维持性血液透析患者合并肺转移性甲状旁腺癌1例并文献复习  

Maintenance hemodialysis complicated with lung-metastatic parathyroid carcinoma:a case report and literature review

作　　者：常晓艳 葛树旺[1] Chang Xiaoyan;Ge Shuwang(Department of Nephrology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肾内科,武汉430030

出　　处：《中华肾脏病杂志》2023年第12期932-935,共4页Chinese Journal of Nephrology

基　　金：湖北省自然科学基金(2023AFB838)。

摘　　要：甲状旁腺癌(parathyroid carcinoma,PC)是一种临床少见的内分泌恶性肿瘤,该文报道维持性血液透析患者合并肺转移性PC 1例,并复习相关文献。患者因移植肾失功后接受维持性血液透析治疗,4年后出现高甲状旁腺素及高钙血症,CT检查示甲状腺左侧叶后下方类圆形无强化软组织密度影,锝99m-甲氧基异丁基异腈(99mTc-MIBI)甲状旁腺显像(双时相法)检查示甲状腺左叶后方浓聚灶。予全麻下甲状旁腺次全切除,组织病理检查诊断为甲状旁腺腺瘤合并甲状旁腺增生。术后患者血甲状旁腺素较术前显著下降,但仍高于正常范围;血钙恢复至正常范围。术后数月内血甲状旁腺素再次升高,术后1年余99mTc-MIBI甲状旁腺显像示双肺上叶多发低密度放射性增浓结节影,组织病理学检查证实肺部病变为转移性PC。Parathyroid carcinoma(PC)is a rare endocrine malignancy.We report a case of lung metastases of PC in a maintenance hemodialysis patient with renal allograft loss and review the relevant literature.The patient developed hyperparathyroid hormone and hypercalcemia 4 years after hemodialysis treatment.CT examination showed that a round-shaped,soft tissue density shadow without typical enhancement was located in infero-posterior left lobe of thyroid gland.Dual-phase 99mTc-MIBI parathyroid imaging showed abnormal 99mTc-MIBI uptake behind the left lobe of the thyroid gland on both early and delayed imaging.The patient underwent subtotal parathyroidectomy under general anesthesia.Histopathological diagnosis was parathyroid adenoma and parathyroid hyperplasia.The serum parathyroid hormone decreased significantly,but remained above normal,and the serum calcium returned to normal range after the surgery.However,the parathyroid hormone level gradually increased several months after the surgery.99mTc-MIBI parathyroid imaging showed multiple low-density nodules with increased uptake of 99mTc-MIBI in superior lobe of both lungs one year after the surgery.Ultimately,pulmonary metastasis of PC was confirmed by pathological examination.

关 键 词：甲状旁腺肿瘤 甲状旁腺功能亢进症 肾透析 肺 甲状旁腺素 

分 类 号：R692.5[医药卫生—泌尿科学] R736.1[医药卫生—外科学]