A Case of Radical Resection of a Mediastinal Invasive Parathyroid Tumor via a Thoracoscopic Approach.
- 1Department of Digestive Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
- 2Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
Abstract
Parathyroid carcinoma is a rare malignancy that accounts for 0.3%-5.6% of cases of primary hyperparathyroidism (PHPT). Owing to the risk of tumor seeding, biopsy and fine-needle aspiration are contraindicated, posing a challenge to preoperative diagnosis of parathyroid carcinoma. Furthermore, complete tumor resection without capsular rupture is crucial because R1 resection substantially increases the risk of local recurrence. A 71-year-old woman with hypercalcemia and renal dysfunction was referred to our hospital for further evaluation. Laboratory tests revealed a serum calcium level >12 mg/dL and markedly elevated intact parathyroid hormone (iPTH) levels. CT revealed diffuse skeletal sclerosis, leading to a diagnosis of PHPT caused by a parathyroid tumor. Imaging studies demonstrated that the tumor extended from the lower right neck into the superior mediastinum, with indistinct borders from the trachea and esophagus, raising concerns regarding malignancy and possible invasion. Therefore, a thoracoscopic approach was planned to achieve safe dissection and assess the feasibility of en bloc resection. The patient was initially placed in the left lateral decubitus position, and thoracoscopic mobilization of the mediastinal portion of the tumor was performed without capsular injury. After sufficient mobilization, the patient was moved to a supine position, and cervical dissection was completed through a small incision in the neck, achieving en bloc removal while preserving the recurrent laryngeal nerve. The patient developed pneumonia postoperatively, which resolved with conservative treatment. Pathological examination of the resected tumor revealed a parathyroid adenoma with capsular invasion and negative margins. The patient was discharged on POD 9 with normalized calcium and iPTH levels. The thoracoscopic approach may be a useful and safe strategy for treating parathyroid tumors that extend into the mediastinum, facilitating precise mobilization and en bloc resection without capsular rupture. Hence, a combined approach may enhance both the safety and curative potential of surgery in selected cases of parathyroid tumors with mediastinal extension.
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BibTeX
@article{suzuki2026case,
title = {{A Case of Radical Resection of a Mediastinal Invasive Parathyroid Tumor via a Thoracoscopic Approach.}},
author = {Yusuke Suzuki and Hiroshi Sato and Yutaka Miyawaki and Ayumi Kodama and Masatoshi Yoshizawa and Tasuku Furube and Kazuaki Matsui and Tetsuro Toriumi and Yutaka Kishimoto and Gen Ebara and Shinichi Sakuramoto},
journal = {Surgical case reports},
year = {2026},
month = oct,
doi = {10.70352/scrj.cr.26-0266},
url = {https://europepmc.org/article/MED/42953870},
note = {CC BY},
}
RIS
TY - JOUR
TI - A Case of Radical Resection of a Mediastinal Invasive Parathyroid Tumor via a Thoracoscopic Approach.
AU - Yusuke Suzuki
AU - Hiroshi Sato
AU - Yutaka Miyawaki
AU - Ayumi Kodama
AU - Masatoshi Yoshizawa
AU - Tasuku Furube
AU - Kazuaki Matsui
AU - Tetsuro Toriumi
AU - Yutaka Kishimoto
AU - Gen Ebara
AU - Shinichi Sakuramoto
PY - 2026
DA - 2026/10/24
JO - Surgical case reports
DO - 10.70352/scrj.cr.26-0266
UR - https://europepmc.org/article/MED/42953870
AB - Parathyroid carcinoma is a rare malignancy that accounts for 0.3%-5.6% of cases of primary hyperparathyroidism (PHPT). Owing to the risk of tumor seeding, biopsy and fine-needle aspiration are contraindicated, posing a challenge to preoperative diagnosis of parathyroid carcinoma. Furthermore, complete tumor resection without capsular rupture is crucial because R1 resection substantially increases the risk of local recurrence. A 71-year-old woman with hypercalcemia and renal dysfunction was referred to our hospital for further evaluation. Laboratory tests revealed a serum calcium level >12 mg/dL and markedly elevated intact parathyroid hormone (iPTH) levels. CT revealed diffuse skeletal sclerosis, leading to a diagnosis of PHPT caused by a parathyroid tumor. Imaging studies demonstrated that the tumor extended from the lower right neck into the superior mediastinum, with indistinct borders from the trachea and esophagus, raising concerns regarding malignancy and possible invasion. Therefore, a thoracoscopic approach was planned to achieve safe dissection and assess the feasibility of en bloc resection. The patient was initially placed in the left lateral decubitus position, and thoracoscopic mobilization of the mediastinal portion of the tumor was performed without capsular injury. After sufficient mobilization, the patient was moved to a supine position, and cervical dissection was completed through a small incision in the neck, achieving en bloc removal while preserving the recurrent laryngeal nerve. The patient developed pneumonia postoperatively, which resolved with conservative treatment. Pathological examination of the resected tumor revealed a parathyroid adenoma with capsular invasion and negative margins. The patient was discharged on POD 9 with normalized calcium and iPTH levels. The thoracoscopic approach may be a useful and safe strategy for treating parathyroid tumors that extend into the mediastinum, facilitating precise mobilization and en bloc resection without capsular rupture. Hence, a combined approach may enhance both the safety and curative potential of surgery in selected cases of parathyroid tumors with mediastinal extension.
SN - 2198-7793
ER -