Cervical Retrieval of Giant Posterior Mediastinal Parathyroid Adenoma with Bizarre Morphology

Parathyroid adenoma is the most common cause of primary hyperparathyroidism and rarely reaches huge sizes. As the gland enlarges it may exhibit atypical morphology and extension to the mediastinum which may complicate the excision of the tumor while preserving the capsular integrity. We present a 35-year-old male patient who was referred to our department with a complaint of severe hypercalcemia. Neck ultrasound and parathyroid scintigraphy revealed an adenoma of 45x25 mm in size in the left parathyroid lobe extending to the retrosternal area. The patient underwent an uneventful parathyroidectomy. The patient remained well with no evidence of biochemical recurrence during the 4-year follow-up. Here, we presented a very original case of one of the largest parathyroid adenomas (8 cm) with atypical configuration (having multiple spicular extensions from the main body) ever reported in the literature which was completely retrieved from the posterior mediastinum via cervical route.