第十一节
甲状旁腺肿瘤

临床特征

甲状旁腺腺瘤和罕见的甲状旁腺腺癌在临床上可被误诊为甲状腺结节，大多数患者有高钙血症。其他甲状旁腺功能亢进的临床症状包括：慢性肾衰竭、囊性纤维性骨炎（棕色瘤）、血清碱性磷酸酶和甲状旁腺激素升高等 ^{［ 17 ］} 。

细胞形态学特征 ^{［ 17 , 48 ］}

· 细胞量丰富，细胞间互相黏附呈片状、索状，偶尔形成小腺泡结构（图2-76）；亦可见单个的细胞和裸核。

· 可见毛细血管，周边细胞排列成栅栏状。

· 细胞核呈圆形，染色质为粗颗粒状，核仁小或突出；局部可见轻度核多形性（图2-77）。

· 胞质较丰富，可呈细颗粒状（主细胞）或嗜酸性（嗜酸性粒细胞）。

· 无胶质。

鉴别诊断

甲状旁腺肿瘤经常会被误诊为甲状腺滤泡性肿瘤 ^{［ 49 , 50 ］} 。甲状腺滤泡性肿瘤细胞大小较甲状旁腺细胞大，一般缺乏多形性；无毛细血管；患者血钙正常；甲状腺球蛋白和TTF-1免疫组化染色为阳性，而甲状旁腺激素染色为阴性。

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