背景:非功能性甲状旁腺癌(PC)是最罕见的恶性肿瘤之一。由于缺乏症状和实验室检查结果,它主要在AQ2晚期诊断,当当地入侵和传播已经存在时。然而,我们的案子是个例外,因为它是在早期发现的,没有当地入侵。我们介绍了一个最小的无功能PC的案例,并对文献进行了回顾。
方法:一名47岁的妇女进入门诊,对双侧甲状腺结节(载玻片1)和中央颈部肿块(载玻片2)进行细针穿刺活检(FNAB),怀疑是淋巴结节或甲状旁腺肿大。结果作为BethesdaI-胶体返回(幻灯片1),和贝塞斯达四世(幻灯片2),指出很难区分甲状腺嗜氧细胞病变和甲状旁腺细胞。进行了甲状腺全切除术以及左中央颈肿块切除术,没有任何周围结构的参与。病理检查提示双侧甲状腺滤泡性结节性病变,乳头状微小癌,和甲状旁腺癌伴血管和包膜浸润,测量10×8×7毫米。免疫组织化学特征包括PTH阳性,嗜铬粒蛋白A,和负TTF1。
结论:非功能性PC通常诊断为晚期,已经涉及相邻结构;然而,这个案例提供了一个罕见的例子。重要的是,在没有升高的Ca和PTH血清水平的情况下,不排除PC作为鉴别诊断。后续行动将很困难,因为没有可依赖的预后参数。
BACKGROUND: Non functional
parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our
case is an exception, because it was detected in early stage, with no local invasion present. We present a
case of the smallest non-functional PC yet reported and review of the literature.
METHODS: A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or
parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1.
CONCLUSIONS: Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this
case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on.