Thoracoscopic excision of mediastinal parathyroid adenomas: a report of two cases

Two patients with primary hyperparathyroidism caused by solitary ectopic mediastinal parathyroid adenomas have been successfully treated by thoracoscopic excision. The patients were not suitable for open thoracic surgery. Both had right-sided adenomas confirmed by sestamibi and computerised tomography - one adjacent to the oesophagus at the level of D3, the other anterolateral to the ascending aorta. Both procedures were performed through one 12-mm camera port and two 5-mm operating ports, and were uncomplicated, with 30-45 minutes skin-to-skin operating time. Both patients were well enough to be discharged the next day, and both rapidly became normocalcaemic. At follow-up, neither had developed any complications. In selected cases, where an ectopic adenoma lies immediately deep to the mediastinal pleura, thoracoscopic excision offers considerable advantage over open thoracic surgery.     

Multiple gastric polyps and parathyroid adenomas. Report of two cases.

Two cases of multiple gastric polyps associated with parathyroid adenomas are presented. A review of the literature revealed four patients with multiple gastric polyps and multiple endocrine adenomatosis. The possiblity of multiple gastric polyps as a variant of the MEA syndrome complex is explored. Emphasis is placed on the need for thorough endocrine evaluation in patients with multiple gastric polyps.     

Localization of parathyroid adenomas by digital subtraction angiography. A report of 4 cases

Intravenous digital subtraction angiography provides an accurate but not specific method for localization of small vascular tumours. It is carried out on outpatients as an intravenous procedure and takes only 40 minutes. It appears to be eminently suited to the demonstration of parathyroid adenomas and shows that a hyperplastic parathyroid gland can produce a significant enough vascular blush to create a visible image.     

Thoracoscopic excision of mediastinal parathyroid adenomas: a report of two cases and review of the literature

Background:Most abnormal parathyroid glands can be removed through a standard cervical incision; even those in the superior mediastinum. Those located in certain areas of the mediastinum, for example posteriorly or in the aortopulmonic window, historically have required excision through a median sternotomy or thoracotomy. Angioablation is a nonsurgical alternative to management of these lesions.Study Design:We present two case reports of mediastinal parathyroid adenomas that were excised thoracoscopically, and review the literature regarding the management of mediastinal parathyroid adenomas.Results:Both patients who underwent precise localization and thoracoscopic excision of their mediastinal parathyroid adenomas had resolution of their hypercalcemia with minimal associated morbidity and shortened recovery periods.Conclusions:We suggest that thoracoscopic excision of mediastinal parathyroid adenomas is the better means of controlling hypercalcemia secondary to parathyroid adenoma in those patients considered for either median sternotomy, thoracotomy or angiographic ablation where the exact location of the lesion can be established preoperatively.     

Multiple parathyroid adenomas: Three operative explorations with removal of two tumors

A case is reported of a sixty-two-year-old male who had pulmonary tuberculosis twenty-five years before admission to the hospital; a left nephrotomy for the removal of multiple renal calculi twenty-one years ago; and who subsequently developed a bladder calculus with all the signs and symptoms of hyperparathyroidism. The first operation at which only the right side of the neck was explored, resulted in the removal of a parathyroid adenoma. However, the symptoms persisted as did the hypercalcemia and the elevated serum phosphatase. A second operation seven weeks later failed to reveal a second parathyroid adenoma. Further studies were continued, the patient meanwhile showing no improvement, and it was decided to reoperate a third time. A large parathyroid tumor containing remnants of thymus tissue was found on the left side. The patient died shortly afterward with evidence of cardiac failure.The question of what influence, if any, the treatment for pulmonary tuberculosis with its high caloric diet and increased milk intake, and subsequent load on the parathyroids, is properly raised. Also the long-standing interval between the appearance of the renal calculi twenty-one years before, and the subsequent development of the typical signs and symptoms of hyperparathyroidism is discussed. Attention is called to the fact that an exhaustive exploration must be done thoroughly on both sides even though a large tumor may be readily found on one side. Cope's admonition that the problems of parathyroid surgery are not those of the regional anatomy of the neck, but are peculiar to the anatomy and physiology of the parathyroid glands, should be emphasized. Likewise special training is required for this type of surgery.     

Intrathyroid parathyroid adenomas

The authors present 27 cases of intrathyroid adenomas of the parathyroid glands that made up 22.68% of 119 patients operated on for parathyroid tumors. Clinical manifestations of primary hyperparathyrosis were diagnosed in 10 out of 27 patients. In 17 of these patients the hormonal-inactive parathyroid adenomas, detected accidentally during operations for different diseased of the thyroid gland, were ablated. The authors stress a careful revision of the thyroid to be necessary in order to exclude an intrathyroid localization of parathyroid neoplasms which can result in persistence of the disease if not ablated.     

