Ata Türker ARIKÖK, Gaye ŞEKER, Tevfik KÜÇÜKPINAR, Şahin KAHRAMANCA, Alper ÖZKARDEŞ, Mehmet KILIÇ

Paratiroid Kanseri: 4 Olgunun Sunumu

Amaç: Paratiroid kanseri nadir görülen bir endokrin tümördür. Bütün hiperparatiroidi olgularının %1 ile %5indegörüldüğü bildirilmiştir. Bu çalışmanın amacı, paratiroid kanseri tanısı alan olguları literatür ışığında tartışmaktır. Yöntem ve Gereçler: 2009 ile 2011 yılları arasında paratiroid kanseri tanısı alan 4 olgu incelendi. Hastalarınşikayetleri, preoperatif serum kalsiyum (Ca), parathormon (PTH), alkalen fosfataz (ALP) düzeyleri ve ultrasonografsonuçları ile yapılan ameliyat ve postoperatif patoloji sonuçları değerlendirildi.Bulgular: Olgularımızın preoperatif ortalama serum Ca düzeylerinin 16,7 mg/dL ve PTH düzeylerinin 1118 pg/ mL olduğu ve bunun primer hiperparatiroidi olgularına göre daha yüksek olduğu gözlendi. Ultrasonografde kanserşüphesi uyandıracak bulgular hastaların biri dışında diğerlerinde saptanmazken, intraoperatif olarak dört olgununbirinde reoperasyon ve üçünde paratiroid kanseri düşünülerek en bloc rezeksiyon yapılmış ve reoperasyona gerekkalmamıştır. Bu olguların mevcut takiplerinde nüks veya metastaz saptanmamıştır.Sonuç: Paratiroid kanseri tanısının preoperatif konulmasının çok zor olduğu bilinmektedir. En bloc rezeksiyon buolgular için en önemli kür şansı olduğundan, ultrasonografde heterojenite ve düzensiz kenarlar gözlenmesi kanserolasılığını desteklemekle beraber bunlar bulunmasa bile, preoperatif Ca, PTH ve ALP düzeylerinin primer hiper- paratiroidi olgularında gözlenenden yüksek olması, intraoperatif paratiroid bezinin büyük ve komşu dokulara invazy- on bulgularının saptanması durumunda paratiroid kanseri olasılığı akılda tutularak operasyon şekli planlanmalıdır.Paratiroid kanseri saptanan olgular, nüks ve metastaz açısından yakın Ca düzeyleri ile de takip edilmelidir.

Parathyroid cancer: Presentation of 4 cases

Aim: Parathyroid cancer is a rare endocrine malignancy. It accounts for 1% and 5% of patients with primary hyper- parathyroidism. Herein our objective is to discuss our patients with parathyroid cancer by reviewing the literature. Material and Method: We analyzed 4 patients with parathyroid cancer operated between 2009 and 2011. Thesymptoms, preoperative serum calcium (Ca), parathormone(PTH) and alkaline phosphatase (ALP) levels and ultra- sonographic fndings are evaluated together with operation and pathology results. Results: The average serum Ca and PTH levels were 16,7 mg/dL and 1118 pg/mL respectively and these resultswere higher than the levels seen in primary hyperparathyroidism. Neither ultrasonographic fndings were suspicousfor parathyroid cancer except in one patient. Reoperation in one patient, en bloc resection was performed to 3 of 4 patients regarding the possibility of parathyroid cancer intraoperatively and there was no need for second operation.There was no recurrences or metastasis in their follow up so far. Discussion: It is well known that it is diffcult to diagnose parathyroid cancer preoperatively. En bloc surgical resec- tion remains only the potantial curative treatment, despite the lack of ultrasonographic fndings such as heterogenityand irregular borders, preoperative high Ca, PTH and ALP levels than expected in primary hyperparathyroidism,intraoperatively large parathyroid tumor and invasion to adjacent structures fndings should arise high suspicion forcancer and operation should be performed according to this possibility. These patients should be closely followed upfor hypercalcemia, regarding recurrences and metastasis.

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