Multicenter Study of 19 Aortopulmonary Window Parathyroid Tumors: The Challenge of Embryologic Origin

• Published in: World journal of surgery Vol. 34; no. 9; pp. 2211 - 2216
• Main Authors: Arnault, Vincent, Beaulieu, Anthony, Lifante, Jean-Christophe, Sitges Serra, Antonio, Sebag, Frederic, Mathonnet, Muriel, Hamy, Antoine, Meurisse, Michel, Carnaille, Bruno, Kraimps, Jean-Louis
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.09.2010; Springer‐Verlag; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Abdominal Surgery; Adenoma; Adenoma - embryology; Adolescent; Adult; Aged; Aged, 80 and over; Bilateral Neck Exploration; Biological and medical sciences; Cardiac Surgery; Choristoma - diagnosis; Choristoma - embryology; Choristoma - surgery; Female; General aspects; General Surgery; Humans; Life Sciences; Male; Mediastinal Diseases - diagnosis; Mediastinal Diseases - embryology; Mediastinal Diseases - surgery; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neck - blood supply; Neck - innervation; Parathyroid Gland; Parathyroid Glands; Parathyroid Lesion; Parathyroid Tumor; Retrospective Studies; Surgery; Thoracic Surgery; Vascular Surgery; Young Adult; Parathyroid Lesion; Parathyroid Gland; Adenoma; Parathyroid Tumor; Bilateral Neck Exploration; Medicine; Parathyroid glands; Tumor; Treatment; Surgery; Multicenter study; Mediastinal Diseases; Humans; Middle Aged; Parathyroid Glands; Choristoma; Male; 80 and over; Young Adult; Adolescent; Adult; Female; Aged; Retrospective Studies; Neck
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0622-1

Background Ectopic abnormal parathyroid glands are relatively common in the superior mediastinum but are rarely situated in the aortopulmonary window (APW). The embryological origin of these abnormal parathyroid glands is controversial. The purpose of this investigation was to investigate the embryological origin and the surgical management of abnormal parathyroid glands situated in the APW. Methods The databases of patients operated on for primary, secondary, and tertiary hyperparathyroidism at eight European medical centers with a special interest in endocrine surgery were reviewed to identify those with APW adenomas. Demographic features, localization procedures, and perioperative and pathology findings were documented. The embryological origin was determined based on the number and position of identified parathyroid glands. Results Nineteen (0.24%) APW parathyroid tumors were identified in 7,869 patients who underwent an operation for hyperparathyroidism (HPT) and 181 patients (2.3%) with mediastinal abnormal parathyroid glands. Ten patients had primary, eight had secondary, and one had tertiary HPT. Sixteen patients had undergone previous unsuccessful cervical exploration. In three patients, an APW adenoma was suspected by preoperative localization studies and was cured at the initial operation. Sixteen patients had persistent HPT of whom 15 were reoperated, resulting in 6 failures. Evaluation of 17 patients who had bilateral neck exploration allowed us to determine the most probable origin of the APW parathyroid tumors: 12 were supernumerary, 4 appeared to originate from a superior, and 1 from an inferior gland. Conclusions Abnormal parathyroid glands situated in the APW are rare and usually identified after an unsuccessful cervical exploration. Preoperative imaging of the mediastinum and neck are essential. The origin of these ectopically situated tumors is probably, as suggested by our data, from a supernumerary fifth parathyroid gland or from abnormal migration of a superior parathyroid gland during the embryologic development.