Xin Yunhui, Zhao Teng, Wei Bojun, Gu Hua, Jin Mulan, Shen Hong, Liu Xing, Wang Jiacheng, Wang Qian
Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China.
Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China.
Endocrine. 2020 Aug;69(2):456-460. doi: 10.1007/s12020-020-02283-8. Epub 2020 Apr 4.
Ectopic parathyroid glands are thought to be the cause of a significant portion of failed primary surgery for hyperparathyroidism. Parathyroid carcinoma (PTCA) is a rare malignant tumor, and ectopic PTCA is a particularly unusual situation. Here, we describe, for the first time, a case of intrapericardial PTCA.
We describe the case of a 53-year-old female presented with 1-year history of backache, multiple fractures, nephrolithiasis, nausea, vomiting, fatigue, and unexplained myocardial ischemia-like symptoms. Physical examination revealed a barrel chest and sternal tenderness with stable vital signs. Blood tests confirmed hypercalcemia (3.70 mmol/L) and hyperparathyroidism (>1900 pg/ml). Tc-sestamibi scan indicated ectopic findings in the mediastinum highly suggestive of parathyroid adenoma.
After more tests, cardiac magnetic resonance imaging (MRI) revealed a mass closely related to the great vessels of the heart. The ectopic tumor in the pericardium was successfully resected through sternotomy, with subsequent histopathological confirmation of PTCA. The metabolism of calcium and phosphorus and the level of PTH returned to normal after surgery.
This unique case reinforces the tremendous variety of possible ectopic locations of parathyroid glands. Although most patients with primary hyperparathyroidism (PHPT) carry a high suspicion of a benign course, the entity of ectopic PTCA also needs to be considered. Accurate preoperative locating diagnosis as well as en bloc tumor resection offers the highest chance of cure in patients with PHPT.
异位甲状旁腺被认为是导致大部分原发性甲状旁腺功能亢进症初次手术失败的原因。甲状旁腺癌（PTCA）是一种罕见的恶性肿瘤，而异位PTCA则是一种极为特殊的情况。在此，我们首次描述了一例心包内PTCA病例。
我们描述了一名53岁女性的病例，该患者有1年的背痛、多处骨折、肾结石、恶心、呕吐、疲劳以及不明原因的心肌缺血样症状病史。体格检查发现桶状胸和胸骨压痛，生命体征稳定。血液检查证实有高钙血症（3.70 mmol/L）和甲状旁腺功能亢进（>1900 pg/ml）。锝- sestamibi扫描显示纵隔有异位表现，高度提示甲状旁腺腺瘤。
经过更多检查后，心脏磁共振成像（MRI）显示有一个与心脏大血管密切相关的肿块。通过胸骨切开术成功切除了心包内的异位肿瘤，随后经组织病理学证实为PTCA。术后钙磷代谢及甲状旁腺激素水平恢复正常。
这一独特病例强化了甲状旁腺可能异位的位置极其多样这一观点。尽管大多数原发性甲状旁腺功能亢进症（PHPT）患者高度怀疑病情为良性，但异位PTCA的情况也需要考虑。准确的术前定位诊断以及整块肿瘤切除为PHPT患者提供了最高的治愈机会。
