Ectopic Mediastinal Parathyroid Adenoma Research Articles

Ectopic mediastinal parathyroid adenoma: Diagnostic and therapeutic difficulties across three cases

Ectopic mediastinal parathyroid adenoma: Diagnostic and therapeutic difficulties across three cases

Primary hyperparathyroidism related to mediastinal ectopic parathyroid adenoma: about 2 cases

Primary hyperparathyroidism related to mediastinal ectopic parathyroid adenoma: about 2 cases

A case of mediastinal ectopic parathyroid adenoma completely resected after identification using a radioisotope technique combined with intraoperative intact-PTH monitoring

A case of mediastinal ectopic parathyroid adenoma completely resected after identification using a radioisotope technique combined with intraoperative intact-PTH monitoring

SAT201 A Rare Case Of A Mediastinal Atypical Parathyroid Adenoma Resulting In Severe Hypercalcemia And Brown Tumor

Abstract Disclosure: O.A. Aluko: None. D. Franey: None. R. Quiros: None. W. Burfeind: None. R.E. Amori: None. Introduction: Primary hyperparathyroidism is most often from parathyroid adenomas located usually in close association to the thyroid gland. Ectopic parathyroid glands result in significant variability in the position of the gland, however rarely in the mediastinum. We report a case of a patient with severe hypercalcemia from a large, ectopic mediastinal parathyroid adenoma. Case Report: A 53-year old male with a past medical history of hypercalcemia and nephrolithiasis was sent to the ER for evaluation of hypercalcemia after he was found to have a corrected calcium of 12.5 mg/dl (n8.4 - 10.2 mg/dl) on routine labs. Repeat blood work at presentation confirmed hypercalcemia with a corrected calcium 11.9 mg/dl and elevated ALP of 211 U/l (n 43 - 122 U/L), elevated initial PTH of799 pg/ml (n 18.4 - 80.1 pg/ml), Vit D 32.7 ng/ml (n 30 - 100 ng/ml), and low phosphorus 2.4 mg/dl (n2.7 - 4.5 mg/dl). Calcium slightly improved to 11.7 mg/dl after IV hydration. Chest CT showed a large mediastinal mass compressing trachea and esophagus, suspicious for parathyroid origin, with a smaller left sided lesion suspicious for parathyroid adenoma. CT also showed multiple bone lesions likely brown tumors. He underwent complete robotic resection of the mediastinal mass. Immediately prior to surgery, PTH was 1002.8 pg/ml, and fell to 131.1 pg/ml and 44.1 pg/ml following removal of the mediastinal mass. Adherence of the mass to surrounding structures made resection challenging, resulting in a right vocal cord paralysis. After surgery, he was empirically started on IV calcium and calcitriol for high clinical concern for hungry bone syndrome, both later discontinued as serum calcium remained within normal limits. Pathologic findings reported as highly suspicious, however not definitive for parathyroid carcinoma with no evidence of perineural or lymphovascular invasion. Given rarity, he was referred to a tertiary cancer center where he was diagnosed with Atypical parathyroid Adenoma (APA). He underwent a right pubic biopsy with pathology diagnosis of brown tumor of hyperparathyroidism. He started on cinacalcet 30 mg daily after surgery. There is a future plan for resection of the smaller left sided parathyroid adenoma. Conclusion: This case highlights two rare entities; a mediastinal ectopic parathyroid and atypical parathyroid adenoma. Atypical Parathyroid Adenoma is a not-well defined entity which could mimic a parathyroid carcinoma as seen in our case. The location of the mass in the superior mediastinum is unusual, making it more difficult to diagnose, and could increase risk of complications during resection. Delayed diagnosis of these entities can lead to severe hypercalcemia and skeletal complications infrequently seen in common primary hyperparathyroidism cases. Presentation: Saturday, June 17, 2023

Identification of micro-recurrent lesions using methylene blue for mediastinal ectopic parathyroid adenoma: a case report

BackgroundMediastinal ectopic parathyroid adenomas are rare, and several methods are used to diagnose and localize them preoperatively. Technetium-99m methoxy isobutyl isonitrile scintigraphy has been used to diagnose parathyroid tumors. However, it is difficult to identify tumors buried in adipose tissue during surgery.Case presentationWe report a case in which methylene blue effectively identified small recurrent lesions in a mediastinal ectopic parathyroid adenoma. After intravenous injection of methylene blue prior to surgery, the stained parathyroid adenoma was easily identifiable. Additionally, we identified other small recurrent lesions that could not be confirmed on preoperative imaging using real-time in vivo imaging guidance during surgery. Using this strategy, complete macroscopic resection can be performed during video-assisted thoracic surgery.ConclusionPreoperative intravenous methylene blue injection is useful for identifying small recurrent lesions, even in cases of mediastinal ectopic parathyroid adenoma with suspected recurrence.

Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1

BackgroundHyperparathyroidism in patients with multiple endocrine neoplasia 1 is attributed to the excessive secretion of parathyroid hormone (PTH) from multiple parathyroid glands. This can be successfully treated through complete resection of the parathyroid glands; however, subsequent surgery is often required because of the presence of supernumerary or ectopic parathyroid glands. Therefore, identifying the locations of all functional glands is crucial for precise resection. Here, we report a case of ectopic mediastinal parathyroid adenoma that was successfully resected using robot-assisted thoracoscopic surgery.Case presentationA 53-year-old woman underwent a total parathyroidectomy with autotransplantation for multiple endocrine neoplasia 1-associated primary hyperparathyroidism. The patient previously underwent laparoscopic distal pancreatectomy for a pancreatic neuroendocrine tumor. She also presented with a mediastinal tumor and nonfunctional pituitary adenoma that could be followed up. Blood tests before total parathyroidectomy showed high levels of intact PTH (183 pg/mL) and calcium (Ca; 10.3 mg/dL); however, postoperative blood tests still revealed high levels of intact PTH (103 pg/mL) and Ca (11.4 mg/dL). Computed tomography and magnetic resonance imaging revealed a 45-mm-sized mass in the right upper mediastinum as a well-defined solid and cystic lesion, whereas 99mTc-methoxyisobutylisonitrile scintigraphy indicated a strong accumulation of tracers, suggesting an ectopic lesion in the mediastinum. Persistent hyperparathyroidism after total parathyroidectomy via neck incision was attributed to an ectopic parathyroid tumor in the mediastinum. Thus, we decided to resect the tumor using robot-assisted thoracoscopic surgery to perform the procedure gently and carefully. During surgery, a mediastinal tumor was identified as it was detected radiographically. Because it did not invade the surrounding tissues, it could be completely resected without injuring the capsule. The patient was discharged without complications. Postoperatively, Ca and intact PTH levels decreased back to normal. The final pathological diagnosis confirmed that the mass was an ectopic mediastinal parathyroid adenoma.ConclusionsMinimally invasive surgical resection of a remnant ectopic lesion was successfully performed in a patient with multiple endocrine neoplasia 1 using robot-assisted thoracoscopic surgery.

O160 The utility of pre-operative localisation scans (ultrasound and Tc99M Sestamibi) for primary hyperparathyroidism is limited in up to 40% of the patients

Abstract Introduction The aim of this study was to evaluate the diagnostic accuracy of pre-operative localisation scans for primary hyperparathyroidism (PHPT). Methods Patients with PHPT had pre-operative localisation scans; ultrasound (US) and Tc99m Sestamibi and were operated between 12/2020 and 12/2022. Patients with persistent/recurrence PHPT post-operatively were excluded. Results 97 patients with PHPT were included. The mean age was 60 (SD:13) years old. The male/female ratio was 1:4.4. The mean hospital stay was 1.1 days (SD:0.3). 94 and 91 patients had US and Tc99m Sestamibi scans respectively while 88 patients had both scans. There was 1 patient with an ectopic mediastinal parathyroid adenoma. On the histopathology, 72 patients had single-gland disease, 13 patients had 2 abnormal parathyroid glands, 9 patients had 4-gland hyperplasia. The diagnostic accuracy, sensitivity, specificity, Positive Predictive Value and negative predictive value of US scan was 62% (95%CI: 51-72%), 64% (95%CI: 53-74%), 20% (95%CI: 0.51-72%), 93% (95%CI: 90-96%) and 3% (95%CI: 0.5-16%), respectively. In 9 patients the US missed other/extra pathologic glands. The diagnostic accuracy, sensitivity and Positive Predictive Value of Tc99m Sestamibi scan was 63% (95%CI: 53-73%), 65% (95%CI: 54-75%) and 97% (95%CI: 97-97%) respectively. In 8 patients the Tc99m Sestamibi missed other/extra pathologic glands. Conclusion Parathyroid pathology in primary hyperparathyroidism is complex and the diagnostic accuracy of pre-operative localisation scans (ultrasound and Tc99m Sestamibi) is limited in up to 40%. The presence of negative pre-operative localisation scans should not be an obstacle to offering the patient a curative parathyroidectomy.

