RADIO-GUIDED PARATHYROIDECTOMY USING Tc-99m MIBI FOR ECTOPIC  PARATHYROID ADENOMA : A CASE REPORT

Anamarija Jankulovska; Zeynep Yentur; Ylenia Borg; Ege Ozmenekse; Natasha Stojkovska; Nevena Manevska; Sinisha Stojanoski

Anamarija Jankulovska Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, "Ss. Cyril and Methodius" University in Skopje, North Macedonia
Zeynep Yentur Faculty of Medicine, Yeditepe University, Istanbul, Turkey
Ylenia Borg Faculty of Medicine and Surgery, University of Malta, Msida, Malta
Ege Ozmenekse Faculty of Medicine, Yeditepe University, Istanbul, Turkey
Natasha Stojkovska Institute of Histology and Embryology, Faculty of Medicine, "Ss. Cyril and Methodius", University in Skopje , North Macedonia
Nevena Manevska Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, "Ss. Cyril and Methodius" University in Skopje ,North Macedonia
Sinisha Stojanoski Institute of Pathophysiology and Nuclear Medicine , Faculty of Medicine,"Ss. Cyril and Methodius" University in Skopje ,North Macedonia

Abstract

Ectopic parathyroid adenomas pose diagnostic and therapeutic challenges. Preoperative Tc-99m sestamibi SPECT/CT scan and radio-guided surgical technique enhance intraoperative accuracy enabling precise detection of an ectopic parathyroid gland. Case presentation: We present a case of a 54-year-old female patient with PHPT due to an ectopic parathyroid adenoma located in the suprasternal region. Neck ultrasonography showed a normal-sized thyroid with a cystic nodule in the right lobe and a hypoechoic mass in the suprasternal region, raising suspicion of an enlarged parathyroid gland. Dual-phase SPECT parathyroid scintigraphy with Tc-99m sestamibi revealed homogeneous uptake in both thyroid lobes and intense accumulation below the right thyroid lobe, suggesting hyperfunctional ectopic parathyroid tissue. The patient successfully underwent a minimally invasive radio-guided parathyroidectomy using a handheld gamma probe. Conclusion: The management of ectopic parathyroid adenomas requires a multidisciplinary approach, utilizing advanced imaging and minimally invasive techniques such as parathyroid scintigraphy with SPECT/CT and intraoperative gamma probes for the safe and precise removal of these hyperfunctional glands.

Keywords: Ectopic parathyroid adenoma, 99mTc-sestamibi scintigraphy,SPECT/CT, radio–guided surgery.

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