the anterior mediastinum, dissected free from the surrounding tissue and excised. The capsulated mass, which had a diameter of 3 × 1.5 × 0.7 cm, was confirmed as parathyroid adenoma histopathologically. Postoperative calcium and parathormone levels decreased dramatically to normal levels. Anterior mediastinal localization of an ectopic parathyroid adenoma is a rare entity. The transsternal approach is the most preferred method, but video-thoracoscopy can be used safely and effectively.
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21
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Cvasciuc T, Mihai R, Black E. Video-Assisted Thoracoscopic Parathyroidectomy for an Ectopic Parathyroid Adenoma. VideoEndocrinology 2018. [DOI: 10.1089/ve.2017.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Titus Cvasciuc
- Department of Endocrine Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Radu Mihai
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Edward Black
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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22
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Makay Ö, Durmaz SF, Özdemir M, Şimşir I, İçöz G, Akyıldız M. Robot-assisted endoscopic mediastinal parathyroidectomy. Turk J Surg 2018; 34:315-318. [PMID: 30664431 DOI: 10.5152/ucd.2017.3437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 06/17/2016] [Indexed: 11/22/2022]
Abstract
Ectopic parathyroid glands can be located at any anatomical location from the base of the tongue to the mediastinum. One-third of these glands migrate deep into the mediastinum, which are not accessible with a low cervical incision. In this article, we described the robotic approach to an ectopic mediastinal parathyroid gland. This management method of mediastinal adenomas has significant advantages when compared to conventional surgery.
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Affiliation(s)
- Özer Makay
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Said F Durmaz
- Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Nederlands
| | - Murat Özdemir
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Ilgın Şimşir
- Division Endocrinology and Metabolic Diseases, Department of Internal Medicine, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Gökhan İçöz
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Mahir Akyıldız
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
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23
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Wang X, Zhu YM, Huang H, Zhang LP, Zhang Y, Wang XL. Surgery for Ectopic Parathyroid Adenoma in Lower Part of Superior Mediastinum through a Transcervical Incision. Chin Med J (Engl) 2017; 130:1376-1377. [PMID: 28524839 PMCID: PMC5455049 DOI: 10.4103/0366-6999.206350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Xing Wang
- Department of Head-neck Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yi-Ming Zhu
- Department of Head-neck Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hui Huang
- Department of Head-neck Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li-Peng Zhang
- Department of Head-neck Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ye Zhang
- Department of Head-neck Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Lei Wang
- Department of Head-neck Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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24
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Martos-Martínez JM, Sacristán-Pérez C, Pérez-Andrés M, Durán-Muñoz-Cruzado VM, Pino-Díaz V, Padillo-Ruiz FJ. Prevertebral cervical approach: a pure endoscopic surgical technique for posterior mediastinum parathyroid adenomas. Surg Endosc 2016; 31:1930-1935. [PMID: 27553796 DOI: 10.1007/s00464-016-5197-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/17/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parathyroid gland mediastinal ectopia is an unusual but challenging condition in surgical management of hyperparathyroidism. Posterior mediastinum parathyroid ectopia is rare, and glands need to be removed either with a broad open cervical or thoracic approach. In recent years, several minimally invasive approaches to mediastinal parathyroid glands have been described, but for posterior mediastinum adenomas, proposed techniques are transthoracic. METHODS The aim of this paper is to describe, to our best knowledge for the first time, a standardized pure endoscopic cervical technique to approach posterior mediastinal parathyroid adenomas which we have used in three patients. RESULTS The technique was applied in three patients which excellent surgical, postoperative, and cosmetic results. CONCLUSIONS Endoscopic prevertebral approach is a feasible, sure and inexpensive standardized pure endoscopic cervical approach to posterior mediastinal parathyroid adenomas, which may result in a less aggressive surgical option when compared with thoracic approaches.
