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Gamma probe-assisted excision of an ectopic parathyroid adenoma located within the thymus: case report and review of the literature.

Daliakopoulos SI, Chatzoulis G, Lampridis S, Pantelidou V, Zografos O, Ioannidis K, Sapranidis M, Ploumis A - J Cardiothorac Surg (2014)

Bottom Line: PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively.We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery.The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece. savvas.lampridis@gmail.com.

ABSTRACT
Primary hyperparathyroidism due to parathyroid adenomas may be associated with ectopic parathyroid gland localization in 20-25% of the patients. We report herein the excision of an ectopic parathyroid adenoma which was detected in the thymus gland by gamma probe intraoperatively. A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcaemia, and PTH elevation. A combination of Technetium-99 m sestamibi scintigraphy and Computed Tomography scan of the chest and neck revealed an ectopic parathyroid adenoma of 8.5 mm in its greatest dimension. The patient underwent sternotomy and the adenoma was found within the right lobe of the thymus gland with the intraoperative use of gamma probe. PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively. We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery. The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration.

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Intraoperative image of an ectopic parathyroid adenoma inside the thymus gland. An intraoperative image, after a median sternotomy, of an ectopic parathyroid adenoma located within the thymus gland.
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Figure 3: Intraoperative image of an ectopic parathyroid adenoma inside the thymus gland. An intraoperative image, after a median sternotomy, of an ectopic parathyroid adenoma located within the thymus gland.

Mentions: During the operation, the patient initially underwent bilateral exploration of the lower pole of the thyroid in the neck and then, at the same stage, a median sternotomy (Figure 3). The use of gamma-probe radioactivity consisted of monitoring the thyroid background as a guide, whereas within the thymus high pitch signals in a ratio parathyroid/thyroid = 2.5 were recorded. The gamma probe is a hand held probe containing a radiation detector, providing a count rate from gamma rays. This hand held probe is connected to a power supply and a unit that receives the electrical audible high pitch signals that come from the radiation detector. Subsequently, the parathyroid adenoma was removed as it was located inside the thymus gland. The intraoperative documentation of the existence of adenoma was made by three ways: a) The intraoperative use of gamma probe with increasing signals of the gamma-probe output (the high-pitch signals produced by the gamma probe) when the probe was in contact with parathyroid adenoma in vivo or ex vivo producing high radioactivity. b) The frozen biopsy of the parathyroid adenoma. c) The intraoperative PTH serum value (after removal of ectopic parathyroid adenoma) was 31 pg/ml (80% below from baseline). Operative time was approximately 1.5 hours.


Gamma probe-assisted excision of an ectopic parathyroid adenoma located within the thymus: case report and review of the literature.

Daliakopoulos SI, Chatzoulis G, Lampridis S, Pantelidou V, Zografos O, Ioannidis K, Sapranidis M, Ploumis A - J Cardiothorac Surg (2014)

Intraoperative image of an ectopic parathyroid adenoma inside the thymus gland. An intraoperative image, after a median sternotomy, of an ectopic parathyroid adenoma located within the thymus gland.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230425&req=5

Figure 3: Intraoperative image of an ectopic parathyroid adenoma inside the thymus gland. An intraoperative image, after a median sternotomy, of an ectopic parathyroid adenoma located within the thymus gland.
Mentions: During the operation, the patient initially underwent bilateral exploration of the lower pole of the thyroid in the neck and then, at the same stage, a median sternotomy (Figure 3). The use of gamma-probe radioactivity consisted of monitoring the thyroid background as a guide, whereas within the thymus high pitch signals in a ratio parathyroid/thyroid = 2.5 were recorded. The gamma probe is a hand held probe containing a radiation detector, providing a count rate from gamma rays. This hand held probe is connected to a power supply and a unit that receives the electrical audible high pitch signals that come from the radiation detector. Subsequently, the parathyroid adenoma was removed as it was located inside the thymus gland. The intraoperative documentation of the existence of adenoma was made by three ways: a) The intraoperative use of gamma probe with increasing signals of the gamma-probe output (the high-pitch signals produced by the gamma probe) when the probe was in contact with parathyroid adenoma in vivo or ex vivo producing high radioactivity. b) The frozen biopsy of the parathyroid adenoma. c) The intraoperative PTH serum value (after removal of ectopic parathyroid adenoma) was 31 pg/ml (80% below from baseline). Operative time was approximately 1.5 hours.

Bottom Line: PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively.We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery.The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece. savvas.lampridis@gmail.com.

ABSTRACT
Primary hyperparathyroidism due to parathyroid adenomas may be associated with ectopic parathyroid gland localization in 20-25% of the patients. We report herein the excision of an ectopic parathyroid adenoma which was detected in the thymus gland by gamma probe intraoperatively. A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcaemia, and PTH elevation. A combination of Technetium-99 m sestamibi scintigraphy and Computed Tomography scan of the chest and neck revealed an ectopic parathyroid adenoma of 8.5 mm in its greatest dimension. The patient underwent sternotomy and the adenoma was found within the right lobe of the thymus gland with the intraoperative use of gamma probe. PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively. We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery. The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration.

Show MeSH
Related in: MedlinePlus