Walton Benjamin, Gleinser David, Boroumand Nahal, Watts Tammara, Underbrink Michael
Departments of Otolaryngology, University of Texas Medical Branch , Galveston, TX, USA.
Departments of Pathology, University of Texas Medical Branch , Galveston, TX, USA.
Rare Tumors. 2014 Jun 25;6(2):5197. doi: 10.4081/rt.2014.5197. eCollection 2014 May 13.
While there is an intimate anatomical and embryological relationship between the inferior parathyroid gland and thymus, concurrent pathology is rare. Three cases have been reported in the literature of a parathyroid adenoma in conjunction with a thymoma. We present a case report of a 60-year-old female with a past medical history of hypercalcemia subsequently found to have primary hyperparathyroidism. Sestamibi scan of the parathyroid revealed increased uptake in the lower left neck consistent with a parathyroid adenoma. A standard transverse neck incision was performed with exploration of the lower left thyroid pole. Further dissection was required to identify the parathyroid gland which was intimately associated with thymic tissue in the superior mediastinum. Both thymic tissue and the parathyroid gland were sent for pathology. Permanent pathology subsequently revealed a parathyroid adenoma with an incidental spindle cell thymoma. The embryological relationship of the inferior parathyroid glands and the thymus is well known as both are derived from the third branchial pouch. However, there are only 3 other previous reports of parathyroid adenoma associated with a thymoma in the current literature. Interestingly, up to 16% of parathyroid adenomas are found in the mediastinum, and the current literature states the incidence of thymoma varies from 10-42%.
虽然甲状旁腺下腺与胸腺之间存在密切的解剖学和胚胎学关系，但并发病变却很罕见。文献中已报道了3例甲状旁腺腺瘤合并胸腺瘤的病例。我们报告一例60岁女性病例，该患者既往有高钙血症病史，随后被诊断为原发性甲状旁腺功能亢进。甲状旁腺的锝99m甲氧基异丁基异腈扫描显示左颈部下方摄取增加，符合甲状旁腺腺瘤表现。采用标准的横向颈部切口，探查左甲状腺下极。需要进一步解剖以识别与上纵隔胸腺组织紧密相连的甲状旁腺。胸腺组织和甲状旁腺均送去做病理检查。最终病理结果显示为甲状旁腺腺瘤伴偶然发现的梭形细胞胸腺瘤。甲状旁腺下腺与胸腺的胚胎学关系众所周知，因为二者均起源于第三鳃囊。然而，目前文献中仅有另外3例甲状旁腺腺瘤合并胸腺瘤的报道。有趣的是，高达16%的甲状旁腺腺瘤位于纵隔，且目前文献表明胸腺瘤的发病率在10%至42%之间。
