Male and female had the same risk to get PTC. The onset age was somewhat younger than that of PHPT. Most patients were bone-renal mixture type with severe symptoms. Serum calcernia were more than 3.5mmol/L. with high PTH level. Diagnosis of PTC mainly depended on operative findings. PTC was lobulated, hard mass,surrounded by a dense fibrous grayish-white capsule that adhered tenaciously to adjacent tissues. Frozen section was of little value in distinguishing malignant from benign disease. The histopathological features were not high specific.

All four glands should be explored during operation. When gross pathological findings suggested malignancy,lesion should be removed completely with ipsilateral thyroid-isthnus and any contiguous tissues adhered. Radical lymph node excision was also performed. Serum calcium and PTH level were monitored every three months. Recurrent carcinoma in neck was treated with wide excision of involved area. And accessible distant metastases were resected when possible. PTC was not a radiosensitive tumor. Chemotherapy had uncertain effect. PTC tended to recur locally, spread in neck, metastases via lymphatic and hematogenous routes. 

PTC was the tumor with relative low malignant potential. Diagnosis depended on intra-operative gross pathological findings. Frozen examination had little value. Early recognition and complete resection at initial operation carried the best prognosis. For recurrence or metastatic cases, surgical procedure was the primarily management. For very late cases, well control of hypercalcemia could prolong survival time.

参考译文

PTC 患者男女比例相当,平均发病年龄较PHPT轻,大多数患者为骨肾混合型,且症状较严重,不少患者可扪及颈部肿块。患者的血钙可高达3.5mmol/L以上,PTH 也明显增高。PTC 的诊断很大程度上依赖术中大体标本的判断,它呈分叶状,质地坚硬,大多有灰白色致密纤维样物与周围组织紧密粘连,很难分离。术中冷冻对鉴别甲状旁腺肿瘤的良恶性意义不大,镜下病理学检查的特异性不强。

手术要全面探查4个旁腺,切除肿瘤、患侧甲状腺叶至峡部及所有与肿瘤粘连的组织,彻底清扫颈部淋巴结。术后每3个月复查1次血钙及PTH。颈部复发的再次手术需广泛切除受累区域,远处转移要尽可能切除。PTC对放疗、化疗不敏感。它可局部复发、颈部播散,并通过淋巴和血运途径转移。

PTC是一种相对低度恶性的肿瘤。诊断是依靠术中大体标本得到的判断，冷冻价值不大。首次手术时的早期认识和彻底根治是影响预后最重要的影响因素。对复发或转移仍应积极手术,病程晚期也要尽力控制高血钙以延长生存期。

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