[Diagnosis and surgical treatment of 48 cases of parathyroid adenoma and parathyroid carcinoma]

Abstract

Objective: To summarize the experience in diagnosis and surgical treatment of parathyroid adenoma and carcinoma (PTA and PTC) in our department.

Methods: The clinical and pathological data of 48 cases admitted in our department from Jan 1995 to Dec 2005 were reviewed. Among the 48 cases, 46 cases were of parathyroid adenoma and 2 cases of parathyroid carcinoma. The average clinical history of the 48 cases was 3.65 +/- 2.83 years. The serum calcium and PTH levels were elevated in all the 48 cases. In 31 cases ultrasonographic results were consisted with that of 99mTc-MIBI scintigraphy. Unilateral neck exploration was performed in 18 cases and no case with post-operative tumor remnants was found. In other 13 cases bilateral exploration was performed but no one case was found to be tumor positive in the opposite side of the glands. Tumors resection was performed in all the 48 cases, among which in the 2 cases with PTC, ipsilateral thyroid lobe excision and modified neck dissection were also performed.

Results: Clinical symptoms of all the patients were relieved after operation. No recurrent case was found during the follow-up periods (from 1 month to 10 years). The average level of serum calcium and PTH declined significantly after operation. The post-operational serum calcium and PTH levels at 3 days after operation were even lower than normal. Transient post-operational hypocalcemia was found in almost all the patients. The serum calcium and PTH levels in all patients recovered to normal level within a periods from 1 week to 3 months after operation. The sensitivity and positive prediction value of localization methods were 97.0% and 94.1% of ultrasonography, respectively, and 100% and 97.3% of 99mTc-MIBI scintigraphy, respectively.

Conclusion: Patients with chronic bone diseases, repeatedly recurrent nephrolithiasis, peptic ulcer disease or pancreatitis should be regarded as suspicious cases of PTA and PTC, and serum calcium assay should be performed as a routine screening procedure. Serum calcium and PTH assays are both reliable methods for the diagnosis of PTA and PTC. A combination of ultrasonography and 99mTc-MIBI scintigraphy is sufficient for locating adenomas. Accompanied by intraoperative pathological examination, unilateral neck exploration is an acceptable approach for patients with definitely preoperative confirmed adenoma localization.