Placzkowski Kimberly, Christian Rose, Chen Herbert
Department of Medicine, University of Wisconsin, Madison, WI 53792, USA.
Clin Nucl Med. 2007 May;32(5):358-60. doi: 10.1097/01.rlu.0000259623.79805.2d.
We report a case of radioguided parathyroidectomy in a patient with parathyroid carcinoma. A 61-year-old woman presented to our center with persistent hypercalcemia (17.2 mg/dL) and hyperparathyroidism (PTH=324 pg/mL) following her second neck resection for recurrent parathyroid carcinoma at an outside facility. Her elevated serum calcium had not responded to treatment with intravenous bisphosphonates, furosemide, or calcitonin. Calcimemetic therapy (Cinacalcet) was effective but had to be discontinued due to GI intolerance. She requested a second opinion at our center after being referred for palliative radiation therapy for presumed inoperable disease. On presentation, she remained symptomatic with bone and joint pain, diffuse abdominal pain and fatigue. Repeat technetium-99m sestamibi (Tc-99m sestamibi) scintigraphy showed a faint area of uptake near the right clavicular head, adjacent to the site of her previous resections. With the intraoperative guidance of a hand-held gamma probe, a 2 cm recurrent parathyroid carcinoma was located and successfully excised. Intraoperative PTH levels confirmed surgical cure of this previously undetected foci of disease. The use of radioguidance and intraoperative PTH monitoring were the keys to a successful resection, and our patient remains disease free with 17 months of follow-up.
我们报告了一例甲状旁腺癌患者接受放射性引导甲状旁腺切除术的病例。一名61岁女性因复发性甲状旁腺癌在外院接受第二次颈部切除术后,出现持续性高钙血症(17.2mg/dL)和甲状旁腺功能亢进(甲状旁腺激素=324pg/mL),前来我院就诊。她升高的血清钙对静脉注射双膦酸盐、呋塞米或降钙素治疗均无反应。拟钙剂治疗(西那卡塞)有效,但因胃肠道不耐受而不得不停药。在因假定无法手术的疾病被转诊接受姑息性放射治疗后,她到我院寻求第二种意见。就诊时,她仍有骨和关节疼痛、弥漫性腹痛及疲劳等症状。重复进行的锝-99m甲氧基异丁基异腈(Tc-99m sestamibi)闪烁扫描显示,在右锁骨头部附近有一个微弱的摄取区域,毗邻她之前手术切除的部位。在手持γ探头的术中引导下,定位并成功切除了一个2cm的复发性甲状旁腺癌。术中甲状旁腺激素水平证实手术治愈了这个之前未被发现的病灶。放射性引导和术中甲状旁腺激素监测的使用是成功切除的关键,我们的患者在17个月的随访中仍无疾病复发。