Montenegro Fabio Luiz de Menezes, Tavares Marcos Roberto, Durazzo Marcelo Doria, Cernea Claudio Roberto, Cordeiro Anói Castro, Ferraz Alberto Rosseti
Department of Head and Neck Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Sao Paulo Med J. 2006 Jan 5;124(1):42-4. doi: 10.1590/s1516-31802006000100009. Epub 2006 Apr 3.
Adequate management of parathyroid carcinoma apparently relates to the surgeons ability to identify it at the first operation. The objective of this paper was to evaluate the role of clinical suspicion in the management of parathyroid carcinoma.
Retrospective analysis of parathyroid carcinoma patients treated in Department of Head and Neck Surgery, Faculdade de Medicina da Universidade de São Paulo.
Cross-sectional study of 143 patients who underwent surgery from 1995 to 2000, due to hyperparathyroidism. These cases were reviewed to ascertain whether preoperative and intraoperative suspicion of parathyroid carcinoma were helpful during the operation, and which factors demonstrated the suspicion of cancer best.
Among 66 patients with primary hyperparathyroidism there were four cases of parathyroid carcinoma (6.1%), and one case was found in secondary hyperparathyroidism (1.3%). Palpable nodules were found in five patients with primary hyperparathyroidism, four of them with parathyroid carcinoma. Preoperative levels of calcium in primary hyperparathyroidism with cancer patients varied from 12.0 mg/dl to 18.2 mg/dl. Two patients had gross macroscopic spread of the tumor to adjacent structures. Except for one patient, with extensive disease, tumors were resected en bloc. In secondary hyperparathyroidism, parathyroid carcinoma was found in a fifth mediastinal gland. One atypical adenoma was observed.
High levels of calcium, palpable tumors and adherence to close structures are more common in parathyroid carcinoma. These clinical signs may be helpful for decision-making during parathyroid surgery.
甲状旁腺癌的充分管理显然与外科医生在首次手术时识别它的能力有关。本文的目的是评估临床怀疑在甲状旁腺癌管理中的作用。
对圣保罗大学医学院头颈外科治疗的甲状旁腺癌患者进行回顾性分析。
对1995年至2000年因甲状旁腺功能亢进接受手术的143例患者进行横断面研究。对这些病例进行回顾，以确定术前和术中对甲状旁腺癌的怀疑在手术期间是否有帮助，以及哪些因素最能表明对癌症的怀疑。
在66例原发性甲状旁腺功能亢进患者中，有4例甲状旁腺癌（6.1%），在继发性甲状旁腺功能亢进患者中发现1例（1.3%）。在5例原发性甲状旁腺功能亢进患者中发现可触及的结节，其中4例患有甲状旁腺癌。原发性甲状旁腺功能亢进伴癌症患者的术前血钙水平在12.0mg/dl至18.2mg/dl之间。2例患者肿瘤有肉眼可见的向相邻结构的扩散。除1例广泛病变患者外，肿瘤均整块切除。在继发性甲状旁腺功能亢进中，在第五个纵隔腺中发现甲状旁腺癌。观察到1例非典型腺瘤。
高血钙水平、可触及的肿瘤以及与周围结构的粘连在甲状旁腺癌中更为常见。这些临床体征可能有助于甲状旁腺手术中的决策。
