Khan Shahab, Sekhon Harpreet, Mihai Radu, Jenkins Stephanie
Department of Endocrine Surgery, Churchill Cancer Centre, Churchill Hospital, Headington, Oxford OX3 7LE, UK.
Department of General Surgery, Princess Alexandra Hospital, Harlow, Essex, CM20 1QX, UK.
AME Case Rep. 2018 May 15;2:22. doi: 10.21037/acr.2018.04.04. eCollection 2018.
Primary hyperparathyroidism secondary to true sporadic synchronous parathyroid cancer (PTCa) and adenoma (PTa) is rare. This is a case of an 80-year-old female admitted with symptomatic hypercalcaemia, raised serum calcium (Ca) of 3.39 mmol/L and raised parathyroid hormone (PTH) of 44.3 pmol/L. Ultrasonic evaluation of the neck revealed a mass posterior to the right thyroid lobe. Imaging of the left neck was unremarkable. Subsequent sesta-MIBI and single-photon emission computed tomography-computed tomography (SPECT-CT) scanning highlighted conspicuous activity over the right lower neck consistent with the neck ultrasound scan findings. Pre-operatively, PTa was suspected. Intra-operatively, malignancy was suspected due to infiltration of the parathyroid tumour into the thyroid. The right inferior parathyroid and right thyroid gland were resected. Histology confirmed PTCa. Despite surgical treatment, she was found to have persistently high Ca and PTH levels. Further investigation with a repeat sesta-MIBI and SPECT-CT suggested a left inferior parathyroid tumour. Excision of this mass revealed a PTa. Recovery was unremarkable and serum biochemistry returned to normal ranges.
继发于真正散发性同步甲状旁腺癌（PTCa）和腺瘤（PTa）的原发性甲状旁腺功能亢进症较为罕见。这是一例80岁女性患者，因症状性高钙血症入院，血清钙（Ca）升高至3.39 mmol/L，甲状旁腺激素（PTH）升高至44.3 pmol/L。颈部超声检查发现右甲状腺叶后方有一个肿块。左颈部影像学检查无异常。随后的锝-甲氧基异丁基异腈（sesta-MIBI）和单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）扫描显示右颈部下方有明显的放射性浓聚，与颈部超声检查结果一致。术前怀疑为PTa。术中，由于甲状旁腺肿瘤浸润甲状腺，怀疑为恶性肿瘤。切除右下甲状旁腺和右甲状腺。组织学检查证实为PTCa。尽管进行了手术治疗，但发现她的钙和PTH水平持续升高。再次进行sesta-MIBI和SPECT-CT检查提示左下甲状旁腺肿瘤。切除该肿块后发现是PTa。恢复情况良好，血清生化指标恢复至正常范围。
