摘要
背景与目的:甲状旁腺癌是一种罕见的恶性肿瘤,其病因尚不明。由于甲状旁腺癌的低发病率,至今对其的认知都仅来源于个案报道和国外数个回顾性的研究,临床医生缺乏对该病的认识,往往容易造成误诊。本文通过具体临床病例并结合文献资料,对甲状旁腺癌的临床特点,诊断及治疗等内容作一讨论。
材料与方法:回顾总结分析了浙江大学医学院自2001年9月至2007年9月期间收治3例甲状旁腺癌病例,全部病例都经术后病理证实,均作术后随访。并作国内外文献分析。
结果和结论:提高临床对甲状旁腺癌的警惕性。它的主要临床表现是颈部肿块和由于严重的高钙血症引起的肾脏、骨疾病。甲状旁腺癌的术前诊断十分困难。血钙和血清PTH的检查作为筛查手段应列为常规,多普勒彩超和~(99m)Tc-MIBI相结合可获得准确的定位诊断。术中的探查对甲状旁腺癌的诊断是必要的。手术是甲状旁腺癌最有效的治疗手段,en bloc切除术是金标准。
Context&Objective: Parathyroid carcinoma is a rare malignancy, the etiology of the tumour remains unclear. Because the disease is so uncommon, our experience of parathyroid carcinoma mainly derives from case reports and a few retrospective studies. The poor recongention may leads to misdiagnosis. The aim of this article is to explore the clinical characteristics, diagnosis and treatment of parathyroid with the clinical cases.
Material&Methods: The clinical data of 3 cases of parathyroid carcinoma, collected in 2nd affiliated hospital Zhejiang University college of medicine from Sep 2001 to Sep 2007, were reviewed and analyzed retrospectively. All cases were confirmed by pathological examination after surgery and followed up. Literatures were reviewed accordingly.
Results&Conclusions: All 3 cases with parathyroid carcinoma were misdiagnosed before surgery, suggestive of enhancing consciousness of the disease. The main clinical presentations of patients with PC are a palpable cervical mass and concomitant kidney and bone diseases mainly related to the severely increased secretion of PTH. The pre-operative diagnosis of malignancy is very difficult, and, thus, intra-operative recognition of PC is mandatory. Serum calcium and PTH assay should be performed as a routine screening procedure. A combination of ultrasonography and ~(99m)Tc-MIBI scintigraphy is sufficient for locating the tumor. Surgical resection is the most effective treatment of Pc. The en bloc resection of the tumour represents the gold standard of initial surgical treatment of patients. Whereas the radiotherapy is an alternative for later unresected cases.
引文
[1] Iacobone M, Lumachi F, Favia G Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol, 2004, 88(4):223-228.
[2] Obara T, Fujimoto Y. Diagnosis and treatment of patients with parathyroid carcinoma. An update and review. World J Surg, 1991,15(6):738-744.
[3] DeLe Hi RA. Parathyroid carcinoma: an overview. Adv Anat Pathol, 2005, 12(2):53-61.
[4] Shane E. Clinical review 122: parathyroid carcinoma. J Clin Endocrinol Metab,2001,86(2):485-493.
[5] Favia G, Lumachi F, Polistina F, et al. Parathyroid carcinoma: sixteen new cases and suggestions for correct management. World J Surg, 1998, 22(12): 1225-1230.
[6] Mittendorf EA ,McHenry CR. Parathyroid carcinoma. J Surg Oncol, 2005, 89(3):136-142.
[7] Koea JB , Shaw JH. Parathyroid cancer: biology and management. Surg Oncol, 1999,8(3):155-165.
[8] Rodgers SE, Perrier ND. Parathyroid carcinoma. Curr Opin Oncol, 2006, 18(1):16-22.
[9] Messerer CL, Bugis SP, Baliski C, et al. Normocalcemic parathyroid carcinoma: an unusual clinical presentation. World J Surg Oncol, 2006,4:10.
[10] Lee JE. Predicting the presence of parathyroid carcinoma. Ann Surg Oncol, 2005,12(7): 1-2.
[11] Kebebew E, Clark OH. Parathyroid adenoma, hyperplasia, and carcinoma: localization, technical details of primary neck exploration, and treatment of hypercalcemic crisis. Surg Oncol Clin N Am, 1998, 7(4):721-748.
[12] Castellani M, Reschini E, Longari V, et al. Role of Te-99m sestamibi scintigraphy in the diagnosis and surgical decision-making process in primary hyperparathyroid disease. Clin Nucl Med, 2001,26(2): 139-144.
[13] Weber AL, Randolph G, Aksoy FG. The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am, 2000, 38(5): 1105-1129.
[14] Obara T, Okamoto T, Kanbe M, et al. Functioning parathyroid carcinoma, clinicopathlogic features and rational treatment. Semin Surg Oncol, 1997, 13(2):134-141.
[15] Schantz A, Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer, 1973,31(3):600-605.
[16] Kebebew E, Arici C, Duh QY, et al. Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg, 2001, 136(8):878-885.
[17] Kebebew E. Parathyroid carcinoma. Curr Treat Options Oncol, 2001, 2(4):347-354.
[18] Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg, 1992, 16(4):724-731.
[19] Laeobone M, Rufolo C, Lumachi F, el al. Results of iterafive surgery for persistent and recurrent parathyroid carcinoma. Langenbeck Arch Surg, 2005, 390(5):385-390.
[20] Thompson SD, Prichard AJ. The management of parathyroid carcinoma. Curr Opin Otolaryngol Head Neck Surg, 2004,12(2):93-97.
[21] Rao SR, Shaha AR, Singh B, et al. Management of cancer of the parathyroid. Acta Otolaryngol, 2002, 122(4):448-452.
