目的:总结和探讨甲状旁腺癌的诊断和治疗方法。方法:回顾性总结本院5例甲状旁腺癌的临床资料。结果:5例患者术前颈部均扪及质硬包块,平均血钙浓度为3.82 mmol/L,平均PTH浓度为153.6 pmol/L,4例术中发现周围浸润表现。5例中4例同时行甲状旁腺肿瘤和同侧甲状腺腺叶切除,1例仅行甲状旁腺肿瘤切除。5例术后均诊断为甲状旁腺癌。术后4例得到随访,时间4月～5年。其中2例术后无复发;1例于术后半年局部复发行患侧甲状腺切除,后无复发;1例因全身转移于术后8个月死亡。结论:甲状旁腺癌的诊断非常困难,异常高浓度血钙、血PTH及术中浸润表现和组织病理学特征是甲状旁腺癌诊断的重要依据,99m-Tc-MIBI扫描及超声是病变定位的首选手段,肿瘤及其周围受侵组织的“整块切除”(en bloc resection)是首选的治疗方式。
ObjectiveTo analysis the clinical symptoms, diagnosis, and treatment of primary hyperparathyroidism (PHPT). MethodsA retrospective study was made in consecutive patients with PHPT who performed operation and had integral data between January 2004 to December 2012 in West China Hospital. ResultsThe 136 cases were composed of 52 cases (38.23%) bone types, 17 cases (12.50%) nephrocalcinosis, 7 cases (5.15%) skeletal and renal involvements, 24 cases (17.65%) asymptomatic primary hyperparathyroidism, and 36 cases (26.47%) combined with other clinical symptoms. The preoperative parathyroid hormone (PTH) levels were (106.20±88.88) pmol/L (6.91-390 pmol/L) and serum calcium were (3.12±0.66) mmol/L (2.15-5.77 mmol/L). The coincidence rate between the examinations preoperation and pathology:B type ultrasound was 75.00%, 99Tcm-MIBI scan was 85.29%, ultrasound and 99Tcm-MIBI combined with computerized tomography (CT) scan was 86.76%. Pathology presentation:129 patients (94.85%) were benign lesions, 7 cases (5.15%) were parathyroid carcinoma. Of the 129 patients, 114 cases (95.80%) were single parathyroid adenoma, 5 cases (4.20%) were multiple parathyroid adenoma or combined parathyroid hyperplasia, 10 cases (7.75%) were parathyroid hyperplasia. Of the patients, the PTH level decreased to below normal upper limit within 3 days after surgery in 124 cases (91.18%). One hundred and twenty-four cases (91.18%) were followed-up. The follow-up time was 6-112 months, a median follow-up time was 49 months. Twelve patients (8.82%) were lost to follow-up, 2 patients (1.47%) with carcinoma recurrence, the rest patients without recurrence and metastasis. Three patients (2.20%) with parathyroid carcinoma died. Of the 3 patients, 2 died of systemic metastasis of parathyroid carcinoma in 18 and 23 months after surgery, 1 died of cardiovascular accident in 19 months after surgery. ConclusionSurgical excision of the lesion parathyroid tissue is the most effective treatment for PHPT.
ObjectiveTo explore the diagnosis and treatment features of parathyroid carcinoma (PTC). MethodsThe clinical data of 7 cases of parathyroid carcinoma treated from January 1993 to April 2014 were analyzed retrospectively. ResultsAll of the 7 patients had symptoms of hyperparathyroidism. Four patients had palpable neck mass. The average serum calcium level of preoperation was 3.07 mmol/L (2.35-4.98 mmol/L). The average parathyroid hormone (PTH) level was 1 181.5 pg/mL (78.4-2 061.7 pg/mL), which elevated 17 times the upper limit of normal. One case had operation in other hospital and six cases in Jishuitan hospital. The tumors located in the left inferior parathyroid gland in 3 cases, 2 cases of right lower parathyroid, and right superior parathyroid gland in 1 cases. One case underwent parathyroidectomy, parathyroidectomy including ipsilateral thyroid lobe or part of it was performed in 5 cases. Of 5 cases, 1 case was added central compartment lymphadenectomy. Three cases of postoperative tumor recurrence underwent reoperation, of which 1 case recurred 3 times. Two cases died. The remining 5 had survived until now, had survived for 5 years in 3 cases. ConclusionsA comprehensive approach with clinical presentation, serum calcium and PTH levels, B-ultrasonography, 99Tcm-MIBI, intraoperation aberrant findings, and histopathology offers help to accurate diagnosis of parathyroid carcinoma. Surgery is en bloc resection of the primary lesion. Recurrence needs reoperation, and long-term follow-up is advised.
ObjectiveTo summarize the experience of comprehensive treatment of parathyroid carcinoma (PTC).MethodThe clinicopathologic data of patient with PTC admitted to the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed.ResultsThe patient was a 42-year-old male, who was diagnosed with the primary hyperparathyroidism after suffering from systemic joint pain for more than 2 years. The patient accepted the first operation in a primary hospital, including the resection of the PTC and ipsilateral thyroid lobectomy, and the PTC was confirmed pathologically. The second operation was performed due to the tumor relapse within thyroid bed. The third operation was performed with the palliative resection of the recurrent tumor in the right neck and the three-dimensional conformal radiation therapy was performed. The fourth operation was performed in the left neck with lateral lymph node dissection of level Ⅲ and level Ⅳ. The lower left lung cuneiform resection was performed in the fifth operation. For the last operation, the mediastinal metastatic tumor was removed with thoracoscopy. The multiple imaging evaluation showed no evidence of recurrence in the neck, but the extensive pulmonary metastasis occurred.ConclusionsSurgery is the only effective treatment for PTC. En bloc excision consists of resection of primary tumor, ipsilateral thyroid lobectomy, other surrounding structures involved by the tumor and central neck dissection. During operation, tumor rupture should be avoided. Accessible metastatic tumor should be resected when possible. Radiotherapy should be performed in patient with local infiltration or unresectable tumor. Effect of chemotherapy for PTC is poor. Supportive medical care should be given for fatal hypercalcemia in patient when treatment failed to control tumor.