Vainas I G, Tsilikas C, Grecu A, Pasaitu K, Stergiou I, Kortsaris A H
Thagenion Cancer Institute, Thessaloniki, Greece.
J Exp Clin Cancer Res. 1997 Dec;16(4):429-32.
We report the case of a 46-year-old male patient who, after disease-free intervals of five, four and one and a half years following resection of an 'atypical' parathyroid adenoma in 1982, relapsed with clinical and laboratory recurrence of primary hyperparathyroidism (PHP). Noninvasive, traditional and modern imaging methods localized small distinct metastatic foci in both lungs without evidence of primary thyroid, neck or mediastinal tumor. Three successive bilateral lung nodule excisions resulted in a long PHP remission, while a three month treatment with normal saline infusions, diuretics, calcitonine and pamidronate infusions, following the last recurrence, resulted in moderate improvement of hypercalcemia and hypercalciuria with no effect on both PTH secretion or on the size of new metastatic lung foci. Recurrent mPCa with or without secretion of biologically active PTH is optimally treatable with successive surgical resections of the metastases and intermittent medical treatment to achieve PTH secreting tumor mass reduction and a beneficial metabolic effect.
我们报告了一例46岁男性患者的病例，该患者在1982年切除“非典型”甲状旁腺腺瘤后，分别间隔5年、4年和1年半无病期后，原发性甲状旁腺功能亢进症（PHP）出现临床和实验室复发。非侵入性、传统和现代成像方法在双肺发现了小的明显转移灶，未发现原发性甲状腺、颈部或纵隔肿瘤的证据。连续三次双侧肺结节切除术使PHP得到了长期缓解，而在最后一次复发后，进行了为期三个月的生理盐水输注、利尿剂、降钙素和帕米膦酸输注治疗，高钙血症和高钙尿症有中度改善，但对甲状旁腺激素分泌或新的肺转移灶大小均无影响。复发性有或无生物活性甲状旁腺激素分泌的mPCa，通过连续手术切除转移灶和间歇性药物治疗，以减少分泌甲状旁腺激素的肿瘤肿块并获得有益的代谢效果，可得到最佳治疗。
