Respir Case Rep. 2018; 7(1): 26-29 | DOI: 10.5505/respircase.2018.80958

Ektopik Paratiroid Adenomu: Nadir Bir Mediastinal Tümör

Orkide Kutlu¹, Mustafa Çalýk², Cevdet Duran³, Hýdýr Esme², Omer Karahan^4
1Saðlýk Bilimleri Üniversitesi Konya Eðitim ve Araþtýrma Hastanesi Dahiliye Kliniði, Konya
²Saðlýk Bilimleri Üniversitesi Konya Eðitim ve Araþtýrma Hastanesi Göðüs Cerrahisi Kliniði, Konya
³Saðlýk Bilimleri Üniversitesi Konya Eðitim ve Araþtýrma Hastanesi Dahiliye Kliniði Endokrinoloji ve Metabolizma Hastalýklarý Servisi, Konya
⁴Saðlýk Bilimleri Üniversitesi Konya Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði, Konya

Primer hiperparatiroidizm (PHPT) genellikle soliter paratiroid adenomuna baðlýdýr ve bu adenomlarýn % 1'inde ektopik mediastinal yerleþim olduðu bildirilmiþtir. Ektopik paratiroid adenomu tanýsýnda Tc99m-MIBI sintigrafisi, yaklaþýk % 100 duyarlýlýðý vardýr; ancak tümörün preoperatif lokalizasyonu belirlenmesi için MR ve / veya BT görüntüleri ile birlikte deðerlendirilmelidir. Genelde tedavisi sternotomi gerektirebilen servikal yaklaþým, nadiren de antero-lateral torakotomidir. Son zamanlarda özellikle viseral tümörlerde, video yardýmlý torakoskopik cerrahi (VATS) ile etkin ve rahat bir tedavi seçeneðidir. Bu yazýda, genel cerrahi tarafýndan yapýlan total tiroidektomi ve paratiroidektomi ameliyatýndan sonra devam eden klinik ve laboratuvar hiperparatiroidizmli hastanýn Tc-99m sintigrafisi ve SPECT ile belirlenen; lateral torakotomi ile baþarýlý eksize edilen mediastinal paratiroid adenomunu bildirmeyi amaçladýk. Hasta L-tyroxine, kalsiyum ve D vitamini replasman tedavileri ile takip aþamasýndadýr.

Anahtar Kelimeler: Hiperparatiroidizm, adenom, mediastinal, torakotomi

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Ectopic Parathyroid Adenoma: A Rare Mediastinal Tumor

Orkide Kutlu¹, Mustafa Çalýk², Cevdet Duran³, Hýdýr Esme², Omer Karahan^4
1Department of Internal Medicine, Health Sciences University, Konya Training and Research Hospital, Konya, Turkey.
²Department of Thoracic Surgery, Health Sciences University, Konya Training and Research Hospital, Konya, Turkey
³Department of Internal Medicine, Division of Endocrinology and Metabolism, Health Sciences University, Konya Training and Research Hospital, Konya, Turkey
⁴Department of General Surgery, Health Sciences University, Konya Training and Research Hospital, Konya, Turkey

Primary hyperparathyroidism is generally due to a solitary parathyroid adenoma and among those adenomas, 1% have been reported to have an ectopic mediastinal location. In the diagnosis of ectopic parathyroid adenoma, technetium-99m methoxyisobutylisonitrile scintigraphy is an imaging method with a sensitivity of approximately 100%; however, in preoperative localization of the tumor, it should be evaluated together with magnetic resonance imaging and/or computed tomography images. In general, the treatment necessitates a cervical approach that may require a sternotomy, though rarely, an anterolateral thoracotomy is warranted. Recently, especially in visceral tumors, an effective and comfortable treatment option has been defined with video assisted thoracoscopic surgery. The aim of this article was to report the successful excision of a mediastinal parathyroid adenoma with a lateral thoracotomic approach that was localized with Tc-99m MIBI scintigraphy and single-photon emission computed tomography imaging in a patient with ongoing clinical and laboratory findings of HPT after the first operation, in which a general surgical team performed a total thyroidectomy and parathyroidectomy. The patient is still in follow-up with L-thyroxine, calcium, and vitamin D replacement treatment.

Keywords: Hyperparathyroidism, adenoma, mediastinal, thoracotomy

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ATIF KOPYALA