Parathyroid adenoma associated with thymoma in a female adult with primary hyperparathyroidism

Surgical Clinique, Naousa General Hospital, Afoi Lanara & Pexlivanou 3, 59200 Naousa, Imathia, Greece. Electronic address: .
International Journal of Surgery Case Reports 10/2012; 4(1):105-107. DOI: 10.1016/j.ijscr.2012.09.012
Source: PubMed


Parathyroid adenoma associated with a thymoma is a rare clinical entity and few cases have been reported in the literature. This association can be explained by the common embryologic origin of the parathyroid glands and the thymus. These patients may present only with clinical signs and symptoms of primary hyperparathyroidism making it difficult to suspect the coexistence of thymoma.

Presentation of case:
A 68-year-old female with medical history of primary hyperparathyroidism underwent surgical excision of a single parathyroid adenoma. Intra-operatively a small mass was detected in the proximity of the parathyroid adenoma and was also removed. Pathologic examination revealed parathyroid adenoma as suspected pre-operatively whereas the small mass excised was identified as a type A thymoma. The postoperative course of the patient was favourable, with normal serum calcium levels and in six months follow-up the patient is symptom-free and with no recurrence.

Objective of this study is to report the rare case of a female adult with a parathyroid adenoma and a coexisting thymoma in order to underline the importance of these two pathologies and the ideal treatment that should be followed according to the latest records.

Surgical removal of parathyroid adenoma is the treatment of choice for primary hyperparathyroidism, with complete recovery and no postoperative complications. Thymoma may be associated with primary hyperparathyoridism, with or without clinical signs and symptoms of myasthenia gravis and this is a rare clinical entity as very few cases have been described worldwide. To our knowledge this is the first case reported in Greece.

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    • "They found 37 lesions (16.7%) had descended down into the mediastinum.1 The overall incidence of thymomas in the general population is about 0.13 per 100,000 persons.3,4 Thymomas are epithelial neoplasms characterized by an admixture of epithelial cells and mature lymphocytes. "
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    ABSTRACT: While there is an intimate anatomical and embryological relationship between the inferior parathyroid gland and thymus, concurrent pathology is rare. Three cases have been reported in the literature of a parathyroid adenoma in conjunction with a thymoma. We present a case report of a 60-year-old female with a past medical history of hypercalcemia subsequently found to have primary hyperparathyroidism. Sestamibi scan of the parathyroid revealed increased uptake in the lower left neck consistent with a parathyroid adenoma. A standard transverse neck incision was performed with exploration of the lower left thyroid pole. Further dissection was required to identify the parathyroid gland which was intimately associated with thymic tissue in the superior mediastinum. Both thymic tissue and the parathyroid gland were sent for pathology. Permanent pathology subsequently revealed a parathyroid adenoma with an incidental spindle cell thymoma. The embryological relationship of the inferior parathyroid glands and the thymus is well known as both are derived from the third branchial pouch. However, there are only 3 other previous reports of parathyroid adenoma associated with a thymoma in the current literature. Interestingly, up to 16% of parathyroid adenomas are found in the mediastinum, and the current literature states the incidence of thymoma varies from 10-42%.
    Full-text · Article · May 2014 · Rare tumors