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Affiliation(s)
- Juan Manuel Martos-Martínez
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain.
| | - Cristina Sacristán-Pérez
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | - Marina Pérez-Andrés
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | | | - Verónica Pino-Díaz
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | - Francisco Javier Padillo-Ruiz
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
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25
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Tonelli F, Biagini C, Giudici F, Cioppi F, Brandi ML. Aortopulmonary window parathyroid gland causing primary hyperparathyroidism in men type 1 syndrome. Fam Cancer 2015; 15:133-8. [PMID: 26394783 DOI: 10.1007/s10689-015-9840-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Primary hyperparathyroidism (HPT) is the most common endocrinopathy in Multiple Endocrine Neoplasia type 1 (MEN1) syndrome. Supernumerary and/or ectopic parathyroid glands, potentially causes of persistent or recurrent HPT after surgery, have been previously described. However, this is the first ever described case of ectopic parathyroid gland localized in the aortopulmunary window causing HPT in MEN1. After a consistent concordant pre-operative imaging assessment the patient, a 16 years old male affected by a severe hypercalcemia, underwent surgery. The parathyroid was found very deeply near the tracheal bifurcation, hidden by the aortic arch itself and for this reason not visible at the beginning of the dissection but only after being identified by palpation for its typical consistence. The intraoperative PTH decreased at normal level 10 min after removal of the ectopic gland. The patient remained with normal value of calcemia and PTH during the 10 months of follow-up.
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Affiliation(s)
- Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy.
| | - Carlo Biagini
- Signa Diagnostic Centre of Public Health Assistence, Florence, Italy
| | - Francesco Giudici
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Federica Cioppi
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
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26
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Hu J, Ngiam KY, Parameswaran R. Mediastinal parathyroid adenomas and their surgical implications. Ann R Coll Surg Engl 2015; 97:259-61. [PMID: 26263931 PMCID: PMC4473861 DOI: 10.1308/003588415x14181254789088] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/22/2022] Open
Abstract
Primary hyperparathyroidism is a relatively common problem encountered by any endocrine surgical unit. Ectopic parathyroid adenomas have been known to be a common cause of persistent hyperparathyroidism after surgery. A common site of the missed ectopic gland will be that in the mediastinum. However, with the increasing improvement in available imaging, it is likely that this can be diagnosed preoperatively. The surgical approach to the mediastinal parathyroid has also changed vastly over the last decade from maximally invasive to minimally invasive with minimal complications. We provide a review on the entity of mediastinal parathyroid adenomas and their surgical implications.
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Affiliation(s)
- Jesse Hu
- National University Hospital, Singapore
| | - KY Ngiam
- National University Hospital, Singapore
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27
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Schwarzlmüller T, Brauckhoff K, Løvås K, Biermann M, Brauckhoff M. High cardiac background activity limits 99mTc-MIBI radioguided surgery in aortopulmonary window parathyroid adenomas. BMC Surg 2014; 14:22. [PMID: 24758398 PMCID: PMC4003509 DOI: 10.1186/1471-2482-14-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radioguided surgery using 99m-Technetium-methoxyisobutylisonitrile (99mTc-MIBI) has been recommended for the surgical treatment of mediastinal parathyroid adenomas. However, high myocardial 99mTc-MIBI uptake may limit the feasibility of radioguided surgery in aortopulmonary window parathyroid adenoma. CASE PRESENTATION Two female patients aged 72 (#1) and 79 years (#2) with primary hyperparathyroidism caused by parathyroid adenomas in the aortopulmonary window were operated by transsternal radioguided surgery. After intravenous injection of 370 MBq 99mTc-MIBI at start of surgery, the maximum radioactive intensity (as counts per second) was measured over several body regions using a gamma probe before and after removal of the parathyroid adenoma. Relative radioactivity was calculated in relation to the measured ex vivo radioactivity of the adenoma, which was set to 1.0. Both patients were cured by uneventful removal of aortopulmonary window parathyroid adenomas of 4400 (#1) and 985 mg (#2). Biochemical cure was documented by intraoperative measurement of parathyroid hormone as well as follow-up examination. Ex vivo radioactivity over the parathyroid adenomas was 196 (#1) and 855 counts per second (#2). Before parathyroidectomy, relative radioactivity over the aortopulmonary window versus the heart was found at 1.3 versus 2.6 (#1) and 1.8 versus 4.8 (#2). After removal of the adenomas, radioactivity within the aortopulmonary window was only slightly reduced. CONCLUSION High myocardial uptake of 99mTc-MIBI limits the feasibility of radioguided surgery in aortopulmonary parathyroid adenoma.
