Uncommon Mediastinal Tumors

Report of two parathyroid adenomas, one nonfunctional parathyroid carcinoma and one "bronchial-type-adenoma"

¹ Departments of Surgery and Pathology, Laboratory of Surgical Pathology, Columbia University College of Physicians and Surgeons

We have reviewed three uncommon types of mediastinal tumor: two parathyroid adenomas, one functional and the other nonfunctional; one nonfunctional parathyroid carcinoma, and one extrapulmonary "bronchial-type-adenoma." The knowledge that as many as 20 per cent of parathyroid adenomas may be located within the thorax must be re-emphasized, for in patients with hyperparathyroidism and negative exploration of the neck, it behooves the surgeon to investigate the possibility of the tumor being in an aberrant location. Furthermore, the fact that these tumors may be found in the posterior mediastinum will mitigate against fruitless operations in those situations where the neoplasm is found neither in the neck, nor in the anterior mediastinum.

The diagnosis of carcinoma of the parathyroid gland will depend on the specific criteria that are acceptable to the given observer such as mitotic activity and the topographic location of the tumor. The exclusion of other primary sites, particularly the thyroid gland, will aid in the identification of parathyroid carcinoma in the rare instance when they fail to demonstrate endocrine activity.

In those cases whose lymph node biopsies have revealed tumor of the bronchial adenoma type, and x-rays and bronchoscopy have failed to reveal an intrapulmonary lesion, it will be of assistance to consider the rare possibility that the primary tumor may be a "bronchial-type-adenoma" located within the mediastinum.