Mediastinal, cystic and functional parathyroid adenoma in patients with double parathyroid adenomas: a case report

Primary hyperparathyroidism is usually caused by single adenoma. Ectopic adenomas are a frequent cause of recurrent or persistent hyperparathyroidism. Parathyroid cysts are rarely seen and most of them are non functional. This case report describes a patient with double adenoma, one is solid and cervical, the other is cystic and located in mediastinum; both of them are functional.     

非功能性甲状旁腺囊肿五例的临床分析

目的 了解非功能性甲状旁腺囊肿的特点，探讨其诊治方法。方法 回顾研究了1985～1999年收治的非功能性甲状腺囊肿5例患者的临床表现及血钙、B超和核素扫描等辅助检查的特点，以及病理学及免疫组织化学的特征。结果 本组5例患者均行手术切除治疗，病理学检查证实均为非功能性甲状旁腺囊肿，免疫组织化学检查嗜铬素（CgA）、突触素（Syn）、神经原特异性烯醇化酶（NSE）阳性支持本诊断。术后随访均无复发。结论 手术切除对非功能性甲状腺囊肿的治疗较为理想，而病理学检查是最可靠的诊断方法。     

多发性脑膜瘤32例报告

目的探讨多发性脑膜瘤的发生、分类、诊断与治疗。方法对32例多发性脑膜瘤患者的临床资料进行回顾性分析研究。结果32例多发性脑膜瘤包括原发多发18例,术后多发7例,合并神经纤维瘤病4例,脑膜瘤病1例,合并垂体瘤、合并胶质瘤各1例。全部采取手术治疗,治愈25例,好转7例。结论各类多发性脑膜瘤的发生学不同,雌激素可能在其发生中起重要作用;多数患者可一期切除全部肿瘤,由于多数患者对多次手术有较好的耐受性,不能一期切除的肿瘤应尽可能分期切除;各类多发性脑膜瘤的治疗原则和预后不同。     

Multiple schwannomas: report of two cases

In this paper authors present two cases of multiple schwannomas without the features of neurofibromatosis (NF). The authors retrospectively reviewed the hospital charts, radiology films, operative notes and pathology slides of these two patients. There was no family history of neurofibromatosis. The two patients had contrast enhanced MRI, which was negative for vestibular schwannomas. Both underwent surgical excision of symptomatic lesions. Histopathology confirmed these lesions as schwannomas. Molecular genetic analysis in case 1 demonstrated two distinct mutations of the NF2 gene in two different schwannomas, with concomitant loss of heterozygosity in both tumours. In contrast peripheral blood lymphocytes did not reveal mutations of NF2. The authors recommend surgery for symptomatic lesions. Asymptomatic tumours can be monitored. Regular follow up is essential as they may develop fresh lesions at any time. The relevant literature is discussed.

     

Preoperative localization of parathyroid adenomas

During a 12-month period, 64 patients were operated on for primary hyperparathyroidism. Sixty-one had single adenomas and 3 had double adenomas. Preoperative imaging was used to localize the adenomas. Half of the patients (32 of 64) had magnetic resonance, thallium-201/technetium-99m subtraction scintigraphy, and high-resolution ultrasonography; the other 32 patients had 1 or 2 of the imaging modalities. Sensitivity and specificity of magnetic resonance imaging was 82 percent and 97 percent, respectively; the sensitivity and specificity of the other two modalities was 59 and 98 percent for subtraction scintigraphy and 73 and 98 percent for ultrasonography. The use of preoperative imaging facilitated surgical exploration, reduced operating time, and resulted in an increased number of successful operations. There were no negative explorations in this series as compared with 19 negative explorations (2.6 percent) in our prior experience with 720 operations.     

Localization of parathyroid adenomas by computer-assisted parathyroid scanning.

In an attempt to localize adenomas of the parathyroid glands 36 patients with suspected hyperparathyroidism were studied with a computer-assisted double isotope scanning technique. Six patients were excluded from the statistical analysis because of uninterpretable scans. A definite localization was made with the computer-assisted scan in 16 patients. In 14 of these patients the site of the tumours was correctly predicted. In 14 patients no localization was seen on the scan. Four of these patients were classified as false negatives. In 14 out of the 16 correctly localized tumours two-thirds had weights equal to or less than 1-5 g.     

