Medas Fabio, Erdas Enrico, Loi Giulia, Podda Francesco, Pisano Giuseppe, Nicolosi Angelo, Calò Pietro Giorgio
Department of Surgical Sciences, University of Cagliari, S. S. 554, Bivio Sestu, 09042 Monserrato, CA, Italy.
Int J Surg. 2016 Apr;28 Suppl 1:S94-8. doi: 10.1016/j.ijsu.2015.12.040. Epub 2015 Dec 18.
Parathyroid carcinoma is a rare malignancy representing less than 1% of primary hyperparathyroidism cases. Its management is controversial due to lack of large-scale, multicentric studies. We report 8 new cases of parathyroid carcinoma and review the literature. Preoperative diagnosis of carcinoma was possible in 2 (25%) cases. Unclear surgical margins were present in 5 (62.5%) patients; 4 of them underwent subsequent re-exploration and ipsilateral hemithyroidectomy, in one case associated to central lymph node dissection. Recurrent disease is reported in 2 (25%) patients. Considering the high incidence of local recurrence in case of unclear surgical margins, a re-exploration with ipsilateral hemithyroidectomy is indicated in these patients. A neck dissection should be performed only in case of clinically involved lymph nodes, avoiding prophylactic lymphectomy. An aggressive approach is indicated in case of local or distant recurrence to reduce hypercalcemia.
甲状旁腺癌是一种罕见的恶性肿瘤，在原发性甲状旁腺功能亢进病例中占比不到1%。由于缺乏大规模、多中心研究，其治疗存在争议。我们报告8例甲状旁腺癌新病例并回顾相关文献。2例（25%）病例术前得以诊断为癌。5例（62.5%）患者手术切缘不明确；其中4例随后接受再次探查及同侧甲状腺半切术，1例同时行中央淋巴结清扫术。2例（25%）患者报告有疾病复发。鉴于手术切缘不明确时局部复发率较高，这些患者应行再次探查及同侧甲状腺半切术。仅在临床发现有淋巴结受累时才行颈部清扫术，避免预防性淋巴结切除术。对于局部或远处复发的病例，应采取积极治疗方法以降低高钙血症。
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