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題 名 | 副甲狀腺腺癌併多發性轉移--一病例報告=Parathyroid Carcinoma with Multiple Metastases--A Case Report |
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作 者 | 沈耿裕; 陳天令; 王朝弘; 詹錕鋙; | 書刊名 | 內科學誌 |
卷 期 | 9:3 1998.09[民87.09] |
頁 次 | 頁148-152 |
分類號 | 415.662 |
關鍵詞 | 副甲狀腺腺癌; Parathyroid carcinoma; |
語 文 | 中文(Chinese) |
中文摘要 | 一名74歲男性,近十多年來有多次上消化道出血而住院的病史,最 近二個月來因體重減輕(8-12公斤 、噁心、嘔吐、全身無力、便秘、頭痛、 腹脹而到急診求助,發現高鈣血症。經鉈-鎝掃瞄(Thallium-201,Technetium-99 subtraction scan)(Tl-Tc scan)顯示副甲狀腺腫瘤,遂接受手術以解決高血鈣危 象;術中發現有侵犯到鄰近食道及甲狀腺的現象,而懷疑惡性病灶,故做右側 甲狀腺及腫瘤質塊切除,經病理檢查證實為副甲狀腺腺癌,術後病情迅速改善。 十月後因有聲音沙啞及復發高鈣血症,經證實副甲狀腺腺癌復發,病人再次接 受手術,切除左側甲狀腺及腫瘤質塊。術後接受多次化療,及抑鈣素等藥物治療。 一年後發現併發肺部及肋膜轉移,並有大量右側肋膜積水 ,患者於一年半後死 亡。副甲狀腺腺癌在診斷上十分不容易,若在超音波見有不規則邊緣、沾粘到 附近器官,使邊緣模糊或直接侵犯,可供術前懷疑為副甲狀腺腺癌之參考。病 理學方面以厚的纖維性包膜(capsule)及有絲分裂(mitosis),有血管及包膜侵 襲性,及壞死組織,則應高度懷疑為惡性病灶,應做en block手術。當有懷疑 腺癌病變時不宜做細針穿刺及冰凍切片來做診斷,以免造成腺癌轉移及復發; 若有術後復發 ,宜再做廣泛的病灶及淋巴腺切除。早期診斷出甲狀腺腺癌及術 中完整切除腫瘤是決定預後之重要關鍵。 |
英文摘要 | A 74 year-old man was admitted to our hospital with complaints of body weight loss (8-12kg) within two months, nausea, vomits, general weakness, headache, constipation and abdominal fullness. Physical examination revealed a palpable mass over his right neck. Laboratory examination showed increased serum calcium and parathormone. The Thallium-201, Technetium-99 subtraction scan(Tl-Tc scan) showed parathyroid tumor. The patient underwent total thyroidectomy and right parathroidectomy for hypercalcemia crisis. During the operation, the invasion of thyroid gland and esophagus was found. The pathologic diagnosis was parathyroid carcinoma. General condition improved soon after this operation. The resection of left thyroid gland and tumor was performed for recurrence of the tumor after ten months. Then chemotherapy and calcitonin were given to him. Lung metastasis and massive right pleura effusion was found one year later. Unfortunately, The patient expired after 1.5 years. Initial preoperation study for malignancy should be considered when ultrasonography demonstrates signs of gross invasion and marked irregularity of tumor margin. The pathological criteria for malignancy are invasion of surrounding tissues, capsular invasion, dense fibrous septae, vascular or lymphatic metastasis, the presence of mitotic figures and visceral metastasis. Needle biopsy and frozen section should not be performed prior a confirmed diagnosis of parathyroid carcinoma since that will cause metastases. It can be effectively treated by en-block resection. An aggressive surgical approach for recurrent lesion and lymph nodes was considered if recurrence found. A favorable prognosis can be anticipated if early diagnosis was made and en block section was performed. (J Intem Med Taiwan 1998;9:148-152) |
本系統中英文摘要資訊取自各篇刊載內容。