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A Surgical Case Report of Parathyroid Lipoadenoma

Ashtyn PHILIPSHECK ; William COBB ; John HOFF ; Tien-Anh TRAN ; Joseph PORTOGHESE

Journal of Endocrine Surgery.2025;25(1):24-29. doi:10.16956/jes.2025.25.1.24

Parathyroid lipoadenoma is a rare entity with very few cases reported in the literature. It is defined as a benign neoplasm resembling a hamartoma, featuring both chief cells and significant stromal elements, and may be functioning or non-functioning. Typical presenting symptoms are similar to hyperparathyroidism. Here we present a 43-year-old male with multinodular goiter, experiencing worsening dysphagia, that while undergoing total thyroidectomy, was noted to have an abnormal right inferior parathyroid gland. The patient underwent parathyroidectomy in conjunction with thyroidectomy and was incidentally found to have a parathyroid lipoadenoma. Post-operatively his parathyroid hormone decreased, and he reported no symptoms of hypocalcemia. The patient underwent successful removal of a parathyroid lipoadenoma.

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Single-Port Robotic Bilateral Cortical-Sparing Adrenalectomy in MEN 2A Patients With Bilateral Pheochromocytomas: A Case Report

Joonseon PARK ; Solji AN ; Ja Seong BAE ; Kwangsoon KIM

Journal of Endocrine Surgery.2025;25(1):36-45. doi:10.16956/jes.2025.25.1.36

Multiple endocrine neoplasia type 2A (MEN 2A) is a hereditary disorder characterized by medullary thyroid carcinoma (MTC), pheochromocytomas, and primary hyperparathyroidism. We present the case of a 28-year-old male diagnosed with MEN 2A, exhibiting bilateral MTC and bilateral pheochromocytomas. The patient underwent a total thyroidectomy with bilateral central lymph node dissection, followed by bilateral corticalsparing adrenalectomy (CSA) utilizing single-port (SP) robotic posterior retroperitoneoscopic approach. The patient’s blood pressure remained consistently stable at an average of 125/85 mmHg after surgery, and he was discharged without complications on postoperative day 5 with good postoperative recovery and patient satisfaction. Adrenal function was successfully preserved, allowing for gradual tapering of hormone replacement therapy. This case underscores the efficacy of SP robotic CSA in managing bilateral pheochromocytomas within the context of MEN 2A, highlighting its role in tumor resection while maintaining adrenal function. The minimally invasive nature of the SP robotic approach and CSA offered advantages including reduced operative time, diminished postoperative discomfort, and enhanced cosmetic outcomes. Nonetheless, careful patient selection and diligent long-term follow-up are imperative to monitor adrenal function and detect potential tumor recurrence.

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The Influence of Glycolytic Enzyme Expression on the Aggressiveness of Papillary Thyroid Carcinoma Using TCGA Data

Won Woong KIM ; Daham KIM ; Jin Kyong KIM ; Sang-Wook KANG ; Jandee LEE ; Jong Ju JEONG ; Kee-Hyun NAM ; Woong Youn CHUNG

Journal of Endocrine Surgery.2025;25(1):13-23. doi:10.16956/jes.2025.25.1.13

Purpose: Several studies suggest that glycolytic enzyme expression may be linked to increased malignancy in various organs. However, the relationship between glycolytic enzyme expression and aggressiveness in papillary thyroid carcinoma (PTC) is not yet fully understood. This study aimed to determine whether glycolytic enzyme expression correlates with aggressiveness, including lymph node metastasis and extrathyroidal extension, using data from The Cancer Genome Atlas (TCGA). Methods: Lactate dehydrogenase A (LDHA), pyruvate kinase isoform M2 (PKM2), and glucose transporter 1 (GLUT1) mRNA expression were examined in 465 PTC samples using TCGA data. We analyzed the correlation between these glycolytic enzymes and transporter protein and the clinicopathological characteristics of PTC, with a particular focus on lymph node metastasis and recurrence. Results: Overexpression of LDHA, PKM2, and GLUT1 was associated with lymph node metastasis and the aggressive subtype of PTC. In the multivariate analysis, younger age, multifocality, advanced T stage (T3/T4), and increased PKM2 mRNA expression were significant predictors of lymph node metastasis. Among the variables, high PKM2 mRNA expression showed the strongest association with lymph node metastasis (odds ratio 6.907, P=0.001). However, there were no significant differences in disease-free survival rates according to LDHA, PKM2, or GLUT1 expression levels. Conclusion LDHA, PKM2, and GLUT1 overexpression is linked to lymph node metastasis and aggressive PTC subtypes. Of these, PKM2 mRNA expression may have particular potential as a biomarker for lymph node metastasis in PTC.

