罕见甲状旁腺腺瘤癌变误诊一例  

Parathyroid Adenoma Carcinogenesis: A Rarely Misdiagnosed Case Report and Literature Review

作　　者：陈贵兵[1] 杨华夏[2] 侯文宇[2] 夏绍友[2] 

机构地区：[1]成都军区总医院普外中心,成都610083 [2]解放军总医院普通外科,北京100853

出　　处：《临床误诊误治》2016年第4期19-21,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨甲状旁腺腺瘤癌变的诊治方法。方法回顾性分析我院收治的1例甲状旁腺腺瘤癌变误诊病例资料。结果患者因右胫骨及胸肋骨疼痛7月余入院,曾于外院误诊为骨巨细胞瘤,给予手术治疗,症状未完全缓解,并出现多饮、多尿及尿频,遂就诊我院。查血钙、全段甲状旁腺激素升高,甲状腺超声检查示:右叶下极后方占位性病变,超声引导下穿刺活检病理示甲状旁腺瘤,予手术切除病灶,经术后病理及免疫组织化学染色(免疫组化)诊断为甲状旁腺腺瘤癌变。术后予静脉补钙、补磷对症治疗,随访9个月,右胫骨及胸肋骨未再疼痛,肿瘤无复发。结论甲状旁腺癌症状、体征、影像学表现和实验室指标缺乏特异性,术前易误诊,术后病理结合免疫组化可确诊。Objective To summarize the misdiagnosis cause and therapy of parathyroid adenoma carcinogenesis.Methods A retrospective analysis was conducted on a misdiagnosed case with parathyroid adenoma carcinogenesis in the General Hospital of PLA. Results The patient suffered from the pain of the right tibia and sternal rib for over 7 months. He had been misdiagnosed as having giant cell tumor of bone in another hospital. The pain was not relieved after surgery. Moreover,he had the obvious polydipsia,polyuria and frequency of micturition before he was admitted to our hospital. Laboratory analyses included hypercalcemia and high parathyroid hormone levels. The thyroid ultrasound confirmed nodules in the rear lower pole of the right lobe of the thyroid,and then it was diagnosed as parathyroid adenoma by the puncture biopsy guided by ultrasound. The lesion underwent complete surgical resection,and the patient was diagnosed as having parathyroid adenoma carcinogenesis by routine pathology examination and immunohistochemistry. Postoperative therapy was mainly infused calcium and phosphorus. The patient had no symptoms of pain sine then,and no recurrence during a 9-month follow up. Conclusion The symptoms,signs,imaging and laboratory of parathyroid carcinoma all lack specificity,therefore it can be easily misdiagnosed in preoperative diagnosis. It can be conformed by histopathology and immunohistochemistry.

关 键 词：甲状旁腺肿瘤 误诊 骨巨细胞瘤 

分 类 号：R736.2[医药卫生—肿瘤]