甲状旁腺囊肿的临床病理特征分析  

Analysis of clinicopathological features of parathyroid cyst

作　　者：张巍 刘慧通[2] Zhang Wei;Liu Huitong(Department of Pathology,Shanxi Provincial People's Hospital,Xi'an 710068,China;Department of Orthopedics,Shanxi Provincial People's Hospital,Xi'an 710068,China)

机构地区：[1]陕西省人民医院病理科,西安710068 [2]陕西省人民医院骨科,西安710068

出　　处：《中华解剖与临床杂志》2022年第9期646-650,共5页Chinese Journal of Anatomy and Clinics

基　　金：陕西省自然科学基础研究计划(2021JQ-914、2021JQ-916);陕西省人民医院科技人才支持计划“菁英人才”项目(2021JY-38、2021JY-50)。

摘　　要：目的探讨甲状旁腺囊肿(PCs)的临床和病理特征。方法回顾性研究。纳入陕西省人民医院2012年11月—2021年11月病理检查确诊PCs的患者15例。其中,男8例、女7例,年龄31~65岁(中位年龄45岁)。患者均行PCs切除治疗。总结患者的临床特征、影像学特点及病理学特征。结果15例患者中有14例为自查或体检时发现颈部包块,1例以咳嗽为首发症状,患者均无其他临床表现。所有患者术前血钙、血磷均在正常范围,甲状旁腺素、甲状腺功能检查均正常。12例在甲状腺左叶或右叶下极,3例在甲状腺腺体内,2例位于胸骨后方纵隔内,1例位于右侧Ⅵ区淋巴结区。超声结果显示颈部见囊性液暗区,边界清;CT示平扫颈部见类圆形薄壁低密度影,增强扫描无强化。病理检查大体标本示,PCs长径1~7(4.33±1.47)cm,囊内多含无色清亮液体;镜下示纤维囊壁内见挤压呈巢状及条索状的甲状旁腺组织,其主要由主细胞及嗜酸性细胞构成;免疫组织化学染色示甲状旁腺组织均嗜铬素A阳性表达,甲状腺球蛋白、甲状腺转录因子、突触素均阴性表达。结论PCs临床少见,解剖位置多变,又缺乏特异的临床及影像学特征,术前诊断较为困难。明确诊断主要依靠病理检查,囊壁内典型甲状旁腺组织是其主要病理特征,可利用免疫组织化学鉴别诊断。Objective To investigate the clinical and pathological features of parathyroid cysts(PCs).Methods Retrospective study.Fifteen patients with pathologically confirmed PCs from November 2012 to November 2021 in Shaanxi Provincial People's Hospital were included.Among the patients,8 were males and 7 were females.The patients were aged 31-65 years(median age 45 years),and all patients underwent PC resection.The clinical features,imaging features,and pathological features of the patients were summarized.Results Out of the 15 patients,14 were found to have a neck mass during self-examination or physical examination,1 had coughing as the first symptom,and none had other clinical manifestations.In all patients,preoperative serum calcium and phosphorus levels were within the normal range,and parathyroid hormone and thyroid function tests were normal.Twelve cases were located in the lower pole of the left or right lobe of the thyroid,3 cases were located in the thyroid gland,2 cases were located behind the sternum,and 1 case was located in the right level VI lymph node area.Ultrasound results showed cystic fluid dark areas in the neck with clear borders.CT scans revealed round thin-walled low-density shadows in the neck.However,enhanced scans showed no enhancement.The PCs were 1-7 cm in size with an average diameter of(4.33±1.47)cm.The cysts mostly contained colorless and clear liquid.Microscopically,the fibrous cyst wall showed extruded parathyroid glands in the form of nests and cords.The parathyroid tissue was mainly composed of chief cells and oncocytic cells.The immunohistochemical staining of parathyroid tissue was positive for Chromogranin-A and negative for thyroglobulin,thyroid transcription factor-1,and synaptophysin.Conclusion PCs are rare clinically.Their variable anatomical location and lack of specific clinical and imaging features make their preoperative diagnosis difficult.Their definite diagnosis mainly depends on pathological examination.The typical parathyroid tissue in the cyst wall is the main patholog

关 键 词：甲状旁腺 甲状旁腺囊肿 病理检查 体征和症状 

分 类 号：R582[医药卫生—内分泌]