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29μ„Έ μ—¬μž ν™˜μžκ°€ μ œμ™•μ ˆκ°œλ₯Ό ν†΅ν•œ μΆœμ‚° 2μ£Ό ν›„λΆ€ν„° μ‹œμž‘λœ 엉덩이, ν—ˆλ¦¬, 닀리 λ“±μ˜ 톡증을 μ£Όμ†Œλ‘œ 개인 μ •ν˜•μ™Έκ³Όμ˜μ›μ—μ„œ MRI 촬영 ν›„ 골쒅양이 μ˜μ‹¬λœλ‹€κ³  ν•˜μ—¬ μ „μ›λ˜μ—ˆλ‹€. ν™˜μžλŠ” ν˜ˆμ•‘μ’…μ–‘λ‚΄κ³Όμ—μ„œ 검사λ₯Ό μ§„ν–‰ν•˜μ˜€κ³ , μ΄λΉ„μΈν›„κ³Όλ‘œ μ „κ³Όλ˜μ–΄ μˆ˜μˆ μ„ μ‹œν–‰ν•˜μ˜€λ‹€. λ‹€μŒμ€ ν™˜μžμ˜ 각쒅 검사 μ†Œκ²¬κ³Ό 수술 및 λ³‘λ¦¬μ†Œκ²¬μ΄λ‹€. 상기 ν™˜μžμ˜ μ§„λ‹¨μœΌλ‘œ μ μ ˆν•œ 것은?
kjorl-60-4-196i1.tif
Fig. 1. 18F-FDG PET-CT scan.
kjorl-60-4-196i2.tif
Fig. 2. Neck CT scan.
kjorl-60-4-196i3.tif
Fig. 3. Neck US.
kjorl-60-4-196i4.tif
Fig. 4. Bone scan 99mTc MIBI parathyroid scan.
Laboratory findings:
SAP 825 (35-104), Free T4 0.715 (0.93-1.71), TSH 1.70 (0.27-4.20), T3 1.12 (0.85-2.02),
Cacium 13.5 (8.6-10.2), ionized Ca 6.99 (4.48-4.92), i-PTH 1530.2 (14-72)
kjorl-60-4-196i5.tif
Fig. 5. Operative findings and pathologic findings.

μ •λ‹΅ 및 ν•΄μ„€

λ‹΅ 뢀갑상선암쒅(parathyroid carcinoma)으둜 μΈν•œ μ›λ°œμ„± 뢀갑상선기λŠ₯항진증(primary hyperparathyroidism) 및 κ°ˆμƒ‰μ’…μ–‘(brown tumor)
ν•΄μ„€ 뢀갑상선암쒅은 맀우 λ“œλ¬Έ μ’…μ–‘μœΌλ‘œ 40λŒ€μ— 많고 μ—¬μ„±μ—κ²Œ 많이 λ°œμƒν•œλ‹€. μž„μƒμ μœΌλ‘œλŠ” ν˜ˆμ€‘ 칼슘이 14 이상, λΆ€κ°‘μƒμ„ ν˜Έλ₯΄λͺ¬μ΄ 높은 μ •μƒκ°’μ˜ 3~10λ°° 이상, λ¦Όν”„μ ˆ 전이가 μ˜μ‹¬λ˜λŠ” μ˜μƒ μ†Œκ²¬, 갑상선 μΉ¨λ²” 및 μ„±λŒ€λ§ˆλΉ„, μ‹ μ§ˆν™˜, κ³¨μ§ˆν™˜μ΄ λ™λ°˜λ˜λŠ” κ²½μš°μ—λŠ” 암쒅을 μ˜μ‹¬ν•˜μ—¬μ•Ό ν•œλ‹€. μœ„ ν™˜μžλŠ” 갑상선에 침범이 있고 κ΄‘λ²”μœ„ν•œ κ°ˆμƒ‰μ’…μ–‘κ³Ό ν•¨κ»˜ λΆ€κ°‘μƒμ„ ν˜Έλ₯΄λͺ¬μ΄ 1500이 λ„˜μ–΄κ°€λŠ” 경우둜 λΆ€κ°‘μƒμ„ μ•”μ’…μœΌλ‘œ μ˜μ‹¬ν•˜μ˜€κ³ , κ°‘μƒμ„ μ—½μ ˆμ œμˆ κ³Ό ν•¨κ»˜ 쀑심 κ²½λΆ€λ¦Όν”„μ ˆ μ²­μ†Œμˆ μ„ μ‹œν–‰ν•˜μ˜€λ‹€.
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