Abstract #1412272: A Case Report of an Ectopic Mediastinal Parathyroid Adenoma that was Challenging to Locate

Primary hyperparathyroidism from an ectopic parathyroid adenoma can pose diagnostic and management challenges when several different imaging modalities do not localize the adenoma and when it is not found on surgical exploration. We report a case of a 69-year-old Caucasian female with history of primary hyperparathyroidism complicated by the inability to localize the adenoma despite several imaging modalities. She underwent neck exploration twice by two different surgeons who were unable to locate a parathyroid adenoma. She underwent 2 separate parathyroid nuclear medicine scans with single photon-emission computed tomographic (SPECT) of the neck and chest done several years apart. The initial SPECT did not demonstrate a parathyroid adenoma in the neck or ectopically nor did several nuclear medicine scans of the neck. Ultimately, the 2nd SPECT of the neck and chest was able to detect a contrast-enhanced mass in the mediastinum. She was referred to a thoracic surgeon who was able to remove the ectopic parathyroid adenoma robotically. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma. She was discharged home from the hospital on calcium and calcitriol supplementation. Her calcium normalized and she ultimately was able to come off calcium and calcitriol supplementation. Calcium and PTH have remained normal several months after surgery. The incidence of ectopic parathyroid glands is approximately 25%. In primary hyperparathyroidism approximately 6-16% of adenomas are located ectopically. Surgical intervention is the mainstay of therapy with preoperative imaging for localization of the adenoma being the standard of care. 4D CT has approximately 85% sensitivity and Sestamibi/SPECT CT has 65% sensitivity for location of a single adenoma with specificity of 92% and 98% respectively. Despite this, in our case the localization of parathyroid adenoma took 7 years, 4 different scans and 3 surgeries in order to successively localize and resect the ectopic parathyroid adenoma.

Supernumerary Ectopic Mediastinal Parathyroid Adenoma Combined With Parathyroid Hyperplasia

Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by elevated parathyroid hormone levels. In most cases, the disease involves a single parathyroid adenoma, followed by parathyroid hyperplasia, but the incidence of ectopic parathyroid adenoma is rare. However, in cases where the parathyroid hormone level remains high even after parathyroid surgery, an ectopic parathyroid gland should be considered. Here in a case of a 60-year-old female who presented PHPT is reported. She had undergone a surgical removal of the parathyroid gland of suspected hyperplasia, but still represented persistent PHPT, postoperatively. Ectopic mediastinal parathyroid adenoma was identified by 99mTc-sestamibi parathyroid scan and surgical excision via a median sternotomy approach was performed. Thirty-eight months postoperatively, there was no evidence of recurrence. Preoperative localization assessment is critical for minimizing surgical failure in cases of PHPT.

Robotic resection of ectopic mediastinal parathyroid adenoma with intraoperative parathyroid hormone monitoring: a case report

BackgroundPrimary 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.Case presentationA 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.ConclusionsWe 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.

Perioperative Clinical Features of Mediastinal Parathyroid Adenoma: A Case Series

Rare ectopic mediastinal parathyroid adenoma can result in persistent or recurrent hyperparathyroidism. In this article, we summarized the perioperative outcomes of six patients with mediastinal parathyroid adenoma. All patients underwent minimally invasive surgery (MIS). Abnormal accumulation of sestamibi was observed in four of five patients for preoperative localization of adenoma. Postoperatively, the blood calcium dropped quickly. In addition, we found adenoma function was negatively related to adenoma volume in these patients. In conclusion, although MIS is feasible for parathyroid adenoma, blood calcium should be monitored in a timely manner to avoid hypocalcemia postoperatively. In addition, sestamibi might be a potential pitfall when locating parathyroid adenoma.

Large Mediastinal Ectopic Parathyroid Adenoma Causing Malignant Hypocalcaemia in a Young Female: A Case Report and Review of Literature

Ectopic parathyroid tissue can pose difficulties in diagnosis and management of patients with hyperparathyroidism. Due to the embryological origins of the inferior parathyroid glands from the 3^rd pharyngeal arch where they develop with the thymus; they can have variable anatomical locations, including the anterior mediastinum. While the incidence of ectopic parathyroid glands varies in the literature mediastinal parathyroid tissue is extremely rare.

