Transoral Excision of a Right Pyriform Sinus Parathyroid Adenoma

Abstract

Abstract

Introduction:

The pyriform sinus is a rare but known site of ectopic parathyroid adenoma within the upper aerodigestive tract. This entity reflects failure of the inferior parathyroid gland to descend during embryologic development. Surgical excision through a transoral endoscopic approach was performed in a patient with a right pyriform sinus parathyroid adenoma. ¹

Materials and Methods:

A 50-year-old woman with primary hyperparathyroidism underwent a parathyroid gland exploration. Her preoperative sestamibi scan and ultrasonography failed to localize a parathyroid adenoma. Three normal parathyroid glands were identified but the right inferior parathyroid gland was not encountered. She then underwent a 4D CT scan, which identified a right pyriform sinus parathyroid adenoma. She subsequently underwent an uncomplicated transoral endoscopic excision of the parathyroid adenoma with resolution of her primary hyperparathyroidism.

Results:

The patient's baseline parathyroid hormone (PTH) level was 157.2 pg/mL and a level of 6.4 pg/mL was drawn 15 minutes post-excision demonstrating an intraoperative drop of 96%. The final pathology report confirmed the pyriform sinus mass to be a parathyroid adenoma. The patient was discharged the same day. At 3 weeks postoperatively, she was doing well and her PTH and calcium remained normal (PTH was 44.3 pg/mL and her serum calcium level was 9.0 mg/dL).

Conclusions:

After failed neck exploration for primary hyperparathyroidism, 4D CT scan imaging may be helpful in identifying an ectopic parathyroid adenoma. Although rare, the pyriform sinus is a potential location for ectopic parathyroid adenomas, and these lesions can be safely excised through a low-morbidity transoral endoscopic approach. ²

No competing financial interests exist.

Runtime of video: 2 mins 21 secs