Fujimoto Y, Obara T
Surg Clin North Am. 1987 Apr;67(2):343-57. doi: 10.1016/s0039-6109(16)44188-5.
Parathyroid carcinoma is a rare tumor and its clinical course is variable. Differentiation of patients with parathyroid carcinoma from those with parathyroid adenoma is often difficult both preoperatively and at operation. For good results, the surgeon must recognize this disorder and perform an en bloc resection at the initial surgery. A neck dissection is necessary only when there is evidence of regional node metastases. After surgery, periodic follow-up of the serum calcium and iPTH levels is essential. When hypercalcemia recurs or the serum iPTH increases, localization studies with the use of thallium-201 scanning help detect local recurrence and regional lymph node metastases, but unfortunately, this method often fails to localize pulmonary metastases. Chest radiographs and CT scanning are useful for delineating pulmonary metastases. A wide excision of locally recurrent tumor, an en bloc radical neck dissection and mediastinum dissection for lymphatic metastases, and an aggressive surgical resection of lung metastases are recommended. Although these operations are rarely curative, they usually offer definite palliation of the marked hypercalcemia, often for a considerable period. Drugs to lower the serum calcium level and systemic chemotherapy are currently of only limited benefit, and radiation therapy is generally ineffective.
甲状旁腺癌是一种罕见的肿瘤，其临床病程多变。术前及术中往往难以将甲状旁腺癌患者与甲状旁腺腺瘤患者区分开来。为取得良好疗效，外科医生必须认识到这种疾病，并在初次手术时进行整块切除。仅当有区域淋巴结转移证据时才需要进行颈部清扫。术后，定期监测血清钙和iPTH水平至关重要。当高钙血症复发或血清iPTH升高时，使用铊-201扫描进行定位研究有助于检测局部复发和区域淋巴结转移，但不幸的是，这种方法常常无法定位肺转移灶。胸部X线片和CT扫描有助于明确肺转移情况。建议对局部复发肿瘤进行广泛切除、对淋巴结转移进行整块根治性颈部清扫和纵隔清扫，以及对肺转移进行积极的手术切除。尽管这些手术很少能治愈，但通常能在相当长一段时间内有效缓解明显的高钙血症。目前，降低血清钙水平的药物和全身化疗的益处有限，放射治疗一般无效。