Localization of Ectopic Mediastinal Parathyroid Adenomas Using Indigo Carmine Injection for Surgical Management: A Preliminary Report.

An ectopic parathyroid adenoma (EPA) is a rare entity. The aim of this study was to report our experience in the preoperative localization and surgical management of EPAs. This was a multicenter retrospective study involving patients diagnosed with an EPA (three males and seven females) from January 2005 to November 2021. The clinical features, preoperative management, and surgical procedures were analyzed. A cervical neck ultrasound was performed in all patients and showed a focus in eight patients. Cervicothoracic enhanced computed tomography was performed in all patients and showed a focus in nine patients. The 99mTc-MIBI scintigraphy was performed in eight patients and showed uptake in six of them. We performed a neck dissection and thoracotomy in one patient, a thoracoscopy in one patient, surgery with a focused approach in seven patients, four of whom were injected with indigo carmine blue, and surgery with a bilateral approach in one patient. 1 h following the parathyroidectomy, the parathyroid hormone (PTH) concentration was decreased to 40–80% of the baseline value. Establishing a preoperative diagnosis of an EPA is challenging for the surgeon, despite the progress in the morphologic assessment. An intraoperative PTH assay and injection of indigo carmine have been shown to be valuable tools in the appropriate surgical management of an EPA.

24 Mediastinal Ectopic Parathyroid Adenoma Causing Malignant Hypercalcaemia in a Young Female - a Case Report and Review of Literature

Abstract Ectopic parathyroid tissue can pose difficulties in diagnosis and management of patients with hyperparathyroidism. Due to the embryological origins of the inferior parathyroid glands from the 3rd pharyngeal arch where they develop with the thymus; they can have variable anatomical locations, including the anterior mediastinum. While the incidence of ectopic parathyroid glands varies in the literature mediastinal parathyroid tissue is extremely rare. This anatomical variation has important diagnostic and surgical ramifications for patients and is an important topic for trainees in medical endocrinology, endocrine surgery, and cardiothoracic surgery to be aware of. We present the case of a 22-year-old woman who presented as an emergency with severe hypercalcaemia. Who was subsequently found to have an ectopic mediastinal parathyroid adenoma. She underwent surgery within days of her initial presentation providing her with an immediate cure and restoring her calcium homeostasis. Despite diagnostic and operative challenges, combined care from our endocrine and cardio-thoracic surgical teams ensured an uneventful post-operative recovery for this patient.

Сложности диагностики первичного гиперпаратиреоза у пациента с эктопированной в средостение аденомой околощитовидной железы и полиоссальной фиброзно-кистозной остеодистрофией

Objective of the Paper: To demonstrate a rare variant of primary hyperparathyroidism in a patient with mediastinal ectopic parathyroid adenoma and polyossal fibrocystic osteodystrophy using a clinical example. Key points. Fibrocystic osteodystrophy is a specific manifestation of primary hyperparathyroidism, which in modern conditions belongs to the casuistically rare. Ectopia of the parathyroid gland into the mediastinum also refers to rare variants of the location of this organ. Our patient's attention is drawn to the poor clinical picture with the rapid development of bone changes. Conclusion. The variety of clinical manifestations of primary hyperparathyroidism, low awareness and alertness of doctors of related specialties in relation to this disease leads to an increase in the time of diagnostic search, the formation of incorrect diagnostic and therapeutic concepts. Determination of plasma calcium level is sufficient, in most cases, to exclude or confirm the diagnosis of primary hyperparathyroidism. Keywords: primary hyperparathyroidism, parathyroid adenoma, ectopic parathyroid adenoma, osteitis fibrosa cystica, brown tumor.

