Parathyromatosis: Critical Diagnosis Regarding Surgery and Pathologic Evaluation

Parathyromatosis, in which several nodules of hyperfunctioning parathyroid tissue form in the neck and mediastinum, is a rare cause of recurrent hyperparathyroidism. However, there are some theories regarding the origin of parathyromatosis, and seeding after rupture of the parathyroid gland capsule during surgical removal of a parathyroid lesions is the most regarded one. Herein, we report a 41-year-old man who presented with multiple parathyroid nodules in and around the left thyroid lobe 5 years after parathyroid surgery for secondary hyperparathyroidism that was finally diagnosed as parathyromatosis. We discuss the differential diagnosis of parathyromatosis from other parathyroid tumors, particularly from parathyroid carcinoma, which is important in the management of a suspected lesion.

Small bowel tumors: insidious and important abdominal problems for surgeons

To evaluate the major clinical symptoms, etiology and presentation of small bowel tumors so that they can be diagnosed. Retrospective study. Izmir Bozyaka Teaching and Research Hospital, Turkey. Forty-five patients with 46 small bowel tumors over a 15-year period were included in the study. Biopsy or small bowel resection. The data obtained from the medical records including clinical features, diagnostic workup, operative procedures and pathologic diagnosis. The male to female ratio was 1.4:1 with a median age at presentation of 53 years [range, 30 - 83 years]. Thirty [66.7%] patients presented with abdominal emergencies such as bowel obstruction [40%], bowel perforation [24.4%] and intestinal bleeding [2.3%]. Non-urgent presentations were found in 15 [33.3%] patients. The preoperative diagnosis of small bowel tumor was positive in nine [20%] of the elective cases. The tumors were located in the ileum in 68.8%, the jejunum in 26% and the duodenum in 6.6% of patients. Thirty-eight [82.6%] malignant and eight [17.4%] benign tumors were identified. In addition, patients with malignant tumors more commonly presented with bowel obstruction and perforation. Segmental resection was done in 41[91%] patients. These observations suggest that small bowel tumors are difficult to diagnose because of delayed presentations and vague symptoms. Clinicians must have a high degree of suspicion and should perform early laparotomy without hesitation