Connolly Michael J, Lazinski Dorothy, Aoki Katherine A, McLean Laurie, Torres Carlos, Dos Santos Marlise P
1 Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
2 Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Ear Nose Throat J. 2019 Jan;98(1):14-17. doi: 10.1177/0145561318822933. Epub 2019 Jan 28.
During routine blood work, a 53-year-old female patient was noted to have asymptomatic hypercalcemia and subsequently found to have hyperparathyroidism. Localization studies for a suspected parathyroid adenoma included Tc Sestamibi scintigraphy, Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) study, and ultrasound of the neck, which were initially read as negative for parathyroid adenoma. A contrast-enhanced CT scan of the neck was performed to locate the suspected parathyroid adenoma and demonstrated a soft tissue lesion within the right piriform sinus. Flexible fiber optic nasolaryngoscopy revealed a submucosal lesion in the right piriform sinus. Following these findings, the initial Tc Sestamibi scintigraphy and SPECT/CT were reviewed with confirmation of a focal area of increased activity superior to the right thyroid lobe, corresponding to a nodule in the right piriform sinus that demonstrated increased activity on SPECT/CT. The patient was brought to the operating room for surgical management where a laryngoscope and operating microscope were utilized. The encapsulated lesion was dissected and excised in total. The parathyroid hormone and ionized calcium levels normalized postoperatively. Pathology confirmed a parathyroid adenoma. Parathyroid adenomas are the most common cause of primary hyperparathyroidism. Sixteen percent of parathyroid adenomas can be situated in an ectopic location. Ectopic parathyroid adenomas in the piriform sinus are rare with only a few previously documented cases. We document a rare case of ectopic parathyroid adenoma in the piriform sinus overlooked on initial imaging studies. These lesions can be challenging to localize, however, an understanding of embryology, close scrutiny of possible ectopic locations, and the application of complementary imaging techniques may prove useful for surgeons and clinicians.
在常规血液检查中，一名53岁女性患者被发现有无症状性高钙血症，随后被诊断为甲状旁腺功能亢进。对疑似甲状旁腺腺瘤的定位研究包括锝-99m甲氧基异丁基异腈（Tc Sestamibi）闪烁扫描、单光子发射计算机断层扫描（SPECT）/计算机断层扫描（CT）以及颈部超声检查，最初这些检查结果显示甲状旁腺腺瘤为阴性。为了定位疑似甲状旁腺腺瘤，进行了颈部增强CT扫描，结果显示右侧梨状窝内有一个软组织病变。纤维光学鼻咽喉镜检查发现右侧梨状窝有一个黏膜下病变。基于这些发现，重新审视了最初的Tc Sestamibi闪烁扫描和SPECT/CT检查结果，确认右侧甲状腺叶上方有一个局灶性活性增加区域，对应于右侧梨状窝内一个在SPECT/CT上显示活性增加的结节。患者被送往手术室进行手术治疗，术中使用了喉镜和手术显微镜。完整切除了包膜完整的病变组织。术后甲状旁腺激素和离子钙水平恢复正常。病理检查证实为甲状旁腺腺瘤。甲状旁腺腺瘤是原发性甲状旁腺功能亢进最常见的病因。16%的甲状旁腺腺瘤可位于异位位置。梨状窝内的异位甲状旁腺腺瘤非常罕见，此前仅有少数病例报道。我们记录了一例在最初影像学检查中被忽视的梨状窝内异位甲状旁腺腺瘤的罕见病例。这些病变的定位可能具有挑战性，然而，了解胚胎学、仔细检查可能的异位位置以及应用辅助成像技术可能对外科医生和临床医生有用。
