Paratiroid karsinomu: Olgu sunumu

Paratiroid karsinomları ender görülen endokrin malignitelerdendir. Hiperkalsemik kriz, peptik ülser, kemik hastalığı, renal taş oluşumu gibi kalsiyum metabolizma bozuklukları ile klinik verir. Ortalama görülme yaşı 45, erkek:kadın görülme oranı 0.8:1'dir. Olgu 46 yaşında, erkektir. Son bir senedir, boyunda giderek artan şişlik, yorgunluk, kas zayıflığı ve pelvik ağrı yakınması bulunmaktaydı. Serum kalsiyum düzeyi, 14.3 mg/dl, parathormon düzeyi (PTH) düzeyi 1606 pg/ml., kemik sintigrafisinde kondromalazi (bilateral patella) ve osteoblastik aktivite artışı saptanan olgunun, yapılan tiroid ultrasonografisinde "paratiroid adenomu" düşünülerek, kitle total olarak eksize edildi. Gönderilen materyal, 4.5x3x2.5 cm. boyutlarında, kapsüllü, solid, sert kıvamlı olup, kesit yüzü kirli-pembe, yer yer miksoid alanlar içermekte idi. Histopatolojik incelemede ise; üniform görünümde esas-hücrelerin kapsül ile ilişkili kalın fibröz bantlar ile bölündüğü saptandı. Hücrelerde trabeküler dizilim ve kapsül ve damar yapıları içerisinde tümör hücre grupları gözlendi. 50 büyük büyütme alanında 2 mitoz dikkat çekti. Paratiroid karsinomu tanısı alan olgu, onuncu ay sonundaki kontrolünde hastalıksız ve sağdır.

Parathyroid carcinoma: Case report

Parathyroid carcinomas are the least common endocrine malignancies, revealing with disorders of calcium metabolism, such as hypercalcemic crisis, bone disease, and renal calcinosis. The mean age of the individuals with parathyroid carcinoma is 45 years, while male:female ratio is 0,8:1. Our case was a 46 years old male. He was complaining of progressive neck mass, fatigue, muscle weakness and pelvic pain. He had a serum levels of calcium 14.3 mg/dL, parathyroid hormone (PTH) 1606 pg/mL, alkaline phosphatase 360 U/L. Bone scans were reported as chondromalasia (in bilateral patella) and increased osteoblastic activity, while thyroid ultrasound was reported as "parathyroid adenoma". The mass was excised totally under local anesthesia. Macroscopic appearance was as follows; 4.5x3x2.5 cm. in size, capsulated, solid and firm in consistency with a cross sectional area of dark-pink color and focal myxoid areas. Histopathologically, uniform chief-cell infiltration divided by thick bands associated with the capsule were seen. Tumor cells formed a neoplastic trabecular pattern and groups of neoplastic cells were observed within the capsule and vascular structures. Two mitosis per 50 high power fields were found. The diagnosis was assessed as parathyroid carcinoma and the patient is still disease-free on the tenth month of clinical follow-up period.

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Ege Tıp Dergisi-Cover
  • ISSN: 1016-9113
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1962
  • Yayıncı: Ersin HACIOĞLU
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