Data Sheet 2_A patient with CKD complicated by secondary hyperparathyroidism and parathyroid carcinoma: a case report.pdf

BackgroundParathyroid carcinoma (PC) is a rare malignancy, representing approximately 0.005% of all malignant tumors. Currently, its etiopathogenesis, diagnostic criteria, and optimal management strategies remain poorly defined. Furthermore, the occurrence of PC in the context of secondary hyperparathyroidism (SHPT) is an infrequent clinical event. This report details a case of PC arising in a patient with chronic kidney disease (CKD) and SHPT.
Case presentationA 53-year-old male with severe renal failure was admitted for clinical evaluation. During the course of hospitalization, SHPT and PC were diagnosed based on clinical, biochemical, and imaging evaluations. Intraoperative pathological assessment confirmed the malignancy, necessitating radical resection with regional lymph node dissection. The patient has achieved a long term disease free survival exceeding 8 years after surgery.
ConclusionThe diagnosis of PC remains clinically challenging due to its rarity and the significant overlap in biochemical and imaging features with benign parathyroid lesions. This diagnostic challenge is further intensified in patients with severe renal insufficiency, as characteristic clinical indicators are often masked by comorbid secondary hyperparathyroidism. This report illustrates the diagnostic process and successful long-term management of PC in this challenging context, providing a clinical reference for the standardized treatment of this rare malignancy.

背景：甲状旁腺癌（Parathyroid carcinoma, PC）是一种罕见恶性肿瘤，约占所有恶性肿瘤的0.005%。目前，其发病机制、诊断标准及最优治疗策略仍尚未明确。此外，在继发性甲状旁腺功能亢进症（secondary hyperparathyroidism, SHPT）背景下发生的甲状旁腺癌属于罕见临床事件。本病例报告详述了1例慢性肾脏病（chronic kidney disease, CKD）合并继发性甲状旁腺功能亢进症患者罹患甲状旁腺癌的病例。
病例介绍：患者为53岁男性，因重度肾功能衰竭入院接受临床评估。住院期间，通过临床、生化及影像学检查确诊为继发性甲状旁腺功能亢进症合并甲状旁腺癌。术中病理评估证实为恶性肿瘤，遂需行根治性切除术联合区域淋巴结清扫术。患者术后无病生存期已长达8年以上。
结论：由于甲状旁腺癌发病率极低，且其生化及影像学特征与良性甲状旁腺病变存在显著重叠，因此临床诊断仍颇具挑战。在重度肾功能不全患者中，这一诊断难度进一步加剧——其特征性临床指标常因合并的继发性甲状旁腺功能亢进症而被掩盖。本病例报告详述了该复杂场景下甲状旁腺癌的诊断流程与成功的长期管理方案，可为这种罕见恶性肿瘤的标准化治疗提供临床参考。