Mediastinal parathyroidectomy: Utilization of a multidisciplinary, robotic-assisted transthoracic approach in challenging cases

BackgroundThe majority of ectopic mediastinal parathyroid adenomas are accessible transcervically and those not amenable to this approach pose a significant clinical and technical challenge. MethodsRetrospective review of transthoracic robot-assisted mediastinal parathyroidectomy (TTRMP) for primary hyperparathyroidism between 2012 and 2019 at a single institution. Results16 patients underwent TTRMP, 63% were female with a mean age of 64 ± 2.0 years. Nine of 16 had prior parathyroidectomy; 80% had persistent disease and a mean 2.8-year delay from index operation until TTRMP. Locations included: intrathymic (8), AP window (4), carina (3), and retroesophageal (1). Two patients underwent parathyroid reimplantation. Mean post-operative calcium and PTH were 9.2 ± 0.2 mg/dL and 20.2 ± 5.6 pg/mL, respectively. Complications included: temporary hypocalcemia (4), permanent hypocalcemia (1), DVT (1), hoarseness (1), and subcostal neuralgia (1). ConclusionIn experienced hands, TTRMP is a safe and effective approach to mediastinal parathyroids not accessible transcervically. A multidisciplinary approach should be used in reoperative cases.

Robotic thoracoscopic parathyroidectomy for ectopic mediastinal parathyroid adenoma

The publication presents the successful experience of using the DaVinci robotic system for the treatment of persistent hyperparathyroidism caused by mediastinal ectopic parathyroid adenoma in 62 years old female patient. The role of single photon emission computed tomography in diagnostics was demonstrated.

Persistent Calciphylaxis and Secondary Hyperparathyroidism in End Stage Renal Disease Patient Due to Ectopic Mediastinal Parathyroid Adenoma- A Case Report

Intruducion: Secondary hyperparathyroidism (SHPT) is prevalent in patients with end-stage renal disease (ESRD) with reported prevalence of 90%. SHPT treatment is usually medical. Although 5% ends up with parathyroidectomy. Indications of parathyroidectomy in ESRD patients include persistent elevation of PTH more than 800, Calcyphylaxis, Osteitis Fibrosa Cystica, and persistent anemia. Among these patients who require surgery, 5–20% present with persistent or recurrent disease and require further re-exploration and excision of parathyroid tissue. We present a case of persistent Calciphylaxis and SHPT in ESRD patient despite Parathyroidectomy which prompted diagnosing an ectopic mediastinal parathyroid adenoma. Case Presentation: 49 year-old male with ESRD for 15 years complicated with SHPT, presented due to worsening Caciphylaxis of bilateral lower extremities despite Cinacalcet, IV sodium thiosulfate, and Phosphate binder. Serum Calcium level was 9.0 mg/dl with corrected levels of 10.2 mg/dl, Phosphorus level of 9.3 with Intact PTH level 1,369 pg/ml. Ultrasound of parathyroid glands was normal. Due to failure of medical treatment, He underwent Total parathyridectomy and left arm parathyroid autograft. Intraoperative PTH level went down to 300 (less than 50%). Calciphylaxis never improved. 5 months later, Parathyroid hormone was elevated 1338 pg/ml, Calcium level 6.9 mg/dl and Phosphorus level 10.0 mg/dl. 99mTc-sestamibi parathyroid scan didn’t show any activity in thyroid gland area and no increased uptake at the autograft area. Although it showed a small focus of persistent activity in substernal area suggestive of ectopic parathyroid tissue. Patient was referred for removal of ectopic adenoma. Discussion: Persistent SHPT is identified as the persistence or recurrence of symptoms, lab abnormalities and radiologic findings within 6 months after parathyroidectomy. Pathophysiology of recurrence is not well studied but one theory suggests that in SHPT, altered Calcium-phosphate hemostasis leads to hyperplasia of parathyroid tissue including ectopic and supernumerary tissue. This aforementioned altered hemostasis continues even after parathyroidectomy and cause hyperplasia and hyperfunction of the residual parathyroid tissue left accidentally by seeding within surgical site or implanted autograft or It can present with ectopic adenoma, even if they were undetected prior to or in the first intervention. Ectopic parathyroid tissue is an uncommon etiology of persistent or recurrent secondary hyperparathyroidism, it is reported in many cases where it was missed at initial workup. Prevalence reported up to 14% in patients with persistent SHPT. It is warranted further investigations to look for ectopic parathyroid tissue in patients with ESRD who present with recurrent or persistent secondary hyperparathyroidism after total parathyroidectomy with reimplantation.

