Parathyromatosis: a rare yet important cause of persistent or recurrent hyperparathyroidism

BACKGROUND: Parathyromatosis is described by as small nodules of hyperfunctioning parathyroid tissue scattered in the soft tissues of the neck and/or mediastinum. Seeding of hypercellular parathyroid glands during surgical excision and overgrowth of parathyroid rests left behind during ontogenesis are the most likely causes of this rare phenomenon. To characterize the clinical presentation and management of this rare condition, we report on a patient with uremia and persistent hyperparathyroidism occurring after total parathyroidectomy. METHODS: The records of one man with parathyromatosis treated from 1989 to 1993 were reviewed. In addition, a review of the literature was undertaken. RESULTS: Findings at the patient's final operation (a median sternotomy) included multiple nodules of hyperplastic parathyroid tissue scattered throughout the thymus. The characteristics of this histologically benign tissue are consistent throughout various case reports in the literature. CONCLUSIONS: This case presentation shows the physiologic significance of parathyromatosis, particularly in the setting of kidney failure. The importance of meticulous handling of potentially hyperplastic parathyroid glands and routine cervical thymectomy among this subset of patients is emphasized.