Gaz R D, Doubler P B, Wang C A
Department of Surgery, Massachusetts General Hospital, Boston.
Surgery. 1987 Dec;102(6):949-57.
From 1926 to 1984, 1200 patients with hyperparathyroidism were treated surgically at Massachusetts General Hospital (MGH). This series included 50 (4%) unusual cases that involved anomalous parathyroid locations or supernumerary hyperfunctioning parathyroid glands. In 42 cases the diseased glands were found in unusual locations: In three patients, glands were high in the neck behind the angle of the jaw; nine patients' glands were entirely encapsulated within the thyroid gland; and 30 patients required sternotomy for removal of mediastinal tumors. The eight remaining patients (as well as five of the mediastinal cases) had supernumerary hyperfunctioning glands. The three undescended parapharyngeal neoplasms, five of the cervical supernumerary tumors, and the majority of the mediastinal glands were associated with the thymus gland or thymic remnants. These glands appeared to arise from undescended parapharyngeal vestiges, partially descended parathymus remnants deposited along the path of developmental migration, or hyperdescended mediastinal inferior glands from branchial pouch III. The nine intrathyroid parathyroids were totally enclosed within the thyroid parenchyma. These appeared to arise from superior parathyroid glands that were trapped during fusion of the lateral wing portion from branchial pouch IV with the developing lateral lobes of the median thyroid primordium. Of these fifty cases, 39 patients had undergone a total of 60 previous operations (57 cervical and three mediastinal explorations) at MGH (16 patients) or other institutions (23 patients). In eleven patients the unusual hyperfunctioning gland was successfully identified at the time of the initial operation. Forty-four patients (88%) were surgically cured, as evidenced by eucalcemia. There were six patients with permanent hypoparathyroidism and none with persistent or recurrent hyperparathyroidism.
1926年至1984年期间，马萨诸塞州综合医院（MGH）对1200例甲状旁腺功能亢进患者进行了手术治疗。该系列包括50例（4%）不寻常病例，涉及甲状旁腺位置异常或额外的功能亢进甲状旁腺。在42例病例中，患病腺体位于不寻常位置：3例患者的腺体位于下颌角后方的颈部高处；9例患者的腺体完全包裹在甲状腺内；30例患者需要开胸手术以切除纵隔肿瘤。其余8例患者（以及5例纵隔病例）有额外的功能亢进腺体。3例未下降的咽旁肿瘤、5例颈部额外肿瘤以及大多数纵隔腺体与胸腺或胸腺残余有关。这些腺体似乎起源于未下降的咽旁遗迹、沿发育迁移路径沉积的部分下降的甲状旁腺残余，或来自第三鳃囊的过度下降的纵隔下腺体。9例甲状腺内甲状旁腺完全被甲状腺实质包裹。这些似乎起源于在第四鳃囊外侧翼部分与甲状腺正中原基发育中的侧叶融合过程中被困住的上甲状旁腺。在这50例病例中，39例患者此前在MGH（16例患者）或其他机构（23例患者）共接受了60次手术（57次颈部和3次纵隔探查）。11例患者在初次手术时成功识别出异常的功能亢进腺体。44例患者（88%）经手术治愈，血钙正常即为证据。有6例患者出现永久性甲状旁腺功能减退，无一例出现持续性或复发性甲状旁腺功能亢进。