Ectopic Atypical Parathyroid Adenoma Presenting With Pancreatitis

Background: Atypical Parathyroid Adenoma (APA) and parathyroid carcinomas (PC) are rare parathyroid tumors (<1%) causing primary hyperparathyroidism. We present a case of ectopic APA in the left anterior mediastinum. Case: A 38 year old male with hyperlipidemia admitted for acute pancreatitis noted to have calcium level of 13.4 mg/dl (8.6–10.3mg/dl) in the absence of family history of hypercalcemia or kidney stones. He was treated with zoledronic acid, intravenous fluids and calcitonin for hypercalcemia. Pancreatitis resolved with fluid management. Calcium on discharge was 9.9 mg/dl. 8 week follow-up labs showed PTH of 420 pg/ml (14–64 pg/ml), calcium 10.2 mg/dl, phosphorus 1.9 mg/dl (2.5–4.5 mg/dl), vitamin D 19 ng/ml (30–100 ng/ml), 24-hour urinary calcium 115 mg/24 hour (55–300 mg/24 hour) and calcium to creatinine ratio 0.41. Hence diagnosis of primary hyperparathyroidism was made but given the degree of calcium and PTH elevation there was a concern for PC. Ultrasound of the neck demonstrated no abnormality. Sestamibi scan showed irregular focal accumulation of radiotracer in the left upper mediastinum suggestive of mediastinal ectopic parathyroid adenoma (EPA). CT chest with contrast showed a 3.9 x 2.2 x 3.4cm lobulated, heterogenous, hypodense, minimally enhancing mass in the left anterior prevascular space. Diagnosis of EPA was made and he underwent left video assisted thoracic surgery. Operative findings showed a multilobular mass at the level of the aortic arch between vagus and phrenic nerves. Intraoperative PTH went from 1124 pg/ml pre-incision to 160 at 15-minute post-excision. Postoperative calcium was 9.6 mg/dl and PTH 51 pg/ml. Final pathology showed 3.7 x 2.5 x 2cm, hypercellular parathyroid with prominent fibrous band and parafibromin retention compatible with APA. Discussion: APA is an intermediate form of parathyroid neoplasm with uncertain malignant potential, showing atypical histological features without evidence of invasive growth. This poses a diagnostic challenge of PC as the histopathological features overlap and requires an expert pathologist to make the diagnosis. Inactivating CDC73 mutations, encoding parafibromin, is the most common genetic abnormality. Loss of parafibromin has been seen in 100% cases of PC and predicts poor prognosis. Due to rarity of the disease there are no clear guidelines on follow up. Based on literature, annual follow up is suggested with biochemical testing and imaging for the first 5 years after surgery and every 2–3 years thereafter due to 3% recurrence rate and potential progression to PC. Cetani et al in 2019 reported 672 cases of APA, only 3 were ectopic in the mediastinum thus making our case rare. APA is a rare entity as biochemical profile and histopathological features overlap with PC and can be misdiagnosed. Greater awareness of APA may improve capture of cases, allowing the development of guidelines to recognize and treat it.

Split Sternotomy in Retrosternal Thyroid and Mediastinal Parathyroid Pathologies.

Objectives:Although cervical incisions are usually sufficient in mediastinal located thyroid and parathyroid pathologies, sometimes mediastinal approaches are required. In recent years, less invasive methods have been used instead of median sternotomy. In this study, the adequacy of the incision and morbidity in patients who underwent split sternotomy due to retrosternal goiter (RG) and mediastinal parathyroid pathology in our clinic were investigated.Methods:The files of patients who underwent split sternotomy in addition to cervical incision or split sternotomy extending from the sternal notch to the third intercostal space with a separate vertical incision due to retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma between January 2010 and January 2021 were retrospectively reviewed. Operative success, exposure provided by split sternotomy, and complication rates were investigated.Results:Twelve patients who underwent split sternotomy were included in the study. The mean age of the patients was 57.25±12.62 (44–83) years. Eight (66.7%) of the patients were female and 4 (33.3%) were male. The indication for surgery was multinodular goiter (MNG) in 3 (25%) patients, recurrent MNG in 3 (25%) patients, hyperparathyroidism in 3 (25%) patients, and thyroid cancer in 3 (25%) patients. Transient hypocalcemia in 6 (50%) patients and unilateral vocal cord paralysis in 1 (8.3%) patient developed postoperatively, and all complications resolved spontaneously in an average of 3 weeks. Median sternotomy was not required for any of the patients.Conclusion:Split sternotomy is an adequate and applicable method for the success of the surgery in RG and mediastinal parathyroid pathologies that cannot be excised with the cervical approach.