V.А. Chernyshev, Р.G. Khamidullin, А.N. Rudyk, М.А. Busygin, А.L. Kosova, G.А. Usmanova
Tatarstan Cancer Centr, Kazan
Chernyshev V.A. ― Cand. Med. Sc., cancer surgeon at Department of head and neck tumors in Tatarstan Cancer Center
29 Sibirsky Tract, Kazan, Russian Federation, 420029, tel. (843) 519-27-40, e-mail: vladcher@list.ru
Abstract
Goal of the study. The aim is to show the complexity of diagnosis and surgical treatment of patients with tumors of the parathyroid glands (PTG) in primary hyperparathyroidism (PHPT).
Materials and methods. The experience and retrospective evaluation of the treatment of 115 patients with tumors of PTG in PHPT in one of the major oncological clinics in Russia during the past 16 years is described in this article. There were 107 women (93%) and 8 men (7%). The age of the patients varied between 18 and 82 years and the average was 56.6±3.1 years. Based on the clinical manifestations of PHPT, these patients were divided into three groups: patients with severe PHPT (23 patients), with moderate to severe PHPT manifestations (45 patients) and with hormonally inactive tumors of PTG, which were accidentally revealed during the thyroid tumors operations (incidentalomas) (47 patients). The topical diagnostics of PTG tumors was mainly based on ultrasound data (64 patients), sestamibi scanning (in 53 patients), and less often (in 10 patients) ― on the data from CT of the neck and mediastinum (ectopic location of PTG adenomas). The removal of single PTG adenomas was performed in 44 patients, in 71 patients together with the removal of single adenomas or PTG cancer a thyroid resection was performed in connection with its tumor or nodal pathology (in 35 ― hemithyroidectomy, in 5 ― subtotal thyroidectomy, in 33 ― thyroidectomy). Ectopic mediastinal PTG tumors were removed from the cervical access in 14 patients, in one case a thoracotomy was performed, in the other ― videothoracoscopy.
Conclusions. 1) The clinical course of PHPT by over a half of the patients (68 of 115) is characterized by a large number of complicated forms (bone, kidney, and mixed). 2) In the recent years, due to the introduction of screening for hypercalcemia in patients with nodular thyroid pathology and tumor at TCC, the number of patients with laboratory PHPT and PTG incidentalomas (47 of 115) increased significantly. 3) Operational allowance for PGT tumors must be performed by an experienced surgeon in specialized head and neck tumors department, and / or by an endocrine surgeon with minimal complications (≤1%). 4) The success of the PGT tumors and PHPT treatment depends on the highly professional team of physicians: X-ray and laboratory diagnostics physician, histopathologist and surgeon. 5) In patients with multiple foci of skeletal system destruction and suspicion of bone metastases, the inspection of parathyroid hormone and blood calcium shall be included in the algorithm of the examination.
Key words: parathyroid adenoma, parathyroid cancer, primary hyperparathyroidism, hypercalcemia diagnostics, surgical treatment.