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Advancements and Clinical Strategies in Parathyroid Transplantation:A Comprehensive Review

Sun Ae HWANG ; Ik Jin YUN ; Kyoung Sik PARK

Journal of Endocrine Surgery.2025;25(1):1-12. doi:10.16956/jes.2025.25.1.1

Parathyroid transplantation is an important therapeutic option for individuals experiencing hypoparathyroidism, often resulting from surgical interventions like thyroidectomy. This review aims to provide a comprehensive overview of advancements and clinical strategies in parathyroid transplantation. A thorough examination of the latest research advancements and clinical practices in parathyroid transplantation was conducted. The review emphasizes innovations in tissue preservation methods, investigations into alternative transplant locations, progress in immunosuppressive strategies, the potential of stem cell-based therapies, and the use of genetic engineering techniques. Parathyroid transplantation demonstrates clinical utility in various contexts, including hypoparathyroidism following thyroidectomy, chronic kidney disease, repeat thyroid surgeries, and allotransplantation.Long-term management strategies and improvements in patients’ quality of life are also considered. Parathyroid transplantation holds significant promise as a treatment for hypoparathyroidism. Further research and clinical trials are warranted to optimize outcomes.

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Histologic Features of Papillary Thyroid Carcinoma Treated With Radiofrequency Ablation Followed by Surgical Intervention

Seungho LEE ; Young A KIM ; Young Jun CHAI

Journal of Endocrine Surgery.2025;25(1):30-35. doi:10.16956/jes.2025.25.1.30

Radiofrequency ablation (RFA) is progressively expanding its application beyond benign thyroid nodules to include malignant thyroid nodules. However, performing thyroidectomy after RFA in the treatment of malignant thyroid nodules, particularly in the context of histopathological analysis and procedural challenges is not well-documented. Here, we present a case of a 50-year-old female patient who underwent RFA based on ultrasound findings suggesting a benign nature, but subsequent fine needle aspiration results confirmed the presence of papillary thyroid carcinoma (PTC), leading to the decision for surgery.Intraoperative findings demonstrated the presence of inflammation and fibrosis attributable to the previous RFA procedure; however, these sequelae did not engender any technical impediments during the surgical intervention, except for adhesions between the thyroid gland and the strap muscles. This case presents intriguing histologic features from a complete specimen for PTC treated with RFA. While further research is warranted, our findings cautiously suggest that RFA may serve as an alternative therapy for PTC cases requiring surgery, as no significant challenges were observed in subsequent surgical procedures.

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A Hybrid Surgical Approach for Retrosternal Goiter: Surgical Experience at a Tertiary Thoracic and Endocrine Surgery Center

Sondus Al JADEEDI ; Moayad USAMA ; Hilal Al HARTHI ; Amani Al SAIDI ; Salma Al SHAMSI ; Yaqoob Al SAWAFI

Journal of Endocrine Surgery.2025;25(3):89-100. doi:10.16956/jes.2025.25.3.89

Purpose: Retrosternal goiter with substantial mediastinal extension often present surgical challenges, with conventional approach frequently necessitating median sternotomy. This case series evaluates the safety, feasibility, and outcomes of a combined video-assisted thoracoscopic surgery (VATS) and transcervical approach in managing sizable retrosternal goiters without resorting to sternotomy. Methods: A retrospective analysis was conducted in the Divisions of the Endocrine and Thoracic Surgery, Department of General Surgery in the Medical City for Military and Security Services. Since the introduction of VATS in the department, 4 patients underwent hybrid approach for retrosternal goiter excision, utilizing VATS in conjunction with conventional cervical thyroidectomy. Results: All cases were completed without conversion to sternotomy. The mean operative time was 245 minutes (range: 150–360), with retrosternal extension ranging from 3.4 to 7 cm and mean thyroid volume of 125.1 g (range: 58–225.4 g). Two patients underwent hemithyroidectomy and another 2 total thyroidectomy. Our findings indicate that VATS thyroidectomy, when combined with conventional cervical thyroidectomy, significantly reduces postoperative pain, hospital stay, and enhances patient satisfaction. Notably, no complications were observed during either the intraoperative and postoperative periods. Conclusion Hybrid approach utilizing VATS and cervical thyroidectomy presents itself as a safe and effective “minimally invasive” alternative to more invasive procedures, such as sternotomy, for selected cases of retrosternal goiters. This approach holds promise for achieving successful outcomes while minimizing patient discomfort and recovery time.

