van Haaren E R, Kievit J, Huysmans H A, van de Velde C J
Department of Surgery, Leiden University Hospital, The Netherlands.
Jpn J Clin Oncol. 1996 Apr;26(2):99-102. doi: 10.1093/oxfordjournals.jjco.a023192.
We describe the effect of repeated surgical procedures in a patient with metastatic parathyroid carcinoma over a period of seven years. Initially a subtotal parathyroidectomy was performed for adenomatous hyperplasia. After two years of normocalcemia, hypercalcemia recurred. Two subsequent re-explorations, one of the neck and one of the mediastinum, showed no abnormalities. Histopathologic revision of the primary specimen demonstrated parathyroid carcinoma. Attention was then focused on extra-regional disease, and a hepatic metastasis was detected and successfully resected. Within one year, functional pulmonary metastases occurred. These metastases were treated by four thoracotomies, each providing effective palliation. Eventually the patient died of uncontrollable hypercalcemia seven years after the primary procedure. Even at the time of death there were no signs of recurrent disease in the neck. Parathyroid carcinoma is known to produce local and distant metastases causing severe hypercalcemia. Because medical treatment mostly offers only temporary success and surgery facilitates effective palliation with minimal morbidity, an aggressive surgical approach for functional metastases of parathyroid carcinoma is recommended.
我们描述了一名转移性甲状旁腺癌患者在七年时间里反复接受外科手术的效果。最初因腺瘤样增生进行了甲状旁腺次全切除术。在血钙正常两年后，高钙血症复发。随后进行的两次再次探查，一次针对颈部，一次针对纵隔，均未发现异常。对原发标本的组织病理学复查显示为甲状旁腺癌。于是将注意力集中在区域外疾病上，检测到一处肝转移并成功切除。在一年内，出现了功能性肺转移。这些转移灶通过四次开胸手术进行治疗，每次均提供了有效的姑息治疗。最终，患者在初次手术后七年死于无法控制的高钙血症。即使在死亡时，颈部也没有复发疾病的迹象。已知甲状旁腺癌会产生局部和远处转移，导致严重的高钙血症。由于药物治疗大多仅取得暂时成功，而手术能以最小的发病率实现有效的姑息治疗，因此推荐对甲状旁腺癌的功能性转移采取积极的手术方法。
