Rıza DOĞAN, Volkan KAYNAROĞLU, Murat KARA, Alkın YAZICIOĞLU

The use of gamma probe for the intraoperative localization of an ectopic parathyroid adenoma

Primer hiperparatiroidizmde en sık etyolojik faktör mediastende de yerleşebilen soliter paratiroid adenomudur. Mediastende yerleşik soliter paratiroid adenomlarına servikal insizyonla ulaşmak güçtür ve torasik bir yaklaşım gerekir. Asendan aortanın önünde timus içerisinde yerleşik primer hiperparatiroidizme neden olan paratiroid adenomlu 55 yaşındaki kadın olgumuzu sunuyoruz. Olguya paratiroid adenomunun doğru lokalizasyonunu sağlayarak cerrahiye yardımcı olan gamma probun intraoperatif kullanımıyla genişletilmiş timektomi uygulandı. Histolojik tanı tümörün ektopik paratiroid adenomu olduğunu doğruladı. Hastada hem kalsiyum hem de paratiroid hormon düzeylerinde azalma ile birlikte olan sorunsuz bir postoperatif dönem gözlendi. Gamma probun tam cerrahi rezeksiyon için ektopik paratiroid adenomunu çevre dokulardan ayırt etmesi nedeniyle çok yararlı bir araç olduğunu belirtmek istiyoruz.

Ektopik paratiroid adenomunun intraoperatif belirlenmesi amacıyla gama prob kullanımı

The most common etiologic factor of primary hyperparathyroidism is a solitary parathyroid adenoma that might be located in the mediastinum. The mediastinally located ectopic parathyroid adenomas are often out of reach with a cervical incision and require a thoracic approach. We present a case of 55 year-old female patient with a parathyroid adenoma located anterior to the ascending aorta within the thymus resulting in primary hyperparathyroidism. The patient underwent an extended thymectomy with intraoperative use of a gamma probe as an adjunct to surgical resection which provided the accurate localization of the parathyroid adenoma. Histologic diagnosis confirmed the tumor to be an ectopic parathyroid adenoma. The patient showed an uneventful postoperative period with decreased levels of both calcium and parathyroid hormone. We emphasize that the gamma probe serves as a very useful device to differentiate the ectopic parathyroid adenoma from surrounding tissues for complete surgical excision.

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