Abstract
Parathyroid glands arise from the third and fourth pharyngeal pouches. Parathyroid lesions sometimes develop ectopically. The aim of this article is to illustrate the knowledge of pharyngeal apparatus development to assist with diagnostic localization of ectopic parathyroid lesions. We retrospectively reviewed charts of 23 patients who received a diagnosis of ectopic parathyroid lesions. The ectopic lesions were widely distributed; cranially lesions were located on the carotid bifurcation, caudally in the right paraaortic region, ventrally on the surface of the sternohyoid muscle, and dorsally in the paraesophageal region. In most cases, parathyroid tissues were associated with structures related to the third or fourth pharyngeal pouches that traveled to regions where the ectopic lesions ultimately developed. In a few cases, lesions were not associated with these pouches and might have developed from parathyroid tissue that migrated due to an anomalous pathway of parathyroid travel. When patients present without entopic lesions, the presence of ectopic lesions should be evaluated based on an understanding of the developmental mechanisms of parathyroid glands and the frequency with which ectopic lesions have been found in specific locations. Systematic diagnosis can minimize the frequency with which ectopic lesions are missed during clinical care and maximize their accurate localization.
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References
Schoenwolf GC, Bleyl SB, Brauer PR, Francis-West PH. Development of the pharyngeal apparatus and face. In: Schoenwolf GC, Bleyl SB, Brauer PR, Francis-West PH, editors. Larsen’s human embryology. 4th ed. Philadelphia: Churchill Livingstone; 2009. p. 543–582.
Skandalakis JE, Gray SW, Todd NW. The pharynx and its derivatives. In: Mitchell CW, editor. Embryology for surgeons. 2nd ed. Baltimore: Williams & Wilkins; 1994. p. 17–64.
Uludag M, Isgor A, Yetkin G, Atay M, Kebudi A, Akgun I. Supernumerary ectopic parathyroid glands: persistent hyperparathyroidism due to mediastinal parathyroid adenoma localized by preoperative single photon emission computed tomography and intraoperative gamma probe application. Hormones (Athens) 2009;8:144–149.
Kaplan EL, Yashiro T, Salti G. Primary hyperparathyroidism in the 1990s: choice of surgical procedures for this disease. Ann Surg 1992;215:300–317.
Medrano C, Hazelrigg SR, Landreneau RJ, Boley TM, Shawgo T, Grasch A. Thoracoscopic resection of ectopic parathyroid glands. Ann Thorac Surg 2000;69:221–223.
De la Rosa A, Jimeno J, Membrilla E, Sancho JJ, Pereira JA, Sitges-Serra A. Usefulness of preoperative Tc-mibi parathyroid scintigraphy in secondary hyperparathyroidism. Langenbecks Arch Surg 2008;393:21–24.
Moinuddin M, Whynott C. Ectopic parathyroid adenomas: multi-imaging modalities and its management. Clin Nucl Med 1996;21:27–32.
Francis IR, Glazer GM, Bookstein FL, Gross BH. The thymus: reexamination of age-related changes in size and shape. AJR Am J Roentgenol 1985;145:249–254.
Kobayashi T, Man-I M, Shin E, Kikkawa N, Kawahara K, Kurata A, et al. Hyperfunctioning intrathyroid parathyroid adenoma: report of two cases. Surg Today 1999;29:766–768.
Lack EE, Delay S, Linnoila RI. Ectopic parathyroid tissue within the vagus nerve: incidence and possible clinical significance. Arch Pathol Lab Med 1988;112:304–306.
Pawlik TM, Richards M, Giordano TJ, Burney R, Thompson N. Identification and management of intravagal parathyroid adenoma. World J Surg 2001;25:419–423.
Reiling RB, Cady B, Clerkin EP. Aberrant parathyroid adenoma within vagus nerve. Lehey Clinic Bull 1972;21:158–162.
Doppman JL, Skarulis MC, Chen CC, Chang R, Pass HI, Fraker DL, et al. Parathyroid adenomas in the aortopulmonary window. Radiology 1996;201:456–462.
Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2006;191:418–423.
Collins P. Development of the pharynx, larynx and oesophagus. In: Standing S, editor. Gray’s anatomy. 39th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 647–648.
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Okuda, I., Nakajima, Y., Miura, D. et al. Diagnostic localization of ectopic parathyroid lesions: developmental consideration. Jpn J Radiol 28, 707–713 (2010). https://doi.org/10.1007/s11604-010-0492-3
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DOI: https://doi.org/10.1007/s11604-010-0492-3