副甲状腺癌の1例
症例は84歳，女性．倦怠感を自覚し，前医で高Ca血症，intact-PTH高値を指摘され，精査加療目的に当院に紹介となった．頸部超音波エコーで甲状腺右葉下極背側に1.4×1.4×1.9cm大で形状不整，境界明瞭，内部エコーは低～等で不均質な腫瘤を認め，D/W比が1.03であり，右下副甲状腺癌の可能性を考えた．術中所見で，腫瘤が硬く甲状腺との境界が不明瞭で剥離に難渋したため副甲状腺癌を強く疑い，甲状腺右葉部分切除を伴う右下副甲状腺切除術，II・右IIIリンパ節郭清を施行した．最終病理組織診断では副甲状腺癌（pT1N0M0）と診断された．現在術後4カ月であるが，再発は認めていない．副甲状腺癌は原発...
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| Published in | 日本臨床外科学会雑誌 Vol. 86; no. 2; pp. 227 - 233 |
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| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.86.227 |
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| Abstract | 症例は84歳，女性．倦怠感を自覚し，前医で高Ca血症，intact-PTH高値を指摘され，精査加療目的に当院に紹介となった．頸部超音波エコーで甲状腺右葉下極背側に1.4×1.4×1.9cm大で形状不整，境界明瞭，内部エコーは低～等で不均質な腫瘤を認め，D/W比が1.03であり，右下副甲状腺癌の可能性を考えた．術中所見で，腫瘤が硬く甲状腺との境界が不明瞭で剥離に難渋したため副甲状腺癌を強く疑い，甲状腺右葉部分切除を伴う右下副甲状腺切除術，II・右IIIリンパ節郭清を施行した．最終病理組織診断では副甲状腺癌（pT1N0M0）と診断された．現在術後4カ月であるが，再発は認めていない．副甲状腺癌は原発性副甲状腺機能亢進症のうち5％以下とされており，比較的稀な疾患である．稀少さゆえに，病期分類について国際的に標準化が進められている段階である．今回，術前および術中に副甲状腺癌を疑って治療を行い，最終的に副甲状腺癌と診断された症例を経験したので報告する． |
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| AbstractList | 症例は84歳，女性．倦怠感を自覚し，前医で高Ca血症，intact-PTH高値を指摘され，精査加療目的に当院に紹介となった．頸部超音波エコーで甲状腺右葉下極背側に1.4×1.4×1.9cm大で形状不整，境界明瞭，内部エコーは低～等で不均質な腫瘤を認め，D/W比が1.03であり，右下副甲状腺癌の可能性を考えた．術中所見で，腫瘤が硬く甲状腺との境界が不明瞭で剥離に難渋したため副甲状腺癌を強く疑い，甲状腺右葉部分切除を伴う右下副甲状腺切除術，II・右IIIリンパ節郭清を施行した．最終病理組織診断では副甲状腺癌（pT1N0M0）と診断された．現在術後4カ月であるが，再発は認めていない．副甲状腺癌は原発性副甲状腺機能亢進症のうち5％以下とされており，比較的稀な疾患である．稀少さゆえに，病期分類について国際的に標準化が進められている段階である．今回，術前および術中に副甲状腺癌を疑って治療を行い，最終的に副甲状腺癌と診断された症例を経験したので報告する． |
| Author | 吉本 皓一 澁谷 祐一 大石 一行 |
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| Copyright | 2025 日本臨床外科学会 |
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| References | 7) Holmes EC, Morton DL, Ketcham AS : Parathyroid carcinoma : a collective review. Ann Surg 1969 ; 169 : 631-640 30) Rozhinskaya L, Pigarova E, Sabanova E, et al : Diagnosis and treatment challenges of parathyroid carcinoma in a 27-year-old woman with multiple lung metastases. Endocrinol Diabetes Metab Case Rep 2017 ; 2017 : 16-0113. doi : 10.1530/EDM-16-0113 31) Kang H, Pettinga D, Schubert AD, et al : Genomic profiling of parathyroid carcinoma reveals genomic alterations suggesting benefit from therapy. Oncologist 2019 ; 24 : 791-797 10) Mazzeo S, Cappelli C, Caramella D, et al : Multidetector CT in diagnostic work-up of patients with primary hyperparathyroidism. Radiol Med 2007 ; 112 : 763-775 9) Hara H, Igarashi A, Yano Y, et al : Ultrasonographic features of parathyroid carcinoma. Endocr J 2001 ; 48 : 213-217 24) Flye MW, Brennan MF : Surgical resection of metastatic parathyroid carcinoma. Ann Surg 1981 ; 193 : 425-435 8) 日本乳腺甲状腺超音波医学会 甲状腺用語診断基準委員会/編:甲状腺超音波診断ガイドブック［改訂第3版］．