Two-Cases of Thoracoscopic Excision for Mediastinal Parathyroid Tumor.

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  • 縦隔内の機能性上皮小体腺腫を胸腔鏡下に摘出しえた２例

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Abstract

Mediastinal ectopic parathyroid tumors have been surgically treated by midline sternotomy or thoracotomy, but these procedures have demerits to offer a severe postoperative pain and a cosmetic problem due to its large surgical wound. Recently, thoracoscopic surgery has expanded with advances in endoscopic surgical instrumentation. We report two patients with mediastinal ectopic parathyroid tumor who underwent successful thoracoscopic excision. A 23-year-old woman was admitted to the hospital for evaluation of ureterolithiasis and hypercalcemia. Hormonal study revealed high level of serum intact parathyroid hormone. Ultrasonographic examination failed to detect any parathyroid tumor. 99mTcmethoxy-isobutyl-isonitrile scintigraphy (MIBI) and magnetic resonance imaging (MRI) revealed on intrathymic mass, 3×2cm in size. Another patient was a 73-year-old woman. She had a 10-year history of hypercalcemia and ureterolithiasis, and underwent an initial parathyroid surgery in other institute 8years before admission, that failed to remove the parathyroid tumor. The tumor was located in the anterior side of the upper thoracic esophagus, which was detected clearly by MIBI scintigram and MRI. For both two patients, right thoracoscopic approach was performed and the tumors were successfully removed. Postoperative course was uneventful, and the outcome of surgery was excellent in two cases. Our initial experiences are encouraging enough to suggest that thoracoscopic excision in patients with intrathoracic parathyroid tumor is a beneficial therapeutic option, which is easy, safe, less invasive and lead to early convalescence.

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