Abstract
Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound and scintigraphy combination. Difficulties can appear. If the gland is not located in a cervical position and has no uptake in scintigraphy but there is high suspition of an adenoma causing the PHPT, some extra tests should be considered. Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy. We report the CT scan and the magnetic resonance imaging (MRI) images that show the tumour. It was surgically resected by a cervical approach. After the excision, the patient recovered normal levels of Calcium and Parathormone (PTH). Conclusion: We review literature about cystic and mediastinal adenomas and diagnostic methods when the standard ones do not give an accurate localization diagnosis.
Highlights
IntroductionThe parathyroid glands can be located in an area that extends from the jaw to the pericardium, they are mostly located in the cervical region
In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma
Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy
Summary
The parathyroid glands can be located in an area that extends from the jaw to the pericardium, they are mostly located in the cervical region. The superior parathyroid glands are immediately positioned in cephalic direction from the junction between the recurrent laryngeal nerve and the inferior thyroid artery, on the lateral or posterior border of the superior thyroid pedicle. They are often in contact with the thyroid capsule. Parathyroid scintigraphy with 99mTc-sestamibi has sensitivities of 75% to 100% and specificities of 75% to 90% It is usually positive but we found negative results (there is a percentage of 15% - 20% of false negatives) in functioning cysts with high concentrations of parathyroid hormone (PTH), probably depending on the amount of coating tissue [4]. Due to the high accuracy of US and scintigraphy combination a more precise localization can be achieved and bilateral cervicotomy has been abandoned, so the major part of cases can be preoperatively localized and a minimal access surgery is nowadays the gold standard [7]
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