• Maria Grazia ChiofaloEmail author
  • Sergio Venanzio Setola
  • Fabio Sandomenico
  • Orlando Catalano
  • Raffaella D’Anna
  • Paolo Vallone
  • Luciano PezzulloEmail author
Part of the Current Clinical Pathology book series (CCPATH)


Mediastinal parathyroid glands are the result of abnormal migration of the parathyroids during embryogenesis. About 60–80% of the ectopic mediastinal parathyroid can be found in the superior mediastinum within the thymus or at the origin of the great vessels. The remaining mediastinal parathyroids are located in the middle and posterior mediastinum in variable percentages. The actual prevalence of mediastinal parathyroid adenoma is unknown but has been reported to range from 6 to 30%. The ectopic mediastinal parathyroid gland is the most common cause for unsuccessful operation for either primary or secondary hyperparathyroidism. Most of the MPAs can be excised through a cervical approach, by removing the anterior mediastinal fat and the thymus either during the first exploration or in the setting of remedial operations. Only 1–2% of ectopic MPAs require a thoracic approach to be resected.


Parathyroid adenoma Mediastinal parathyroid gland Hyperparathyroidism 


  1. 1.
    Mohebati A, Shaha AR. Anatomy of thyroid and parathyroid glands and neurovascular relations. Clin Anat. 2012;25(1):19–31.CrossRefPubMedGoogle Scholar
  2. 2.
    Fancy T, Gallagher D III, Hornig JD. Surgical anatomy of the thyroid and parathyroid glands. Otolaryngol Clin N Am. 2010;43(2):221–7.CrossRefGoogle Scholar
  3. 3.
    Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg. 2006;191(3):418–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Mendoza V, et al. Characteristics of ectopic parathyroid glands in 145 cases of primary hyperparathyroidism. Endocr Pract. 2010;16(6):977–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Hamidi S, et al. Primary hyperparathyroidism: a review of 177 cases. Med Sci Monit. 2006;12(2):26.Google Scholar
  6. 6.
    Summers GW. Parathyroid update: a review of 220 cases. Ear Nose Throat J. 1996;75(7):434–9.PubMedGoogle Scholar
  7. 7.
    Noussios G, Anagnostis P, Natsis K. Ectopic parathyroid glands and their anatomical, clinical and surgical implications. Exp Clin Endocrinol Diabetes. 2012;120(10):604–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Nanka O, et al. [Surgical-anatomical study as a part of operative treatment of primary hyperparathyroidism]. Rozhl Chir. 2006;85(12): 618–23.Google Scholar
  9. 9.
    Hojaij F, et al. Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters: a cadaveric study. Anat Sci Int. 2011;86(4):204–12.CrossRefPubMedGoogle Scholar
  10. 10.
    Kim AW, Detterbeck FC. Surgical approach to mediastinal parathyroid glands. In: Oertli D, Udelsman R, editors. Surgery of the thyroid and parathyroid glands. Berlin: Springer; 2012. p. 495–504.CrossRefGoogle Scholar
  11. 11.
    Kaplan EL, Yashiro T, Salti G. Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann Surg. 1992;215(4):300–17.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chiofalo MG, et al. Huge parathyroid carcinoma: clinical considerations and literature review. World J Surg Oncol. 2005;3:39.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hu J, Ngiam KY, Parameswaran R. Mediastinal parathyroid adenomas and their surgical implications. Ann R Coll Surg Engl. 2015;97(4):259–61.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Iihara M, et al. Thoracoscopic removal of mediastinal parathyroid lesions: selection of surgical approach and pitfalls of preoperative and intraoperative localization. World J Surg. 2012;36(6):1327–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Wang C, Gaz RD, Moncure AC. Mediastinal parathyroid exploration: a clinical and pathologic study of 47 cases. World J Surg. 1986;10(4):687–95.CrossRefPubMedGoogle Scholar
  16. 16.
    Taghavi Kojidi H, et al. Unusual ectopic parathyroid adenoma: a case report. Acta Med Iran. 2016;54(8):547–50.PubMedGoogle Scholar
  17. 17.
    Okada M, et al. Location frequency of missed parathyroid glands after parathyroidectomy in patients with persistent or recurrent secondary hyperparathyroidism. World J Surg. 2016;40(3):595–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Lavely WC, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med. 2007;48(7):1084–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Moka D, et al. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery. 2000;128(1):29–35.CrossRefPubMedGoogle Scholar
  20. 20.
    Roy M, et al. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg. 2013;37(1):102–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Gimm O, et al. Dual-energy computed tomography localizes ectopic parathyroid adenoma. J Clin Endocrinol Metabol. 2010;95(7):3092–3.CrossRefGoogle Scholar
  22. 22.
    Purz S, et al. Visualization of ectopic parathyroid adenomas. N Engl J Med. 2013;369(21):2067–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Gold JS, Donovan PI, Udelsman R. Partial median sternotomy: an attractive approach to mediastinal parathyroid disease. World J Surg. 2006;30(7):1234–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Russell CF, et al. Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinotomy for removal. Ann Surg. 1981;193(6):805–9.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Conn JM, et al. The mediastinal parathyroid. Am Surg. 1991;57(1):62–6.PubMedGoogle Scholar
  26. 26.
    Randone B, et al. Thoracoscopic removal of mediastinal parathyroid glands: a critical appraisal of an emerging technique. Ann Surg. 2010;251(4):717–21.CrossRefPubMedGoogle Scholar
  27. 27.
    Alesina PF, et al. Thoracoscopic removal of mediastinal hyperfunctioning parathyroid glands: personal experience and review of the literature. World J Surg. 2008;32(2):224–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Ismail M, et al. Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system. Br J Surg. 2010;97(3):337–43.CrossRefPubMedGoogle Scholar
  29. 29.
    Brunaud L, et al. Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism. Gland Surg. 2016;5(3):352–60.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Bobanga ID, McHenry CR. Is intraoperative parathyroid hormone monitoring necessary for primary hyperparathyroidism with concordant preoperative imaging? Am J Surg. 2017;213(3):484–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Maria Grazia Chiofalo
    • 1
    Email author
  • Sergio Venanzio Setola
    • 2
  • Fabio Sandomenico
    • 2
  • Orlando Catalano
    • 2
  • Raffaella D’Anna
    • 1
  • Paolo Vallone
    • 2
  • Luciano Pezzullo
    • 1
    Email author
  1. 1.Thyroid Surgery UnitIstituto Nazionale Tumori, IRCCS Fondazione G PascaleNaplesItaly
  2. 2.Radiology UnitIstituto Nazionale Tumori, IRCCS Fondazione G PascaleNaplesItaly

Personalised recommendations