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Affiliation(s)
- Thomas Schwarzlmüller
- Department of Radiology, Centre for Nuclear Medicine/PET, Haukeland University Hospital, Jonas Liesvei 65, Bergen 5021, Norway.
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28
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Said SM, Cassivi SD, Allen MS, Deschamps C, Nichols FC, Shen KR, Wigle DA. Minimally invasive resection for mediastinal ectopic parathyroid glands. Ann Thorac Surg 2013; 96:1229-1233. [PMID: 23968765 DOI: 10.1016/j.athoracsur.2013.05.084] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/21/2013] [Accepted: 05/24/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND We reviewed our experience with ectopic mediastinal parathyroidectomy. METHODS Between March 1980 and September 2010, mediastinal parathyroidectomy was performed in 33 patients with hypercalcemia secondary to hyperparathyroidism. RESULTS Primary hyperparathyroidism was the main diagnosis in 32 patients (97%). Technetium-sestamibi scan was used in 23 (70%) for preoperative localization. Minimally invasive resections were performed in 18 patients (55%), and 15 (45%) underwent open surgery. The most common minimally invasive surgery approach was video-assisted thoracoscopy in 9 patients (27%); the most common open approach was median sternotomy in 11 (33%). Intraoperative parathyroid hormone monitoring was used in 22 patients (67%). The ectopic glands were intrathymic in 15 patients (45%), in the aortopulmonary window in 7 (21%), and in other intrathoracic locations in the remaining 11 (33%). Parathyroid adenomas were identified in 21 patients (64%); parathyroid hyperplasia and carcinoma were identified in 9 (27%) and 3 (9%), respectively. No early mortality occurred in either group. Reoperation was required in 1 patient in the minimally invasive surgery group because of hemothorax. Morbidity occurred in 8 patients (24%), the most common of which was hypocalcemia in 4 (12%). The mean length of stay was significantly shorter in the minimally invasive surgery group (2 versus 6 days; p < 0.001) but mortality and morbidity were not statistically different between the two groups (p = 0.05). Mean follow-up was 3 ± 3.7 years. CONCLUSIONS Minimally invasive mediastinal parathyroidectomy has similar outcomes to open surgery, with significantly shorter length of hospital stay.
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Affiliation(s)
- Sameh M Said
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stephen D Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark S Allen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Claude Deschamps
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Francis C Nichols
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - K Robert Shen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dennis A Wigle
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
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29
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Mészáros L, Kajdácsi Z, Tóth M, Révai T, Vadász P. [Mediastinal parathyroid adenoma: a surgically treated case]. Magy Seb 2013; 66:191-193. [PMID: 23955953 DOI: 10.1556/maseb.66.2013.4.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sixteen percent of primary hyperparathyroidism is caused by ectopic parathyroid glands. These cases present diagnostic and therapeutic challenges. In this article we present the case of a patient underwent surgery for a mediastinal parathyroid adenoma causing symptomatic hypercalcaemia.
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Affiliation(s)
- László Mészáros
- Országos Korányi Tbc és Pulmonológiai Intézet, Semmelweis Egyetem Mellkassebészeti Tanszéki Csoport 1121 Budapest Pihenő út 1
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