目的 总结无症状甲状旁腺腺瘤(parathyroid adenoma,PA)合并甲状腺乳头状癌(pillary thyroid carcinoma,PTC)的主要特征,以提高两病并存时的诊断水平。方法 回顾分析新疆医科大学附属肿瘤医院2005-01至2014-12诊断的12例无症状PA合并PTC患者一般资料及病理组织形态学特点。结果 12例中,2例血清钙和血清甲状旁腺素(parathyroid hormone ,PTH)增高、 血清磷降低。PA镜下实质细胞由主细胞、嗜酸性细胞混合组成。瘤细胞排列成巢状、片状或囊状,核稍大,偶见核分裂象。肿瘤均包膜完整,未见坏死。免疫组化表型所有 12 例PA 病例CK19、PTH、嗜铬粒素A(CgA)均为阳性;甲状腺转录因子-1(TTF-1),甲状腺球蛋白(TG),降钙素均为阴性,Ki-67阳性指数 ＜3%。结论 无症状PA合并PTC临床上比较少见,术前应仔细检查,排除两病共存的情况,避免遗漏。术中有必要行冷冻病理切片检查,而且还应与甲状旁腺癌、PTC等肿瘤鉴别。
Abstract
Objective To improve the diagnosis of parathyroid adenoma by exploring the clinic and pathological manifestations of papillary thyroid carcinoma complicated with asymptomatic parathyroid adenoma.Methods The clinical data and histopathological features of twelve patients who had been diagnosed with PTC and PA in the Affiliated Tumor Hospital to Xinjiang Medical University between January 2005 and December 2014 were retrospectively analyzed.Results Two of the twelve cases suffered from hypercalcemia, increased serum parathyroid hormone(PTH) and hypophosphatemia. Histological examination of PA showed that tumor cells consisted of principal cells and eosinophilic cytoplasm. The tumor cells were nest-like, lamellar or cystic. All of them had intact fibrous capsules. Mitotic figures were rarely encountered and tumor necrosis was absent. Immunohistochemical study showed that the tumor cells in PA were positive(12/12) for CK19, chromogranin A and parathyroid hormone, but were negative for thyroglbulin, TTF-1 and calcitonin. The Ki-67 index was less than 3%.Conclusions The concurrence of PTC and PA is rare.For the coexistence of complex lesions of PA and PTC, preoperative imaging diagnosis is more difficult. Careful preoperative examination is required to rule out the coexistence of the two diseases.
关键词
甲状旁腺腺瘤 /
甲状腺乳头状癌 /
无症状
Key words
parathyroid adenoma /
papillary thyroid carcinoma /
asymptomatic
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