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A 65 years old female patient suffering from multinodular goitre and from hypercalcaemic syndrome which had been
and was being treated with drugs for a number of years. The patient undergoes total thyroidectomy. Surgical neck and
anterior mediastinum exploration was negative for sick parathyroids. Neck and chest TC and `TC sestamibi scintigraphy
showed the presence of a 7 cm hyperfunctional ectopic parathyroid tissue in the postero-superior mediastinum infiltrating
oesophagus.Video bronchoscopy revealed an extrinsic compression of the trachea.
The patient underwent surgery. Through right posterolaterai thoracotomy and mediastinal pleura incision, the adenoma
excision was carried out.
The histological examination revealed a potentially malignant parathyroid adenoma with infiltration, without overreaching
The surgical treatment resulted in an immediate resolution of the clinical simptomatology. One year later, the follow
up bas shown no observable relapse with normai calcium and PTH values.
Today, the tendence to minimally invasive surgery, an accurate preoperative localization of the adenoma and the use of
techniques such as intrasurgical nuclear mapping through manual gamma probes, selective angiography, venous intraoperative
dosage of PTH and intrasurgical ultrasound scan.