南江堂，東京，2016 18) Borel P, Caillaud D, Cano NJ : Vitamin D bioavailability : State of the art. Crit Rev Food Sci Nutr 2015 ; 55 : 1193-1205 25) Munson ND, Foote RL, Northcutt RC, et al : Parathyroid carcinoma : is there a role for adjuvant radiation therapy? Cancer 2003 ; 98 : 2378-2384 19) Imanishi Y, Inaba M, Kawata T, et al : Animal models of hyperfunctioning parathyroid diseases for drug development. Expert Opin Drug Discov 2009 ; 4 : 727-740 32) Kutahyalioglu M, Nguyen HT, Kwatampora L, et al : Genetic profiling as a clinical tool in advanced parathyroid carcinoma. J Cancer Res Clin Oncol 2019 ; 145 : 1977-1986 3) Sadler C, Gow KW, Beierle EA, et al : Parathyroid carcinoma in more than 1,000 patients : A population-level analysis. Surgery 2014 ; 156 : 1622-1629 5) Shane E, Bilezikian JP : Parathyroid carcinoma : a review of 62 patients. Endocr Rev 1982 ; 3 : 218-226 4) Quinn CE, Healy J, Lebastchi AH, et al : Modern experience with aggressive parathyroid tumors in a high-volume New England referral center. J Am Coll Surg 2015 ; 220 : 1054-1062 12) Agarwal G, Dhingra S, Mishra SK, et al : Implantation of parathyroid carcinoma along fine needle aspiration track. Langenbecks Arch Surg 2006 ; 391 : 623-626 23) Obara T, Okamoto T, Ito Y, et al : Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 1993 ; 114 : 1040-1049 1) 杉本利嗣:原発性副甲状腺機能亢進症．日内会誌 2007;96:662-668 16) Erickson LA, Mete O, Juhlin CC, et al : Overview of the 2022 WHO Classification of Parathyroid Tumors. Endocr Pathol 2022 ; 33 : 64-89 17) Williams MD, Erickson DR, Gupta R, et al : Pathology data set for reporting parathyroid carcinoma and atypical parathyroid neoplasm : recommendations from the International Collaboration on Cancer Reporting. Hum Pathol 2021 ; 110 : 73-82 6) Wynne AG, van Heerden J, Carney JA, et al : Parathyroid carcinoma : clinical and pathologic features in 43 patients. Medicine (Baltimore) 1992 ; 71 : 197-205 13) Schantz A, Castleman B : Parathyroid carcinoma. A study of 70 cases. Cancer 1973 ; 31 : 600-605 2) Obara T, Fujimoto Y : Diagnosis and treatment of patients with parathyroid carcinoma : an update and review. World J Surg 1991 ; 15 : 738-744 20) Khan AA, Hanley DA, Rizzoli R, et al : Primary hyperparathyroidism : review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int 2017 ; 28 : 1-19 29) 榎本圭佑，島津宏樹，長井美樹他:副甲状腺癌の遺伝子解析とCetuximab・Docetaxel・S-1を用いた治療経験．日内分泌・甲状腺外会誌 2014;31:232-237 28) 島根俊和，森 智昭，小野智裕他:Docetaxel投与でQOLを維持できた頭頸部腺癌の3例．癌と化療 2010;37:2897-2900 11) Randall GJ, Zald PB, Cohen JI, et al : Contrast-enhanced MDCT characteristics of parathyroid adenomas. AJR Am J Roentgenol 2009 ; 193 : W139-143 15) Iacobone M, Lumachi F, Favia G : Up-to-date on parathyroid carcinoma : analysis of an experience of 19 cases. J Surg Oncol 2004 ; 88 : 223-228 22) Asare EA, Sturgeon C, Winchester DJ, et al : Parathyroid carcinoma : an update on treatment outcomes and prognostic factors from the National Cancer Data Base (NCDB). Ann Surg Oncol 2015 ; 22 : 3990-3995 27) Ordoñez NG, Ibañez ML, Samaan NA, et al : Immunoperoxidase study of uncommon parathyroid tumors. Report of two cases of nonfunctioning parathyroid carcinoma and one intrathyroid parathyroid tumor-producing amyloid. Am J Surg Pathol 1983 ; 7 : 535-542 21) Perrier ND, Arnold A, Costa-Guda J, et al : New and future perspectives for parathyroid carcinoma. Endocr Relat Cancer 2020 ; 27 : T53-T63 26) Busaidy NL, Jimenez C, Habra MA, et al : Parathyroid carcinoma : a 22-year experience. Head Neck 2004 ; 26 : 716-726 14) Levin KE, Galante M, Clark OH : Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 1987 ; 101 : 649-660 |
| References_xml | – reference: 10) Mazzeo S, Cappelli C, Caramella D, et al : Multidetector CT in diagnostic work-up of patients with primary hyperparathyroidism. Radiol Med 2007 ; 112 : 763-775 – reference: 16) Erickson LA, Mete O, Juhlin CC, et al : Overview of the 2022 WHO Classification of Parathyroid Tumors. Endocr Pathol 2022 ; 33 : 64-89 – reference: 18) Borel P, Caillaud D, Cano NJ : Vitamin D bioavailability : State of the art. Crit Rev Food Sci Nutr 2015 ; 55 : 1193-1205 – reference: 32) Kutahyalioglu M, Nguyen HT, Kwatampora L, et al : Genetic profiling as a clinical tool in advanced parathyroid carcinoma. J Cancer Res Clin Oncol 2019 ; 145 : 1977-1986 – reference: 17) Williams MD, Erickson DR, Gupta R, et al : Pathology data set for reporting parathyroid carcinoma and atypical parathyroid neoplasm : recommendations from the International Collaboration on Cancer Reporting. Hum Pathol 2021 ; 110 : 73-82 – reference: 31) Kang H, Pettinga D, Schubert AD, et al : Genomic profiling of parathyroid carcinoma reveals genomic alterations suggesting benefit from therapy. Oncologist 2019 ; 24 : 791-797 – reference: 28) 島根俊和，森 智昭，小野智裕他:Docetaxel投与でQOLを維持できた頭頸部腺癌の3例．癌と化療 2010;37:2897-2900 – reference: 2) Obara T, Fujimoto Y : Diagnosis and treatment of patients with parathyroid carcinoma : an update and review. World J Surg 1991 ; 15 : 738-744 – reference: 9) Hara H, Igarashi A, Yano Y, et al : Ultrasonographic features of parathyroid carcinoma. Endocr J 2001 ; 48 : 213-217 – reference: 20) Khan AA, Hanley DA, Rizzoli R, et al : Primary hyperparathyroidism : review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int 2017 ; 28 : 1-19 – reference: 6) Wynne AG, van Heerden J, Carney JA, et al : Parathyroid carcinoma : clinical and pathologic features in 43 patients. Medicine (Baltimore) 1992 ; 71 : 197-205 – reference: 5) Shane E, Bilezikian JP : Parathyroid carcinoma : a review of 62 patients. Endocr Rev 1982 ; 3 : 218-226 – reference: 27) Ordoñez NG, Ibañez ML, Samaan NA, et al : Immunoperoxidase study of uncommon parathyroid tumors. Report of two cases of nonfunctioning parathyroid carcinoma and one intrathyroid parathyroid tumor-producing amyloid. Am J Surg Pathol 1983 ; 7 : 535-542 – reference: 4) Quinn CE, Healy J, Lebastchi AH, et al : Modern experience