Pylina S V, Kim E I, Bondarenko E V, Krupinova J A, Eremkina A K, Mokrysheva N G
Endocrinology Research Center.
Probl Endokrinol (Mosk). 2023 Feb 25;69(1):15-27. doi: 10.14341/probl13176.
Parathyroid cancer (PTC) is usually sporadic; however, it could be presented as a component of hereditary syndromes. The prevalence of PTC among patients with primary hyperparathyroidism (PHPT) is about 1% cases. The lack of reliable preoperative predictors significantly complicates the diagnosis of PTC. The clinical course is non-specific and in most cases is determined by severe hypercalcemia. The final diagnosis can only be made on the basis of invasive histopathologic features, while an analysis immunohistochemical (IHC) one can be used only as an additional method. Given the rarity the diagnosis of MEN1-related PTC a challenge. We present two clinical cases of patients with PTC and a verified heterozygous mutation in the MEN1 gene. The described cases demonstrate the complexity of morphological diagnosis for PTC, the heterogeneity of clinical manifestations in patients with the MEN1 mutation, as well as the need for timely screening to identify other components of MEN1 syndrome and mutations of the MEN1 gene among first-line relatives.
甲状旁腺癌(PTC)通常为散发性;然而,它也可能作为遗传性综合征的一部分出现。在原发性甲状旁腺功能亢进症(PHPT)患者中,PTC的患病率约为1%。缺乏可靠的术前预测指标使PTC的诊断显著复杂化。其临床过程不具有特异性,在大多数情况下由严重高钙血症决定。最终诊断只能基于侵袭性组织病理学特征做出,而免疫组织化学(IHC)分析仅可作为辅助方法。鉴于MEN1相关PTC的罕见性,其诊断颇具挑战性。我们报告了两例PTC患者的临床病例,且在MEN1基因中检测到已证实的杂合突变。所描述的病例展示了PTC形态学诊断的复杂性、MEN1突变患者临床表现的异质性,以及对一线亲属及时进行筛查以识别MEN1综合征的其他组成部分和MEN1基因突变的必要性。