45例甲状旁腺肿瘤临床分析

目的:探讨甲状旁腺肿瘤的诊断、术前定位、外科治疗及预后.方法:对2001年-2012年间收治的45例甲状旁腺肿瘤病例的临床资料进行回顾性分析.结果:全组45例甲状旁腺肿瘤术前均通过B超和或CT、99mTc-MIBI检查得以定位,阳性率分别为86.7％,93.8％,100％.45例均行手术治疗,均为单发肿瘤,其中左上7例,左下23例,右上4例,右下11例.术后病理证实39例为腺瘤,1例腺癌和5例囊肿.囊肿均为非功能性,腺瘤、腺癌均伴原发性甲状旁腺功能亢进(PHPT).术前PHPT患者均有不同程度的血钙升高和血磷降低,其中24例甲状旁腺激素(PTH)升高;术后血钙明显下降,血磷明显上升(均P＜0.05),1周至3个月恢复正常,PTH明显降低(P＜0.05),22例术后1～5 d即正常,2例1年后正常.术中PTH(IOTPH)判断腺瘤成功切除率100％.40例获随访3个月至10年,均无复发和病灶遗漏.结论:甲状旁腺肿瘤起病缓慢,临床表现复杂多样.血钙、血磷以及血PTH的检测有助于PHPT的诊断;B超可作为甲状旁腺肿瘤的术前定位的首选检查,联合CT和99mTc-MIBI核素扫描能提高定位率;手术治疗为甲状旁腺肿瘤的首选治疗方法,效果良好.     

Diagnosis and treatment of parathyroid adenomas

The classical manifestations of primary hyperparathyroidism (hypercalcemia, hypophosphatemia, hypercalciuria, increased blood alkaline phosphatase level, and bone changes of the type of generalized osteoporosis) were found in approximately half of patients in a group of 23 who were examined. When Recklinghausen's disease is suspected, the patients must be subjected to a purposeful examination. The intraoperative diagnosis of parathyroid adenoma is difficult. In distinction from thyroid tissue, a lymph node, and adipose tissue a parathyroid adenoma almost always has a vascular pedicle, which makes verification of the diagnosis easier.     

Therapy of suspected intrathoracic parathyroid adenomas

BACKGROUND AND AIMS: Ectopic mediastinal parathyroid adenoma as a cause of primary hyperparathyroidism (pHPT) can normally be resected from conventional collar incision. In rare cases with adenomas deeper in the chest, a transthoracic approach is necessary. PATIENTS/METHODS: We report our experience of 19 patients with suspected mediastinal parathyroid adenomas from a total of 1035 patients with pHPT who were operated on between 1986 and 2000 using an open approach (sternotomy or thoracotomy) or video-assisted mediastinal or thoracoscopic surgery (VAMS/VATS). RESULTS: Fourteen patients underwent an open approach with a success rate of 71% (10 of 14). Four patients remained hypercalcaemic. There were four complications in three patients: three permanent recurrent nerve palsies and one chylus fistula, requiring further surgery. VATS was successful in three of four patients with conversion to sternal splitting because of a false-negative frozen section in one patient. Another patient had parathyroid adenoma retrosternally which could not be resected by means of VAMS and had to be excised using a transsternal approach. There were no complications of minimal invasive procedures. All five patients were normocalcaemic after the operation. CONCLUSION: Ectopic parathyroid adenomas not resectable by means of a collar incision are rare causes of pHPT and comprise 1.25% of all patients with pHPT in our series. For these patients, VATS revealed an alternative to conventional open procedures. In questionable cases, however, the collar incision should precede the VATS procedure.     

单鼻孔-经蝶窦入路切除垂体腺瘤70例报告

目的探讨显微神经外科技术经单鼻孔-鼻中隔根部-经蝶窦入路切除垂体腺瘤手术入路的临床效果. 方法显微镜下长鼻镜辅助观察、扩张中鼻道,扩张器置入直达蝶窦前壁、骨性鼻中隔根部,将鼻中隔自根部折断连同对侧鼻黏膜一起推向对侧,余步骤同传统经蝶手术. 结果全组70例中,62例近全切除(>95%),6例大部切除(76%～95%),2例仅为部分切除(≤75%).无手术死亡.术后24例一过性尿崩,均于3周内自愈;8例脑脊液鼻漏,5例卧床2周自愈,3例行腰大池引流治愈.48例随访3个月～2年,平均7个月,2例复发. 结论单鼻孔-鼻中隔根部-经蝶窦入路切除垂体腺瘤疗效满意,对手术通道即鼻部组织损伤小,不必分离鼻中隔及两侧黏膜,手术技术容易掌握,省时间,并发症少.