DIAGNOSIS AND SURGICAL CONTROL OF HYPERPARATHYROIDISM.
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A 67-year-old male visited his physician because of a 2-month history of cough and sputum. An abnormal shadow at the left upper mediastinum on chest x-ray film was detected, and the patient was referred to our department for further examination. Chest x-ray film revealed a round shadow at the left upper posterior mediastinum. Computed tomography(CT)revealed a uniform iso density mass about 4 cm in diameter, with a well-defined border. After the intravenous contrast administration, a slight peripheral enhancement was seen around the mass. On magnetic resonance imaging, the mass was hypointense in T1-weighting and hyperintense in T2-weighting. The contrast pattern was the same as that observed in the CT scan. On sagittal and coronal sections, the mass was adjacent to the aortic arch. Although a benign tumor was mostly suspected based on imaging findings, a malignant tumor was also possible. Accordingly, we resected this mass with video-assisted thoracoscopy. Findings at operation were a cystic mass. The pathological findings were compatible with benign parathyroid cyst, which was suspected to be the cystic degeneration of a parathyroid adenoma.
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Contemporary concepts regarding the use of endoscopic techniques in endocrine surgery have been presented. Laparoscopic adrenalectomy as a generally accepted method of treatment of benign adrenal tumours was discussed. Indications and technique of transperitoneal and retroperitoneal access were given. Operations of hormonally active tumours of the pancreas, parathyroids and thyroid were presented.
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