with aggressive parathyroid tumors in a high-volume New England referral center. J Am Coll Surg 2015 ; 220 : 1054-1062 – reference: 3) Sadler C, Gow KW, Beierle EA, et al : Parathyroid carcinoma in more than 1,000 patients : A population-level analysis. Surgery 2014 ; 156 : 1622-1629 – reference: 11) Randall GJ, Zald PB, Cohen JI, et al : Contrast-enhanced MDCT characteristics of parathyroid adenomas. AJR Am J Roentgenol 2009 ; 193 : W139-143 – reference: 30) Rozhinskaya L, Pigarova E, Sabanova E, et al : Diagnosis and treatment challenges of parathyroid carcinoma in a 27-year-old woman with multiple lung metastases. Endocrinol Diabetes Metab Case Rep 2017 ; 2017 : 16-0113. doi : 10.1530/EDM-16-0113 – reference: 12) Agarwal G, Dhingra S, Mishra SK, et al : Implantation of parathyroid carcinoma along fine needle aspiration track. Langenbecks Arch Surg 2006 ; 391 : 623-626 – reference: 13) Schantz A, Castleman B : Parathyroid carcinoma. A study of 70 cases. Cancer 1973 ; 31 : 600-605 – reference: 15) Iacobone M, Lumachi F, Favia G : Up-to-date on parathyroid carcinoma : analysis of an experience of 19 cases. J Surg Oncol 2004 ; 88 : 223-228 – reference: 21) Perrier ND, Arnold A, Costa-Guda J, et al : New and future perspectives for parathyroid carcinoma. Endocr Relat Cancer 2020 ; 27 : T53-T63 – reference: 8) 日本乳腺甲状腺超音波医学会 甲状腺用語診断基準委員会/編:甲状腺超音波診断ガイドブック［改訂第3版］．南江堂，東京，2016 – reference: 14) Levin KE, Galante M, Clark OH : Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 1987 ; 101 : 649-660 – reference: 25) Munson ND, Foote RL, Northcutt RC, et al : Parathyroid carcinoma : is there a role for adjuvant radiation therapy? Cancer 2003 ; 98 : 2378-2384 – reference: 1) 杉本利嗣:原発性副甲状腺機能亢進症．日内会誌 2007;96:662-668 – reference: 19) Imanishi Y, Inaba M, Kawata T, et al : Animal models of hyperfunctioning parathyroid diseases for drug development. Expert Opin Drug Discov 2009 ; 4 : 727-740 – reference: 7) Holmes EC, Morton DL, Ketcham AS : Parathyroid carcinoma : a collective review. Ann Surg 1969 ; 169 : 631-640 – reference: 26) Busaidy NL, Jimenez C, Habra MA, et al : Parathyroid carcinoma : a 22-year experience. Head Neck 2004 ; 26 : 716-726 – reference: 24) Flye MW, Brennan MF : Surgical resection of metastatic parathyroid carcinoma. Ann Surg 1981 ; 193 : 425-435 – reference: 29) 榎本圭佑，島津宏樹，長井美樹他:副甲状腺癌の遺伝子解析とCetuximab・Docetaxel・S-1を用いた治療経験．日内分泌・甲状腺外会誌 2014;31:232-237 – reference: 22) Asare EA, Sturgeon C, Winchester DJ, et al : Parathyroid carcinoma : an update on treatment outcomes and prognostic factors from the National Cancer Data Base (NCDB). Ann Surg Oncol 2015 ; 22 : 3990-3995 – reference: 23) Obara T, Okamoto T, Ito Y, et al : Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 1993 ; 114 : 1040-1049 |
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| Title | 副甲状腺癌の1例 |
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