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Abstract：
BACKGROUND: Parathyroid carcinoma (PC) is a rare malignancy, often diagnosed incidentally through postoperative pathological examination. The occurrence of nodular goiter, intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma (PA), and papillary thyroid microcarcinoma (PTMC) is extremely uncommon, which prompted us to report our case experience.
METHODS: We describe a 67-year-old male who presented with a cervical mass causing tracheal compression, which prompted him to seek medical advice. Based on preoperative auxiliary examination results from color Doppler ultrasound, SPECT parathyroid imaging, and blood tests, he was initially diagnosed with a suspected parathyroid adenoma and nodular goiter. Excision of the right lobe and isthmus of the thyroid, and left superior parathyroid gland was conducted, which were sent to intraoperative frozen pathological examination. During intraoperative observation, adhesion around the right thyroid lobe was discovered. Consequently, right central area lymph node dissection was performed due to suspicion of an aggressive malignant tumor. Histology and immunohistochemistry analysis revealed incidental intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma, classical papillary thyroid microcarcinoma, and nodular goiter.
CONCLUSIONS: Parathyroid carcinoma should be highly suspected when extremely high levels of PTH and severe hypercalcemia are present, which cannot be simply explained by a preoperatively localized parathyroid adenoma, especially when suspicious malignant adhesion is found during intraoperative exploration. In cases where multifocal thyroid nodules are associated with increased uptake of 99Tc-sestamibi, the possibility of coexisting carcinomas should be considered, not only for thyroid malignancy but also for the potential presence of intrathyroidal parathyroid carcinoma.
METHODS: We describe a 67-year-old male who presented with a cervical mass causing tracheal compression, which prompted him to seek medical advice. Based on preoperative auxiliary examination results from color Doppler ultrasound, SPECT parathyroid imaging, and blood tests, he was initially diagnosed with a suspected parathyroid adenoma and nodular goiter. Excision of the right lobe and isthmus of the thyroid, and left superior parathyroid gland was conducted, which were sent to intraoperative frozen pathological examination. During intraoperative observation, adhesion around the right thyroid lobe was discovered. Consequently, right central area lymph node dissection was performed due to suspicion of an aggressive malignant tumor. Histology and immunohistochemistry analysis revealed incidental intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma, classical papillary thyroid microcarcinoma, and nodular goiter.
CONCLUSIONS: Parathyroid carcinoma should be highly suspected when extremely high levels of PTH and severe hypercalcemia are present, which cannot be simply explained by a preoperatively localized parathyroid adenoma, especially when suspicious malignant adhesion is found during intraoperative exploration. In cases where multifocal thyroid nodules are associated with increased uptake of 99Tc-sestamibi, the possibility of coexisting carcinomas should be considered, not only for thyroid malignancy but also for the potential presence of intrathyroidal parathyroid carcinoma.
摘要：
背景：甲状旁腺癌（PC）是一种罕见的恶性肿瘤，常通过术后病理检查偶然诊断。结节性甲状腺肿的发生，甲状腺内甲状旁腺癌，对侧甲状旁腺腺瘤(PA),甲状腺乳头状微小癌（PTMC）极为罕见，这促使我们报告我们的案例经验。
方法：我们描述了一位67岁的男性，他表现为颈部肿块导致气管压迫，这促使他寻求医疗建议。根据彩色多普勒超声的术前辅助检查结果，SPECT甲状旁腺显像,还有血液测试,他最初被诊断为疑似甲状旁腺腺瘤和结节性甲状腺肿。甲状腺右叶和峡部切除术，左上甲状旁腺进行了检查，术中冰冻病理检查。术中观察,发现甲状腺右叶周围粘连。因此,由于怀疑侵袭性恶性肿瘤，进行了右中央区淋巴结清扫术。组织学和免疫组织化学分析显示偶见甲状腺内甲状旁腺癌，对侧甲状旁腺腺瘤，经典甲状腺乳头状微小癌，结节性甲状腺肿.
结论：当出现极高水平的PTH和严重的高钙血症时，应高度怀疑甲状旁腺癌。这不能简单地用术前局部甲状旁腺腺瘤来解释，尤其是术中探查发现可疑恶性粘连时。在多灶性甲状腺结节与99Tc-sestamibi摄取增加相关的情况下，应该考虑共存癌的可能性，不仅适用于甲状腺恶性肿瘤，还可能存在甲状腺内甲状旁腺癌。
方法：我们描述了一位67岁的男性，他表现为颈部肿块导致气管压迫，这促使他寻求医疗建议。根据彩色多普勒超声的术前辅助检查结果，SPECT甲状旁腺显像,还有血液测试,他最初被诊断为疑似甲状旁腺腺瘤和结节性甲状腺肿。甲状腺右叶和峡部切除术，左上甲状旁腺进行了检查，术中冰冻病理检查。术中观察,发现甲状腺右叶周围粘连。因此,由于怀疑侵袭性恶性肿瘤，进行了右中央区淋巴结清扫术。组织学和免疫组织化学分析显示偶见甲状腺内甲状旁腺癌，对侧甲状旁腺腺瘤，经典甲状腺乳头状微小癌，结节性甲状腺肿.
结论：当出现极高水平的PTH和严重的高钙血症时，应高度怀疑甲状旁腺癌。这不能简单地用术前局部甲状旁腺腺瘤来解释，尤其是术中探查发现可疑恶性粘连时。在多灶性甲状腺结节与99Tc-sestamibi摄取增加相关的情况下，应该考虑共存癌的可能性，不仅适用于甲状腺恶性肿瘤，还可能存在甲状腺内甲状旁腺癌。