[22] Wynne AG, van Heerden J, Carney JA, et al. Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine, 1992, 71(4): 197-205.
[23] Munson ND, Foote RL, Northcutt RC, et al. Parathyroid carcinoma: is there a role for adjuvant radiation therapy?, Cancer, 2003, 98(11):2378-2384.
[24] Kirby-Bott J, Lewis P, Harmer CL, et al. One stage treatment of parathyroid cancer. Eur J Surg Oncol, 2005, 31(1):78-83.
[25] dayman GL, Gonzalez HE, El-Naggar A, et al. Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer, 2004,100(5):900-905.
[26] Hundahl SA, Fleming ID, Fremgen AM, et al. Cancer, 1999, 86(3):538-544.
[1] Rao SR, Shaha AR, Singh B, et al. Management of cancer of the parathyroid. Acta Otolaryngol, 2002,122(4):448-452.
[2] Beus KS, Stack BC Jr. Parathyroid carcinoma. Otolaryngol Clin North Am, 2004, 37(4):845-854.
[3] Iacobone M, Lumachi F, Favia G Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol, 2004, 88(4):223-228.
[4] Obara T, Fujimoto Y. Diagnosis and treatment of patients with parathyroid carcinoma. An update and review. World J Surg, 1991,15(6):738-744.
[5] Rawat N, Khetan N, Williams DW, et al. Parathyroid carcinoma. Br J Surg, 2005,92(11):1345-1353.
[6] DeLe lli RA. Parathyroid carcinoma: an overview. Adv Anat Pathol, 2005, 12(2):53-61.
[7] Mittendorf EA, McHenry CR. Parathyroid carcinoma. J Surg Oncol, 2005, 89(3): 136-142.
[8] Shane E. Clinical review 122: parathyroid carcinoma. J Clin Endocrinol Metab,2001,86(2):485-493.
[9] Pearce SH, Trump D, Wooding C, et al. J Clin Endocfinol(Oxf), 1996, 45(2):195-200.
[10] Yoshimoto K, Endo H, Tsuyuguchi M, et al. 1 J Clin Endocfinol(Oxf), 1998, 48(1):67-72.
[11] Agarwal SK, Schrock E, Kester MB, et al. J Cancer Genet Cytogenet, 1998, 106(1):30-36.
[12] Kytola S, Farnebo F, Obara T, Isola J, et al. Patterns of chromosomal imbalances in parathyroid carcinomas. Am J Pathol 2000, 157(2):579-586.
[13]Carpten JD,Robbins CM,Villablanca A,el al.HRPT2,encoding paralibromin,is mutated in hyperparathyroidism-jaw tumor syndrome.J Nat Genet,2002,32(4):676-80.
[14]Shattuck T,Valimaki S,Obara T,et al.Somatic and germ-line mutations of the HRPT2 gene in sporadic parathyroid carcinoma.N Engl J Med,2003,349(18):1722-1799.
[15]Haven CJ,van Puijenbroek M,Karperien M,et al.Differential expression of the calcium sensing receptor and combined loss of chromosomes 1q and 11q in parathyroid carcinoma.J Pathol,2004,202(1):86-94.
[16]Favia G.Lumachi F,Polistina F,et al.Parathyroid carcinoma:sixteen new cases and suggestions for correct management.World J Surg,1998,22(12):1225-1230.
[17]Rodgers SE,Perrier ND.Parathyroid carcinoma.Curr Opin Oncol,2006,18(1):16-22.
[18]Kebebew E,Clark OH.Parathyroid adenoma,hyperplasia,and carcinoma:localization,technical details of primary neck exploration,and treatment of hypercalcemic crisis.Surg Oncol Clin N Am,1998,7(4):721-748.
[19]徐少明.甲状旁腺癌的诊断和治疗.中国实用外科杂志,1998,18(3):177-179.
[20]Elliott DD,Monroe DP,Perrier ND.Parathyroid histopathology:is it of any value today?.J Am Coll Surg,2006,203(5):758-765.
[21]Spinelli C,Bonadio AG,Berti P,et al.Cutaneous spreading of parathyroid carcinoma after fine needle aspiration cytology.J Endocrinol Invest,2000,23(4):255-257.
[22]Castellani M,Reschini E,Longari V,et al.Role of Te-99m sestamibi scintigraphy in the diagnosis and surgical decision-making process in primary hyperparathyroid disease. Clin Nucl Med, 2001, 26(2): 139-144.
[23] Weber AL, Randolph G, Aksoy FG. The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am, 2000, 38(5):1105-1129.
[24] Collins MT, Skarulis MC, Bilezikian JP, et al. Treatment of hypercalcemia secondary to parathyroid carcinoma with a novel calcimimetic agent. J Clin Endocrinol Metab, 1998, 83(4):1083 - 1088.
[25] Kebebew E. Parathyroid carcinoma. Curr Treat Options Oncol, 2001, 2(4):347-354.
[26] Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg, 1992,16(4):724-731.
[27] Laeobone M, Rufolo C, Lumachi F, el al. Results of iterafive surgery for persistent and recurrent parathyroid carcinoma. Langenbeck Arch Surg, 2005, 390(5):385-390.
[28] Thompson SD, Prichard AJ. The management of parathyroid carcinoma. Curr Opin Otolaryngol Head Neck Surg, 2004,12(2):93-97.
[29] Munson ND, Foote RL, Northcutt RC, et al. Parathyroid carcinoma: is there a role for adjuvant radiation therapy. Cancer, 2003, 98(11):2378-2384.
[30] dayman GL, Gonzalez HE, El-Naggar A, et al. Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer, 2004,100(5):900-905.
[31] Hundahl SA, Fleming ID, Fremgen AM, et al. Cancer, 1999, 86(3):538-544.