An anatomic aberration and a surgical challenge: Mediastinal parathyroid adenoma anterior the pericardium. A case report. (2019)

• Record Type: Journal Article
• Authors: Patrinos, Antonios; Zarokosta, Maria; Piperos, Theodoros; Chrysikos, Dimosthenis; Kakaviatos, Dimosthenis; Theodoropoulos, Panagiotis; Kalles, Vasileios; Tsiaoussis, John; Noussios, George; Mariolis-Sapsako, Theodoros
• Is Part Of: International journal of surgery case reports. Volume 57(2019)
• Page Start: 106
• Page End: 109
• Publication Date: 2019
• Subjects: Single parathyroid adenoma -- Aberrant location -- PHPT -- Hypercalcemia -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.03.014
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Massive localized lymphedema (MLL) constitutes a rare benign clinical disorder, presenting in obese patients, characterized by chronic accumulation of lymph and adipose tissue due to lymphatic flow obstruction. MLL may mimic an abundance of soft tissue tumors. Nevertheless, surgical excision of the soft-tissue mass, seems the most favorable therapeutic approach, as performed in the presented case. Abstract: Introduction: Ectopic parathyroid glands occur in 6–16% of cases of PHPT and they constitute a potential cause of failed primary surgical therapy. In particular, aberrant adenomas located deeper in the mediastinum, as in the presented case, remain a severe challenge for the surgeons. Presentation of case: A 54-year-old Caucasian female proceeded to our institution with signs and symptoms of PHPT. Imaging studies performed identified a large mass localized in the lower anterior mediastinum, on the left of the median line. A mid-sternal thoracotomy was performed and the aberrant adenoma was finally detected anterior to the pericardium and the left pericardiophrenic vessels and the left phrenic nerve. The operation was uneventful. A meticulous review of the literature was conducted as well. Discussion: Single parathyroid adenomas are the key culprits of PHPT. Anatomic aberrations of the location of the parathyroid glands and their adenomas are more common than described in the literature and there are possible anatomic aberrations that have not been described yet. All these anatomic variations constitute major risk-factors of thoracic bleeding and of nerve injury. Conclusion: Detailed preoperative detection in addition to meticulous exposure of the operative field are fundamental in order to perform a safe adenoma excision without harmful impacts to the patient.