The Clinical Analysis Of 29 Cases With Parathyroid Neoplasm And A Review Of Literature

Objective:To investigate the clinical features, diagnosis, treatment and prognosis of parathyroid neoplasm.Method:We retrospectively analyzed 29 cases of parathyroid neoplasms, including the clinical symptoms and signs, laboratory, pathologic and imaging results for diagnosis and treatment in the second affiliated hospital of Zhejiang University from January,2000 to March,2010.Results:The number of patients was 29, with males:females ratio being 1:1.1 and median age 41 years. There were 25 cases of parathyroid adenoma (86.2%),4 cases of parathyroid carcinoma (13.8%) in this study. The symptoms were as follows:11 cases of renal calculi,10 cases of skeleton pain and fatigue,9 cases of neck lump,3 cases of abdominal pain,1 case of dysphagia and dyspnoea,1 case of voice hoarseness,1 case of arrhythmia. Hyperparathyroidism was detected in 85% of them. Renal and skeletal involvement occurred in 56% and 32% respectively, while 12% of cases were mixed type. Serum calciumion and parathyroid hormone (PTH) levels were examined before operation. Ultrasonography, CT, MRI,99mTc—MIBI were used in locating parathyroid neoplasm before operation. All cases were treated with operation. Among 25 cases of parathyroid adenomas,19 cases received simple resections of tumors,5 plus thyroidectomy,1 plus partial resection of thyroid. All these patients achieved symptom remission. While 2 cases of them recurred 3,6 months after operation respectively. For 4 cases of parathyroid carcinomas, two were received radical resection (thyroid gland plus neck lymph node dissection), the others were simple parathyroidectomy. One patient survived 3 months without recurrence, while 2 cases recurred 6,18 months after operation respectively and died because of severe hypercalcemia after 14 and 23 months. Another patient lost follow-up.Conclusion:A possible parathyroid tumor should be highly suspected when a patient had reiterative renal calculi and skeleton pain with hypercalcemia. Detecting the level of serum calcium and PTH together with image examination is useful to confirm diagnose of parathyroid tumor before operation. Surgery is still the best treatment for patient with parathyroid tumor.