Thyroid Cancer Center, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Endocr J. 2010;57(6):493-7. doi: 10.1507/endocrj.k09e-365. Epub 2010 Mar 6.
This study aims to describe our experiences of parathyroid carcinoma.
The data of clinicopathological features, surgical treatment and outcomes of seven cases of parathyroid carcinoma among 171 patients who underwent surgery for primary hyperparathyroidism over a 16-year period were analyzed.
The major symptoms at the diagnosis included a neck mass in three cases and multiple bone pain in five. Two patients were asymptomatic. No remarkable increases of serum calcium levels were noted in the patients, but serum parathyroid hormone (PTH) concentrations were high in most of the patients (4 of 5 in available). A variety of imaging studies including ultrasonography, sestamibi scan, and computed tomography scan were helpful in identifying the abnormal parathyroid glands, but not specific for the diagnosis of parathyroid carcinoma. In most patients, the parathyroid carcinomas were suspected at the time of neck exploration, and confirmed by final histopathologic examinations. All patients underwent complete surgical excision with curative intent. During the follow-up period, one patient developed lung metastases 6 years later and the other one died of unrelated cause.
Preoperative diagnosis of parathyroid carcinoma is difficult, but operative findings are helpful in the diagnosis. The optimal surgical treatment is en block radical resection including adjacent structures when parathyroid carcinoma is suspected. Unusually, although our patients presented with high serum PTH concentrations, they had normal or mild elevated serum calcium concentrations. The reason of why should be investigated in future studies.
本研究旨在描述甲状旁腺癌的诊治经验。
回顾性分析了 16 年间 171 例原发性甲状旁腺功能亢进症患者的临床病理特征、手术治疗及预后。
诊断时的主要症状包括 3 例颈部肿块和 5 例多发骨痛。2 例患者无症状。患者血清钙水平无明显升高，但大多数患者血清甲状旁腺激素（PTH）浓度升高（5 例中 4 例）。各种影像学检查（包括超声、锝扫描和 CT 扫描）有助于识别异常甲状旁腺，但对甲状旁腺癌的诊断特异性不高。大多数患者在颈部探查时怀疑为甲状旁腺癌，并最终通过组织病理学检查证实。所有患者均接受了根治性切除术。随访期间，1 例患者 6 年后发生肺转移，另 1 例患者死于非相关原因。
甲状旁腺癌术前诊断困难，但手术发现有助于诊断。当怀疑甲状旁腺癌时，最佳的手术治疗方法是整块切除包括相邻结构。不同寻常的是，尽管我们的患者血清 PTH 浓度升高，但他们的血清钙浓度正常或轻度升高。这一现象的原因有待进一步研究。
