Nagase Wakako, Kudo Yujin, Matubayashi Jun, Amemiya Ryosuke, Tanigawa Maki, Shimada Yoshihisa, Hagiwara Masaru, Kakihana Masatoshi, Nagao Toshitaka, Ohira Tatsuo, Ikeda Norihiko
Surgery, Tokyo Medical University, Tokyo, JPN.
Anatomic Pathology, Tokyo Medical University, Tokyo, JPN.
Cureus. 2025 Feb 6;17(2):e78638. doi: 10.7759/cureus.78638. eCollection 2025 Feb.
Ectopic mediastinal parathyroid adenoma is rare and is generally managed by surgical resection as a definitive treatment. Intraoperative parathyroid hormone (ioPTH) monitoring is valuable for ensuring the complete removal of a target lesion. However, there is no consensus criteria regarding the utilization of ioPTH for complete resection in patients with ectopic mediastinal parathyroid adenomas. A 65-year-old woman presented with asymptomatic hypercalcemia, and was subsequently diagnosed as having hyperparathyroidism. Radiological imaging displayed a solid mediastinal tumor, suspected to be ectopic mediastinal parathyroid adenoma. Surgical resection was performed together with ioPTH monitoring. Although a transient increase in intact parathyroid hormone (iPTH) level was noted, a 22% decrease in iPTH level compared with the preoperative peak iPTH level was observed 30 minutes after the resection. Intraoperative frozen section diagnosis confirmed complete resection of the ectopic mediastinal parathyroid adenoma. Serum iPTH and calcium levels rapidly decreased postoperatively. The patient was discharged without any complications, and no recurrence was found. We herein report a case of a patient in whom thoracoscopic removal of an ectopic mediastinal parathyroid adenoma using ioPTH monitoring resulted in a successful postoperative outcome. Our present case demonstrates that although ioPTH monitoring is important, it is also crucial to avoid stimulation of the tumor by intraoperative compression and to confirm complete resection by additional modalities, such as by pathological analysis.
异位纵隔甲状旁腺腺瘤罕见，一般通过手术切除作为确定性治疗。术中甲状旁腺激素（ioPTH）监测对于确保靶病变完全切除很有价值。然而，对于异位纵隔甲状旁腺腺瘤患者使用ioPTH进行完全切除，尚无共识标准。一名65岁女性因无症状高钙血症就诊，随后被诊断为甲状旁腺功能亢进。影像学检查显示纵隔实性肿瘤，怀疑为异位纵隔甲状旁腺腺瘤。手术切除时进行了ioPTH监测。尽管观察到完整甲状旁腺激素（iPTH）水平短暂升高，但切除后30分钟iPTH水平较术前峰值降低了22%。术中冰冻切片诊断证实异位纵隔甲状旁腺腺瘤完全切除。术后血清iPTH和钙水平迅速下降。患者无并发症出院，未发现复发。我们在此报告一例患者，通过ioPTH监测胸腔镜切除异位纵隔甲状旁腺腺瘤，术后结果成功。我们目前的病例表明，尽管ioPTH监测很重要，但避免术中压迫刺激肿瘤以及通过病理分析等其他方式确认完全切除也至关重要。
