Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan.
Department of Head and Neck Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan.
J Cardiothorac Surg. 2022 Aug 20;17(1):195. doi: 10.1186/s13019-022-01935-2.
Primary hyperparathyroidism is a disease caused by the secretion of excess parathyroid hormone (PTH) owing to the enlargement of the parathyroid gland. Ectopic parathyroid glands exist in the mediastinum in approximately 1-2% of cases, which is relatively rare. Intraoperative monitoring of serum PTH level is important to assess whether the source of hyperparathyroidism has been eliminated.
A 53-year-old asymptomatic woman was diagnosed with ectopic mediastinal parathyroid adenoma. A three-port robotic partial resection of the thymus containing the tumor was attempted, but bleeding from a swollen pericardial diaphragmatic vein led to the addition of an assist port along the way. The PTH level was measured intraoperatively. After confirming that the 15-min PTH level after removal of the tumor was less than 50% of the baseline value, the operation was completed. The tumor was positive for PTH and was diagnosed as an ectopic mediastinal parathyroid adenoma. Some small ectopic parathyroid gland tissues were observed in other parts of the thymic tissue. Serum calcium and PTH levels decreased and normalized.
We report the usefulness of robotic resection for ectopic mediastinal parathyroid adenoma with PTH monitoring. However, histopathologically, small parathyroid gland tissues may remain in the surrounding thymus. Hence, we believe that a strict follow-up is required for parathyroid function in the future.
原发性甲状旁腺功能亢进症是一种由甲状旁腺激素（PTH）分泌过多引起的疾病，是由于甲状旁腺肿大所致。大约 1-2%的病例中存在纵隔异位甲状旁腺，这相对较为罕见。术中监测血清 PTH 水平对于评估甲状旁腺功能亢进症的来源是否已被消除非常重要。
一位 53 岁无症状女性被诊断为纵隔异位甲状旁腺腺瘤。尝试经三孔机器人胸腺部分切除术切除肿瘤，但心包膈肌静脉肿胀导致术中出血，因此添加了辅助孔。术中测量了 PTH 水平。在确认肿瘤切除后 15 分钟的 PTH 水平低于基线值的 50%后，手术完成。肿瘤 PTH 阳性，诊断为纵隔异位甲状旁腺腺瘤。胸腺组织的其他部位观察到一些小的异位甲状旁腺组织。血清钙和 PTH 水平降低并恢复正常。
我们报告了使用机器人切除纵隔异位甲状旁腺腺瘤并结合 PTH 监测的有效性。然而，从组织病理学上看，周围胸腺中可能仍存在小的甲状旁腺组织。因此，我们认为未来需要对甲状旁腺功能进行严格随访。
