Handra-Luca Adriana
From the Service d'Anatomie Pathologique (AH-L), APHP; and Université Paris Nord Sorbonne Cité (AH-L), Bobigny, France.
Medicine (Baltimore). 2014 Dec;93(27):e201. doi: 10.1097/MD.0000000000000201.
The thymus-parathyroid unit (TPU) occurring in adults is rare.The main symptoms and important clinical findings are as follows: 2 patients presented with neomercazole-resistant Basedow-Graves disease. A third patient presented with thyroid nodules and a fourth patient with a neck mass after thyroid resection for medullary thyroid carcinoma.The main diagnoses were those of thyroid nodules (either in the context of goiter, or not). In the fourth case the diagnosis was of thyroid medullary carcinoma recurrence in the neck. Thyroidectomy was performed in the 2 cases of Basedow-Graves disease and in the third case (wherein selective neck dissection was also performed). In the fourth case, a neck dissection was performed for a possible medullary carcinoma recurrence. A TPU was microscopically detected in 2 cases with perithyroid location, on thyroidectomies for Basedow-Graves disease and in the 2 other cases with neck soft tissue location (associated with thyroid papillary carcinoma and thyroid medullary carcinoma extension). Postsurgical hypocalcemia requiring treatment occurred in both patients with Basedow-Graves disease and in the fourth patient. The presence of TPU should be acknowledged because such lesions can be misdiagnosed as suspect lymph nodes during thyroid surgery for malignant tumors.
成人中出现的胸腺-甲状旁腺单位（TPU）很罕见。主要症状和重要临床发现如下：2例患者患有对新斯的明耐药的巴塞多-格雷夫斯病。第三例患者有甲状腺结节，第四例患者在因甲状腺髓样癌行甲状腺切除术后出现颈部肿块。主要诊断为甲状腺结节（无论是在甲状腺肿的背景下，还是无此背景）。第四例诊断为颈部甲状腺髓样癌复发。对2例巴塞多-格雷夫斯病患者和第三例患者（其中还进行了选择性颈部清扫术）实施了甲状腺切除术。第四例患者因可能的髓样癌复发进行了颈部清扫术。在2例甲状腺周围位置的病例中，通过对巴塞多-格雷夫斯病患者进行甲状腺切除术以及在另外2例颈部软组织位置的病例中（与甲状腺乳头状癌和甲状腺髓样癌浸润相关），显微镜下检测到了TPU。2例巴塞多-格雷夫斯病患者和第四例患者术后均出现需要治疗的低钙血症。应认识到TPU的存在，因为在甲状腺恶性肿瘤手术中，此类病变可能被误诊为可疑淋巴结。
