Undescended superior parathyroid: A case report.

Aberrant migration of parathyroid glands from their embryologic origin may result in undescended parathyroid glands. We present a case of an ectopic parathyroid adenoma at the level of the pyriform sinus. A 41-year-old female was evaluated for primary hyperparathyroidism. Following non-localizing ultrasound and planar sestamibi imaging, the patient underwent SPECT/CT and 4-D computed tomography demonstrating evidence of an ectopic parathyroid adenoma. The surgical approach was modified based on the location. Following extirpation, PTH fell from 80 to 16 pg/mL, and the 15-min post-excision level remained stable at 14pg/mL, indicating a biochemical cure. While rare, undescended parathyroid adenoma should be considered when preoperative imaging fails to identify a target adenoma or after unsuccessful surgery. The combined use of 99m Tc-MBI or 4D CT and other anatomical scans may improve diagnostic accuracy. Due to the potential need to perform a second incision to conduct a four-gland exploration, preoperative patient discussion regarding surgical risks may differ from that of a standard parathyroidectomy.

To oophorectomy or not to oophorectomy: Practice patterns among urologists treating bladder cancer.

OBJECTIVES: Classically, radical cystectomy (RC) involves hysterectomy and bilateral salpingo-oophorectomy (BSO). Current understanding of ovarian cancer pathogenesis and effect of premature oophorectomy has lead to a shift within gynecology toward risk-reducing salpingectomy without oophorectomy in the absence of gynecologic malignancy. The purpose of this study was to assess knowledge base and practice patterns of urologic oncologists with regard to management of the gynecological organs at the time of RC. MATERIALS AND METHODS: An anonymous and voluntary electronic survey was distributed to members of the Society of Urologic Oncology (SUO). Demographic data, training, practice setting and duration, experience, rationale for BSO, and knowledge assessment of ovarian cancer pathogenesis/risks associated with BSO was collected. RESULTS: A total of 159/660 (24%) SUO members responded of whom 110 (69%) were academic urologists and 58 (36%) involved in training urologic oncology fellows. Of all, 75% had performed an ovarian-sparing RC. Furthermore, 14% were aware that salpingectomy alone reduces the risk of ovarian cancer, whereas 95%, 66%, and 26% were aware that BSO increases the risk of osteoporosis, cardiovascular disease, and all-cause mortality, respectively. Reasons for BSO at the time of RC included concern for urothelial carcinoma metastasis (54%), development of future gynecologic pathology (50%), and facilitation of pelvic lymph node dissection (36%). CONCLUSIONS: Many urologic oncologists remain unaware of the benefits of risk-reducing salpingectomy and the risks associated with BSO, identifying a potential area for further education in the urologic community.