Calandra D B, Chejfec G, Foy B K, Lawrence A M, Paloyan E
Surgery. 1984 Dec;96(6):1132-7.
Parathyroid carcinoma is a rare cause of hyperparathyroidism. Cure results from successful en bloc resection. However, because of its rarity, the malignant nature may not be appreciated at the initial operative procedure and as a result, definitive resection may not be accomplished. However, even with extensive en bloc resections, local recurrences do occur and patients die of metabolic derangements associated with hypercalcemia. Thus in addition to operative intervention, palliative chemotherapy may be required to control the hypercalcemia. Radiotherapy has been unsuccessful. A single case of nonfunctioning parathyroid carcinoma responding to treatment with methotrexate, Adriamycin, cyclophosphamide, and CCNU has been reported. We report a case of recurrent functioning parathyroid carcinoma treated with dacarbazine (DTIC) in which biochemical and pathologic evidence of at least a partial response was seen. The patient, a 33-year-old woman, had undergone five previous neck explorations during a 26-month period for aggressive locally recurrent disease. Before DTIC therapy the intact parathyroid hormone (PTH) level was 1032 pg Eq/ml (normal 163 to 347 pg Eq/ml) and the serum calcium level was 16.8 mg/dl (normal 8.8 to 10.0 mg/dl). After a course of DTIC there was a marked improvement in her clinical status and biochemical parameters (intact PTH 545 pg Eq/ml; serum calcium 11.8 mg/dl). For 2 months her condition stabilized, with PTH levels between 700 and 760 pg Eq/ml and serum calcium levels between 10.2 and 16.0 mg/dl. With a slowly progressive rise in biochemical parameters a second course of DTIC was initiated and a marked drop in serum calcium levels (5.7 mg/dl) occurred, but PTH levels remained unchanged. A progressive course of septicemia, malnutrition, and disseminated intravascular clotting ultimately lead to her death 4 weeks later. At autopsy examination the tumor was confined to the neck. Grossly and microscopically there was extensive central as well as peripheral necrosis of the tumor, which was thought to be the result of the cytotoxic effect of DTIC. From this experience and because of the grim prognosis in patients with recurring parathyroid carcinoma, it may be that aggressive use of chemotherapy with DTIC early in the course of treatment should be considered.
甲状旁腺癌是甲状旁腺功能亢进症的一种罕见病因。通过成功的整块切除可实现治愈。然而，由于其罕见性，在初次手术时可能无法认识到其恶性本质，结果可能无法完成根治性切除。即便进行了广泛的整块切除，局部复发仍会发生，患者会死于与高钙血症相关的代谢紊乱。因此，除了手术干预外，可能还需要姑息性化疗来控制高钙血症。放射治疗一直未取得成功。曾有一例无功能甲状旁腺癌经甲氨蝶呤、阿霉素、环磷酰胺和洛莫司汀治疗后有反应的报道。我们报告一例复发性功能性甲状旁腺癌患者，用达卡巴嗪（DTIC）治疗，观察到至少有部分反应的生化和病理证据。该患者为一名33岁女性，在26个月期间因侵袭性局部复发性疾病曾接受过5次颈部探查。在接受DTIC治疗前，完整甲状旁腺激素（PTH）水平为1032 pg Eq/ml（正常为163至347 pg Eq/ml），血清钙水平为16.8 mg/dl（正常为8.8至10.0 mg/dl）。经过一个疗程的DTIC治疗后，她的临床状况和生化参数有显著改善（完整PTH为545 pg Eq/ml；血清钙为11.8 mg/dl）。有2个月她的病情稳定，PTH水平在700至760 pg Eq/ml之间，血清钙水平在10.2至16.0 mg/dl之间。随着生化参数缓慢逐渐升高，启动了第二个疗程的DTIC治疗，血清钙水平显著下降（至5.7 mg/dl），但PTH水平保持不变。败血症、营养不良和弥散性血管内凝血的进行性病程最终导致她在4周后死亡。尸检时肿瘤局限于颈部。大体和显微镜下可见肿瘤广泛的中央及周边坏死，这被认为是DTIC细胞毒性作用的结果。基于这一经验，且鉴于复发性甲状旁腺癌患者的预后严峻，或许应考虑在治疗过程早期积极使用DTIC进行化疗。