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Application of Near-Infrared Autofluorescence Imaging Technology in Assisting Adrenal Gland Localization During Adrenal Tumor Resection:A Case Report and Literature Review

Chang CAI ; Xiao XIAO ; DianXin ZHOU ; YiLing LI ; Xiezhao LI ; Zifeng LUO ; Yifan LIU ; Song WANG

Journal of Endocrine Surgery.2025;25(3):101-108. doi:10.16956/jes.2025.25.3.101

The adrenal gland is a crucial endocrine organ, and adrenal tumors, mostly benign, often require surgical treatment. However, intraoperative localization of the adrenal gland is challenging due to its anatomical features. Laparoscopic surgery is widely used, but current laparoscopes lack real - time adrenal navigation. Near-infrared autofluorescence imaging (NIRAF) is a non-invasive technology that shows potential in adrenal localization, with limited reports globally and none in China. A 37-year-old female with a left adrenal nodule underwent retroperitoneoscopic left adrenal tumor resection. NIRAF technology, combined with laparoscopy, was used. The equipment had white light and near-infrared light modes.In the near-infrared light mode, the adrenal gland's autofluorescence was detected for intraoperative identification. Intraoperative NIRAF laparoscopy showed high-intensity fluorescence of the left adrenal tissue, clearly differentiating it from surrounding tissues.The surgery was completed within one hour without damage to surrounding organs. Postoperative monitoring of indicators such as blood pressure, aldosterone, adrenocorticotropic hormone, and white blood cell count was carried out. NIRAF technology has advantages in adrenal tumor resection, like improving surgical efficiency, reducing tissue manipulation, and lowering bleeding and infection risks. However, it has limitations such as weak light penetration and limited research. Further studies are needed to clarify its autofluorescence mechanism and evaluate its long-term effects.

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Rectum, Penile, Brain and Bladder, Consecutive Rare Distant Metastasis in Two Patients With Papillary Thyroid Carcinoma: Case Reports

Douk KWON ; Won Woong KIM ; Byung-Chang KIM ; Yu-mi LEE ; Ki-Wook CHUNG ; Tae-Yon SUNG

Journal of Endocrine Surgery.2025;25(3):109-117. doi:10.16956/jes.2025.25.3.109

Papillary thyroid carcinoma (PTC) has a favorable prognosis. However distant metastases seldom occur and negatively impact patient outcomes. To our knowledge, this is the first report of PTC metastasizing to the rectum, penis, and bladder. We report 2 patients having PTC with metastases to previously unreported sites. The first male patient had PTC with metastases to the rectum and penis, in addition to lung, liver, spleen, and skeletal muscle involvement at the time of initial diagnosis. Surgical pathology reported classic PTC with clear cell features and infiltrative follicular variant. The second female patient had PTC with aggressive lateral neck lymph node metastases at initial surgery. Surgical pathology reported PTC having tall cell variant with rhabdoid components. Subsequent metastases to bladder, lung, brain, vertebrae, and sternum occurred within 2 years. These cases emphasize the importance of early suspicion and thorough evaluation, particularly in aggressive subtypes, as timely detection may improve treatment strategies and patient outcomes. Due to the lack of established guidelines for rare metastatic sites, additional case reports are essential to guide diagnosis and treatment.

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Retrosternal Goiter: A Mammoth Hiding in Plain Sight: A Case Report

Harshit GUPTA ; Aman BHARDWAJ ; Vivek BHARDWAJ ; Vivek AGGARWAL

Journal of Endocrine Surgery.2025;25(3):118-122. doi:10.16956/jes.2025.25.3.118

We report the case of a 43-year-old woman with a giant retrosternal multinodular goiter causing progressive dyspnea and severe tracheal compression. Imaging revealed a mass extending from C5 to T9 vertebral levels. Given its extensive intrathoracic extension, a combined cervical incision and median sternotomy was performed. The mass was excised completely with preservation of the recurrent laryngeal nerves and parathyroid glands. The patient recovered uneventfully without complications. This case emphasizes the importance of multidisciplinary planning and highlights surgical decision-making in retrosternal goiters with mediastinal extension.

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Unravelling the Connection: The Role of Cushing Syndrome in Accelerating Degenerative Disc Disease: A Case Report and Literature Review

Gargi GAUTAM ; Oluwatoyin Adalia DAIRO ; Ajin Mathews JOHN ; Jasmine KAUR ; Giorgi SEKANIA ; Patrick ASHINZE

Journal of Endocrine Surgery.2026;26(1):31-39. doi:10.16956/jes.2026.26.1.31

Cushing’s syndrome is associated with a spectrum of systemic complications, including under-recognised effects on the musculoskeletal system. We present a case of a 37-year-old male with recurrent Cushing’s Disease who developed progressive lumbar radiculopathy secondary to severe Degenerative Disc Disease. Despite bilateral adrenalectomy, the patient exhibited persistent hypercortisolaemia and classical Cushingoid features. Imaging confirmed L4 disc herniation with nerve root compression. A multidisciplinary team initiated endocrine therapy and performed a successful minimally invasive lumbar discectomy, resulting in clinically documented neurological improvement during the immediate postoperative period. Chronic cortisol excess may disrupt spinal biomechanics and accelerate spinal degeneration through presumed bone demineralisation, muscle atrophy, altered fat distribution, and direct degradation of disc tissue. This case highlights the importance of early endocrine evaluation in patients with atypical or rapidly progressive spinal degeneration. Recognition and management of hypercortisolaemia are essential for surgical planning, optimising outcomes, and preventing recurrent spinal compromise.

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