Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan Province, China.
BMC Endocr Disord. 2024 Jul 25;24(1):125. doi: 10.1186/s12902-024-01656-8.
Parathyroid carcinoma (PC) is a rare malignancy, often diagnosed incidentally through postoperative pathological examination. The occurrence of nodular goiter, intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma (PA), and papillary thyroid microcarcinoma (PTMC) is extremely uncommon, which prompted us to report our case experience.
We describe a 67-year-old male who presented with a cervical mass causing tracheal compression, which prompted him to seek medical advice. Based on preoperative auxiliary examination results from color Doppler ultrasound, SPECT parathyroid imaging, and blood tests, he was initially diagnosed with a suspected parathyroid adenoma and nodular goiter. Excision of the right lobe and isthmus of the thyroid, and left superior parathyroid gland was conducted, which were sent to intraoperative frozen pathological examination. During intraoperative observation, adhesion around the right thyroid lobe was discovered. Consequently, right central area lymph node dissection was performed due to suspicion of an aggressive malignant tumor. Histology and immunohistochemistry analysis revealed incidental intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma, classical papillary thyroid microcarcinoma, and nodular goiter.
Parathyroid carcinoma should be highly suspected when extremely high levels of PTH and severe hypercalcemia are present, which cannot be simply explained by a preoperatively localized parathyroid adenoma, especially when suspicious malignant adhesion is found during intraoperative exploration. In cases where multifocal thyroid nodules are associated with increased uptake of 99Tc-sestamibi, the possibility of coexisting carcinomas should be considered, not only for thyroid malignancy but also for the potential presence of intrathyroidal parathyroid carcinoma.
甲状旁腺癌（PC）是一种罕见的恶性肿瘤，通常通过术后病理检查偶然诊断。结节性甲状腺肿、甲状腺内甲状旁腺癌、对侧甲状旁腺腺瘤（PA）和甲状腺微小乳头状癌（PTMC）同时发生的情况极为罕见，因此我们报告了我们的病例经验。
我们描述了一位 67 岁男性，因颈部肿块压迫气管而就诊。根据术前彩色多普勒超声、SPECT 甲状旁腺成像和血液检查的辅助检查结果，他最初被诊断为甲状旁腺腺瘤和结节性甲状腺肿疑似病例。进行了右叶和峡部甲状腺以及左甲状旁腺的切除术，并进行了术中冰冻病理检查。术中观察到右甲状腺叶周围有粘连，因此怀疑为侵袭性恶性肿瘤，进行了右中央区淋巴结清扫术。组织学和免疫组织化学分析显示意外的甲状腺内甲状旁腺癌、对侧甲状旁腺腺瘤、经典型甲状腺微小乳头状癌和结节性甲状腺肿。
当 PTH 水平极高且严重高钙血症存在，且不能简单地用术前局部定位的甲状旁腺腺瘤来解释时，应高度怀疑甲状旁腺癌，特别是在术中探查时发现可疑恶性粘连时。当多发性甲状腺结节伴有 99Tc-sestamibi 摄取增加时，应考虑同时存在癌的可能性，不仅要考虑甲状腺恶性肿瘤，还要考虑甲状腺内甲状旁腺癌的潜在可能性。
