Clinical Observation |

Endoscopic Laser Excision of Ectopic Pyriform Sinus Parathyroid Adenoma

Alexander Stojadinovic, MD; Craig D. Shriver, MD; John D. Casler, MD; Erich M. Gaertner, MD; Gerry York, MD; David P. Jaques, MD
Arch Surg. 1998;133(1):101-103. doi:10.1001/archsurg.133.1.101.
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Ectopic parathyroid adenomas are one of the causes of failed neck exploration for primary hyperthyroidism. Location of the ectopic gland in the pyriform recess is rarely described premortem. Moreover, removal of such an ectopically located gland using an endoscopic approach, thereby avoiding potentially morbid repeated open neck explorations, to our knowledge, has not been described.

Wang  C The anatomic basis of parathyroid surgery. Ann Surg. 1976;183271- 275
Billingsley  KGFraker  DLDoppman  JL  et al.  Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism. Surgery. 1994;116982- 990
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Figure 1.

Intraoperative view through the Dedo laryngoscope visualizing the parathyroid adenoma (arrowhead) in the lateral wall of the left pyriform sinus.

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Figure 2.

Left, Low-power photomicrograph demonstrating squamous mucosa in the lower right-hand corner. A well-circumscribed neoplasm is identified with neuroendocrine features. Prominent oxyphilic change centrally with peripheral chief cells is evident. These findings in the absence of adipose tissue are consistent with a diagnosis of parathyroid adenoma (hematoxylin-eosin, original magnification ×40). Right, High-power photomicrograph demonstrating neuroendocrine characteristics manifested by a uniform monomorphic cell population with round regular nuclei and a focal group of oxyphilic cells along the right-hand side, findings consistent with the above diagnosis of parathyroid adenoma (hematoxylin-eosin, original magnification ×200).

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