Surgical treatment of hyperparathyroidism with a pathologically changed parathyroid gland found in the mediastinum

Česká verzia

Authors: M. Podhráský; P. Libánský; J. Tvrdoň
Authors place of work: III. chirurgická klinika 1. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole
Published in the journal: Rozhl. Chir., 2023, roč. 102, č. 4, s. 169-173.
Category: Kazuistika
doi: https://doi.org/10.33699/PIS.2023.102.4.169–173

Summary

The most common indication for surgical treatment of parathyroid gland pathology is primary hyperparathyroidism where extirpation of the pathologically changed parathyroid gland is the first-choice treatment. Embryonic development of the lower pair of parathyroid glands is quite complex and is closely related to the tissue of the thymus; for this reason it is not uncommon for a parathyroid adenoma to be located in the mediastinum or directly in the tissue of the thymus. The treatment of primary hyperparathyroidism is becoming a multidisciplinary issue in which radiodiagnostics and nuclear medicine methods play a significant role as they are needed to accurately localize the affected gland and to plan an adequate surgery. In case of intrathoracic localization of parathyroid adenoma, the therapy belongs in the hands of thoracic surgery.

At our department, the endocrine surgery program, including parathyroid gland surgery, has a long tradition, and complicated patients are concentrated here, often patients with refractory hyperparathyroidism after a previous procedure. In the last 10 years, almost 2,300 procedures for parathyroid pathology have been performed at the IIIrd Department of Surgery of the 1st Faculty of Medicine, Charles University and University Hospital in Motol, of which some pathologies with mediastinal localization were managed using minimally invasive methods, i.e. videothoracoscopy or robotic-assisted surgery.

Keywords:

Thymus – primary hyperparathyroidism – parathyroid glands – thymectomy – robotic-assisted surgery

Zdroje

1. Owen R. On the anatomy of the Indian Rhinoceros (Rh. Unicornis, L). Trans Zool Soc Lond 1862;4:31.

2. Sandström I. On a new gland in man and several mammals (glandulae parathyroideae). Ups Läk Förh 1880;15:441.

3. Gilmour, Jr. The gross anatomy of the parathyroid glands. J Pathol Bacteriol. 1938;46:133−149.

4. Akerström G, Malmaeus J, Bergström R. Surgical anatomy of human parathyroid glands. Surgery 1984;95:14.

5. Carlson, BM. Human embryology and developmental biology. 3rd ed., St. Louis, Mosby 2004;317−351.

6. Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98:1122.

7. Libánský P, Adámek S, Broulík P, et al. Parathyroid carcinoma in patients that have undergone surgery for primary hyperparathyroidism. In Vivo 2017 Sep-Oct;31(5):925−930. doi: 10.21873/invivo. 11148.

8. Shen W, Düren M, Morita E, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg 1996;131:861.

9. Kang CH, Hwang Y, Lee HJ, et al. Robotic thymectomy in anterior mediastinal mass: propensity score matching study with transsternal thymectomy. Ann Thorac Surg. 2016 Sep;102(3):895−901. doi: 10.1016/j.athoracsur.2016.03.084. Epub 2016 May 25.

10. Corona-Cruz JF, López-Saucedo RA, Ramírez-Tirado LA, et al. Extended resections of large thymomas: importance of en bloc thymectomy. J Thorac Dis. 2018 Jun;10(6):3473−3481. doi: 10.21037/ jtd.2018.05.101. PMID: 30069343; PMCID: PMC6051786.

11. Randone B, Costi R, Scatton O, et al. Thoracoscopic removal of mediastinal parathyroid glands: a critical appraisal of an emerging technique. Ann Surg. 2010 Apr;251(4):717−721.

12. Libánský P, Broulík P, Fialová M, et al. Videothorakoskopické odstranění mediastinálně uloženého adenomu příštítného tělíska při primární hyperparathyreóze. Rozhl Chir. 2016;95:245−248.

13. Rückert JC, Walter M, Müller JM. Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg. 2000 Nov;70(5):1656−1661. doi: 10.1016/ s0003-4975(00)01972-x.