■甲状旁腺癌极为罕见。这种癌症不会以可预测的方式转移,并且实际上已经注意到血液和淋巴扩散。目前文献中没有报告转移到对侧II级淋巴结的病例。
■我们报告了一例复发性甲状旁腺癌,其中患者因右侧甲状旁腺癌和甲状旁腺功能亢进而接受了多次手术,包括2例重做甲状旁腺切除术,4个颈部解剖,自体移植和自体移植组织的再切除。在初次手术后将近十年,甲状旁腺激素(PTH)水平明显上升,但是核医学(NM)sestamibi扫描,正电子发射断层扫描-计算机断层扫描(PET-CT),超声(US)无法确定疾病复发的来源。最后,颈部US显示可疑的对侧II级淋巴结;淋巴结细针穿刺(FNA)显示甲状旁腺组织,和PTH抽吸物注意到PTH洗脱升高。左外侧颈清扫术后,病理证实复发性转移性甲状旁腺癌,血清钙和PTH水平改善。该病例进一步并发慢性肾脏病和pT1N0M0结肠癌,都在45岁之前。
■在Sestamibi扫描无法定位已知甲状旁腺癌患者的转移灶的情况下,FNA和PTH洗脱是重要的次要研究。
UNASSIGNED: Parathyroid carcinoma is exceedingly rare. This cancer does not metastasize in a predictable manner and has in fact been noted to spread both hematogenously and lymphatically. There are currently no cases in the literature that report metastasis to a contralateral level II lymph node.
UNASSIGNED: We report a
case of recurrent parathyroid carcinoma in which the patient underwent several surgeries for right-sided parathyroid carcinoma and hyperparathyroidism, including 2 redo parathyroidectomies, 4 neck dissections, and auto transplantation and re-excision of the autotransplanted tissue. Almost a decade after initial surgery, parathyroid hormone (PTH) levels rose significantly, but nuclear medicine (NM)
sestamibi scan, positron emission tomography-computed tomography (PET-CT), and ultrasound (US) could not identify the source of recurrent disease. Finally, neck US revealed a suspicious contralateral level II lymph node; fine needle aspiration (FNA) of the lymph node revealed parathyroid tissue, and PTH aspirate noted an elevated PTH washout. After left lateral neck dissection, pathology confirmed recurrent metastatic parathyroid carcinoma, and serum calcium and PTH levels improved. This
case was further complicated by chronic kidney disease and pT1N0M0 colon cancer, all before the age of 45.
UNASSIGNED: In cases where a
sestamibi scan is not able to localize a metastatic focus in a patient with known parathyroid carcinoma, FNA and PTH washout are important secondary studies.