Primary Hyperparathyroidism Patients with Positive Preoperative Sestamibi Scan and Negative Ultrasound Are More Likely to Have Posteriorly Located Upper Gland Adenomas (PLUGs)

BackgroundStandard preoperative imaging for primary hyperparathyroidism usually includes sestamibi scanning (MIBI) and ultrasound (US). In a subset of patients with a positive MIBI and a negative US, we hypothesize that the parathyroid adenomas are more likely to be located posteriorly in the neck, where anatomically they are more difficult to detect by US.MethodsWe retrospectively reviewed the records of 661 patients treated for primary hyperparathyroidism between 2004 and 2009 at a tertiary referral center. We included patients who for their first operation had a MIBI that localized a single lesion in the neck and an US that found no parathyroid adenoma. We excluded patients with persistent or recurrent hyperparathyroidism, and patients with MIBIs that were negative, that had more than one positive focus, or that had foci outside of the neck. Sixty-six cases were included in the final analysis.ResultsA total of 54 patients (83%) had a single adenoma, 4 (6%) had double adenomas, and 7 (11%) had hyperplasia. Thirty-three patients (51%) had a single upper gland adenoma; 19 of these (58%) were posteriorly located upper gland adenomas (PLUGs). PLUGs occurred more often on the right side than on the left (P = 0.048, Fisher's test). PLUGs were also larger than other single adenomas (mean 1.85 vs. 1.48 cm, P = 0.021, t-test). Seventy-six percent of patients successfully underwent a unilateral or focused exploration. Six patients (9%) had persistent disease, which is double our group's overall average (4-5%).ConclusionsPrimary hyperparathyroid patients with preoperative positive MIBI and negative US are more likely to have PLUGs

Tratamiento de rediferenciaci\uf3n para c\ue1ncer tiroideo

La tumorig\ue9nesis y carcinog\ue9nesis tiroideas acompa\uf1an a la p\ue9rdida progresiva de las funciones diferenciadas espec\uedficas del tiroides. Algunos c\ue1nceres tiroideos son o se convierten en desdiferenciados y por tanto se vuelven resistentes a los tratamientos ordinarios de eficacia demostrada, como la terap\ue9utica de ablaci\uf3n con yodo radiactivo y el tratamiento de supresi\uf3n con tirotropina (TSH). El tratamiento de rediferenciaci\uf3n por medio de cualquiera de los agentes rediferenciantes o transferencia g\ue9nica de genes relacionados con la diferenciaci\uf3n puede retrasar el crecimiento del tumor y lograr que los tumores respondan a los tratamientos ordinarios