Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1
Abstract Background Hyperparathyroidism 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 s...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-06-01
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| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-023-01694-9 |
| _version_ | 1797795497767862272 |
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| author | Yuko Ohara Yuka Kadomatsu Toyone Kikumori Toyofumi F. Chen-Yoshikawa |
| author_facet | Yuko Ohara Yuka Kadomatsu Toyone Kikumori Toyofumi F. Chen-Yoshikawa |
| author_sort | Yuko Ohara |
| collection | DOAJ |
| description | Abstract Background Hyperparathyroidism 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 presentation A 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. Conclusions Minimally invasive surgical resection of a remnant ectopic lesion was successfully performed in a patient with multiple endocrine neoplasia 1 using robot-assisted thoracoscopic surgery. |
| first_indexed | 2024-03-13T03:18:51Z |
| format | Article |
| id | doaj.art-216bdb16b86543f0be72e128ed9535b9 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-03-13T03:18:51Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-216bdb16b86543f0be72e128ed9535b92023-06-25T11:26:00ZengSpringerOpenSurgical Case Reports2198-77932023-06-01911410.1186/s40792-023-01694-9Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1Yuko Ohara0Yuka Kadomatsu1Toyone Kikumori2Toyofumi F. Chen-Yoshikawa3Department of Thoracic Surgery, Nagoya University Graduate School of MedicineDepartment of Thoracic Surgery, Nagoya University Graduate School of MedicineDepartment of Breast and Endocrine Surgery, Nagoya University Graduate School of MedicineDepartment of Thoracic Surgery, Nagoya University Graduate School of MedicineAbstract Background Hyperparathyroidism 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 presentation A 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. Conclusions Minimally invasive surgical resection of a remnant ectopic lesion was successfully performed in a patient with multiple endocrine neoplasia 1 using robot-assisted thoracoscopic surgery.https://doi.org/10.1186/s40792-023-01694-9Ectopic parathyroid adenomaHyperparathyroidismMultiple endocrine neoplasia 1Robot-assisted thoracoscopic surgery |
| spellingShingle | Yuko Ohara Yuka Kadomatsu Toyone Kikumori Toyofumi F. Chen-Yoshikawa Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1 Surgical Case Reports Ectopic parathyroid adenoma Hyperparathyroidism Multiple endocrine neoplasia 1 Robot-assisted thoracoscopic surgery |
| title | Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1 |
| title_full | Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1 |
| title_fullStr | Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1 |
| title_full_unstemmed | Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1 |
| title_short | Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1 |
| title_sort | robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1 |
| topic | Ectopic parathyroid adenoma Hyperparathyroidism Multiple endocrine neoplasia 1 Robot-assisted thoracoscopic surgery |
| url | https://doi.org/10.1186/s40792-023-01694-9 |
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