摘要
目的:分析非典型甲状旁腺腺瘤(atypical parathyroid adenoma,APA)的临床和病理资料,提高甲状旁腺肿瘤的诊断水平。方法:回顾性分析我院收治的11例APA临床和病理资料。所有病例均经手术和病理证实。1993年1月-2010年3月我院共收治甲状旁腺腺瘤81例,其中APA 11例(13.6%)。男7例,女4例;发病年龄22～68岁,平均(39.4±13.1)岁。结果:11例APA患者骨型7例(63.6%),肾骨型4例(36.4%);10例血钙升高,9例血磷降低,全部血甲状旁腺素(parathyroid hormone,PTH)升高。病理表现:8例可见肿瘤包膜侵犯但未穿透,1例在肿瘤内的纤维性组织中见到灶性浸润性生长的肿瘤细胞,2例可见肿瘤细胞呈片状、梁状排列,3例可见宽大胶原纤维带,5例可见肿瘤细胞异型性或核分裂像,1例未见明确的肿瘤包膜。有8例APA患者随诊8～47月,平均(19.0±13.1)月,6例(75%)未发现肿瘤复发,2例(25%)出现肿瘤复发。其中1例再次手术后病理证实为甲状旁腺腺癌;另1例发现高血钙、PTH升高,B超提示甲状腺区域内肿物,但患者拒绝再次手术。结论:在甲状旁腺肿瘤中,有相当一部分在初诊时难以确定良恶性。本组APA的临床表现均符合甲状旁腺功能亢进的特点。由于APA的恶性潜能未定,所以要密切随访,监测血钙、PTH水平,必要时结合影像学检查,以防肿瘤复发或发生腺癌。
Objective：To improve the diagnosis for atypical parathyroid adenoma（APA） by exploring the clinical and pathological manifestations of APA. Methods ： Clinical data of 11 cases of APA in our hospital were retrospectively studied. The diagnosis was confirmed by operation and pathology. Eighty-one patients with parathyroid adenomas were admitted between January 1993 and March 2010,among which 11 patients（13.6%） were diagnosed as APA （7 males,4 females;aged 22-68 year-old with an average of （39.4±13.1） year-old）. Results ：There were 7 patients（63.6%） with bone disorders and 4 patients （36.4%） with bone and urinary disorders among 11 patients with APA.Serum level of calcium was raised in 10 patients,phosphorus was decreased in 9 patients and parathyroid hormone（PTH） was elevated in all patients.Histological findings were as follows：incomplete invasion of the capsule （8 patients/11 patients）,focal infiltration into the fibrous connective tissue of the tumor（ 1 patient/11 patients）, trabecular growth pattern （2 patients/11 patients）,thick fibrous bands（3 patients/11 patients）, atypia or mitotic figures（5 patients/11 patients） and no clear tumor capsule （1 patient/11 patients） were observed. Eight patients were followed up for 8-47 months, averaged （19.0± 13.1） months;2 recurrent patients（25%） were observed and 1 patient developed parathyroid carcinoma proved by pathological diagnosis.Another 1 patient was found with recurrent hypercalcemia, high PTH level and ultrasonography revealed a nodule in the thyroid region,but the patient refused another surgery. Conclusions：Among considerable cases of parathyroid neoplasms, it is hard to judge the benign and malignant tumor at the initial diagnosis. Clinical manifestations of this group are in accordance with the characteristics of hyperparathyroidism. Because of the risk of recurrence and malignancy of APA, vigilant follow-up by serum biochemistry and imaging ex- amination is recommended.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2013年第2期186-189,共4页
Journal of Chongqing Medical University
