A case of mediastinal ectopic parathyroid adenoma completely resected after identification using a radioisotope technique combined with intraoperative intact-PTH monitoring

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  • Harata Yuzu
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Imai Kazuhiro
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Takashima Shinogu
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Kurihara Nobuyasu
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Kuriyama Shoji
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Minamiya Yoshihiro
    Department of Thoracic Surgery, Akita University Graduate School of Medicine

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Other Title
  • Radio Isotope法と術中intact-PTHモニタリングを併用し摘出した縦隔内異所性副甲状腺腺腫の1例

Abstract

<p>The patient was a 74-year-old female diagnosed with primary hyperparathyroidism, due to elevated serum levels of calcium and intact parathyroid hormone. CT and 99mTc-MIBI SPECT indicated the presence of an ectopic mediastinal parathyroid adenoma, which prompted her referral to our department for its surgical resection. Based on CT, the nodule was buried within the mediastinal fat and would be difficult to identify during surgery. Therefore, radio-guidance with 99mTc-MIBI and monitoring of intact-PTH were used as intraoperative guides. The operation was performed by hybrid video-assisted thoracic surgery with a 6-cm incision in the 3rd intercostal space, and we resected the nodule buried in the superior mediastinal fat. The nodule showed high 99mTc accumulation, and the intact-PTH level decreased after 10 minutes following resection. This led us to conclude that complete resection had been achieved. The final pathological diagnosis was ectopic mediastinal parathyroid adenoma, and there has been no recurrence to date. This outcome suggests that intraoperative guidance using a radioisotope technique along with intact-PTH monitoring may enable more precise excision of mediastinal ectopic parathyroid adenoma, and that accurate identification of the position of the nodule may reduce the rate of recurrence.</p>

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