Targeted Minimally Invasive Parathyroidectomy for Ectopic Aortopulmonary Adenoma Under Gamma Probe Guidance.

We report a case of 53-year-old woman with the parathyroid adenoma (PA) located in the aortopulmonary window with an aberrant right subclavian artery. Her preoperative calcium level was 11.3 mg/dL (reference range = 8.8-10.6 mg/dL). The parathyroid hormone level was significantly elevated at 127.4 pg/mL (reference range = 12-88 pg/mL) as measured on immunoradiometric assay. Dual-phase technetium-99m-labeled sestamibi parathyroid scintigraphy and fluorine-18 F-fluorocholine positron emission tomography/computed tomography revealed a mediastinal tumor measuring 3 × 5 × 6 mm located anterolateral to the aortopulmonary window. Minimally invasive removal of PA was performed through 3.5-cm reverse J-shaped partial upper sternotomy to the third intercostal space. Postoperative recovery was uneventful, and serum calcium and parathyroid hormone levels normalized within 24 hours of surgery. Our case represents the rare occurrence of a mediastinal PA associated with aberrant right subclavian artery treated with targeted minimally invasive approach using different imaging modalities including technetium-99m-sestamibi scintigraphy and fluorine-18 F-fluorocholine positron emission tomography/computed tomography, and intraoperative use of gamma probe for precise localization PA.

Is local resection sufficient for parathyroid carcinoma?

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy.

Is local resection sufficient for parathyroid carcinoma?

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy. .