Airway obstruction due to giant non-parathyroid hormone-producing parathyroid adenoma.

We present a case of a 39-year-old female patient with acute stridor due to a large tumor located at the level of the upper third of her thoracic esophagus. Parathyroid gland tumors are unusual in the differential diagnosis of mediastinal tumors. This tumor was removed via a thoracocervical approach, which offers multiple advantages when used for tumors in this location. The eventual diagnosis on histology was parathyroid adenoma. The patient had no clinical evidence of metabolic abnormalities and her pre- and postoperative calcium and postoperative parathyroid hormone (PTH) levels were within normal limits. This case poses the interesting question of whether identification of elevated PTH levels is an absolute prerequisite for diagnosing parathyroid adenomas. It is an example of a difficult diagnostic and therapeutic problem.

A case of Cushing's syndrome in ACTH-secreting mediastinal paraganglioma

Paragangliomas are unusual neuroendocrine cell tumors arising from paraganglia, of which ACTH-secreting cases in the mediastinum are extremely rare. A 51-year-old woman was admitted for generalized edema and weakness which began 5 months ago. Chest X-ray and CT scan revealed a tumor mass in the anterior mediastinum. The plasma cortisol and ACTH levels were very high. Other sources secreting ACTH, except mediastinal mass, were not found. Surgical excision of mediastinal mass and left supraclavicular lymph node was performed. The postoperative microscopic finding and immunohistochemical staining revealed organoid tumor cell nests (zellballen) and S-100 protein positive sustentacular cells which are characteristics of paraganglioma. This was thus a case of Cushing's syndrome resulting from ectopic ACTH production in anterior mediastinal paraganglioma.

Unusual cases of hyperparathyroidism

The history, physical and radiologic findings, treatment and pathology in five unusual cases of hyperparathyroidism is presented. The hyperparathyroidism was caused by a large (113 grams) mediastinal adenoma in the first patient, who is alive 25 years after surgery. A parathyroid carcinoma with compression of the esophagus was documented in the second patient. This patient is alive and normocalcemic 23 years after surgical treatment. A third patient with hyperplasia returned with hypercalcemia 20 years postsurgery requiring reoperation. A fourth patient with advanced bone findings was found to have a parathyroid adenoma. The fifth case is a patient with tertiary hyperparathyroidism secondary to hypophosphatemic rickets

Malignant glomus tumor originating in the superior mediastinum: an immunohistochemical and ultrastructural study

An extremely rare case of malignant glomus tumor originating in the superior mediastinum was evaluated immunohistochemically and ultrastructurally. A 78-year-old woman who had been suffering from dysphagia and dyspnea had poorly-defined soft tissue mass, 4.5 x 2.5cm, in the superior mediastinum with direct invasion into the esophagus, trachea, and bilateral thyroid glands. This case is believed to be unique in several respects. There were neither recognizable findings of benign glomus tumor nor sarcomatous areas, in contrast to the previously reported cases. A definite direct invasion into the surrounding organs was identified. We therefore interpreted this case as primary malignant glomus tumor, not as glomangiosarcoma arising in a benign glomus tumor.