Nonfunctioning Parathyromatosis after Endoscopic Thyroid Lobectomy via an Axillo-Breast Approach: A Case Report

Abstract

Parathyromatosis is a rare disease that occurs in the neck and mediastinum as multiple lesions leading to hyperparathyroidism (1, 2). Parathyromatosis is usually divided into 2 types: primary parathyromatosis, which is proliferation of an embryonic remnant, and the more common secondary parathyromatosis, which is a post-surgical growth of retained parathyroid tissues or seeding of parathyroid tissue by capsular rupture of parathyroid adenoma during parathyroidectomy (1, 2). Early diagnosis and treatment of parathyromatosis is important because parathyromatosis also causes recurrent metabolic disorder after a parathyroidectomy for hyperparathyroidism (1-3). We experienced a patient with parathyromatosis without hyperparathyroidism. In this study, we report a case of secondary parathyromatosis after endoscopic thyroidectomy for a presumed thyroid mass via an axillo-breast approach. CASE REPORTA 16-year-old girl visited our institution for treatment of palpable masses in the anterior neck and upper chest wall. She had previously received an endoscopic right thyroid lobectomy via an axillo-breast approach for a painless palpable mass on the right side of the neck at an outside institution 6 months ago. A contrast-enhanced dynamic neck computed tomography (CT) with 2 phase (arterial phase 30 second, delayed phase 150 second) scan performed during the initial visit showed enhanced right thyroid tumor with early enhancement and delayed washout (Fig. 1). Ultrasonography-guided fine needle aspiration (FNA) was performed immediately and the pathologic report of FNA was follicular proliferation. The surgery was performed on the presumptive diagnosis of a tumor originating from the thyroid. Pathologic examination from the surgical exploration revealed a parathyroid adenoma. One month post-operation, pal-