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A Case of Radical Resection of a Mediastinal Invasive Parathyroid Tumor via a Thoracoscopic Approach

Year: 2026

Type: article

Abstract: INTRODUCTION: 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. CASE PRESENTATION: 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. CONCLUSIONS: 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.

Source: Surgical Case Reports

DOI: 10.70352/scrj.cr.26-0266