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Zheng VM, Fei Leong EK, Pinto D, Parameswaran R, Wu B, Tan NJH, Lee JWK. A Case of Parathyroid Carcinoma in Renal Hyperparathyroidism. Case Rep Oncol 2024; 17:283-290. [PMID: 38371168 PMCID: PMC10870123 DOI: 10.1159/000536444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Parathyroid carcinoma is a rare malignant endocrine tumor that is usually associated with primary hyperparathyroidism. The coexistence of parathyroid carcinoma and renal hyperparathyroidism is a rare phenomenon. Hence, we present a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Case Presentation Our patient is a 31-year-old woman with a past medical history of end-stage renal failure (ESRF), on hemodialysis for the past 18 years. She was referred by her nephrologist to the endocrine surgery department for consideration of parathyroidectomy in view of long-standing tertiary hyperparathyroidism complicated by hypercalcemia. Bedside ultrasonography scan (US) of the thyroid revealed three parathyroid glands and a hypoechoic right lower pole thyroid nodule with central calcification. Fine-needle aspiration cytology was performed for the suspected thyroid nodule on the same day, which eventually yielded a follicular lesion of undetermined significance. A right hemithyroidectomy and total parathyroidectomy with deltoid implantation was performed. Intraoperative exploration revealed that the thyroid nodule noted at initial US was found to be the right superior parathyroid gland invading into the right thyroid itself. The right superior parathyroid gland was excised en bloc with the right hemithyroidectomy. Post-operatively, the patient was hypocalcemic but was discharged well on post-operative day 5. Histopathological diagnosis of the right hemithyroidectomy specimen containing the right superior parathyroid gland was consistent with that of parathyroid carcinoma. Conclusion Parathyroid carcinoma is a rare entity that is difficult to diagnose. In patients with ESRF, the presence of concurrent tertiary hyperparathyroidism makes this even more challenging.
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Affiliation(s)
- Victoria Meijia Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Eugene Kwong Fei Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Diluka Pinto
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Rajeev Parameswaran
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, National University Hospital, Singapore, Singapore
- Department of Surgery, Alexandra Hospital, Singapore, Singapore
| | - Bingcheng Wu
- Department of Pathology, National University Hospital, Singapore, Singapore
| | | | - James Wai Kit Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, National University Hospital, Singapore, Singapore
- Department of Surgery, Alexandra Hospital, Singapore, Singapore
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Ivaniš S, Jovanović M, Dunđerović D, Zorić G, Odalović B, Slijepčević N, Taušanović K, Rovčanin B, Buzejić M, Vučen D, Stepanović B, Ilić J, Parezanović M, Marinković M, Stojanović M, Tošković A, Mojsić I, Živaljević V. Case presentation of the smallest non-functional parathyroid carcinoma and review of the literature. Eur Arch Otorhinolaryngol 2023; 280:5637-5647. [PMID: 37493843 DOI: 10.1007/s00405-023-08137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Non functional parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our case is an exception, because it was detected in early stage, with no local invasion present. We present a case of the smallest non-functional PC yet reported and review of the literature. CASE PRESENTATION A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1. CONCLUSION Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on.
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Affiliation(s)
- S Ivaniš
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.
| | - M Jovanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Dunđerović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - G Zorić
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Odalović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - N Slijepčević
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - K Taušanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Rovčanin
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Buzejić
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Vučen
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Stepanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - J Ilić
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Parezanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Marinković
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Stojanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - A Tošković
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - I Mojsić
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - V Živaljević
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
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Farrah JP, Zirgibel BJ, Worts PR, Zapata CA, Wong AM. Simultaneous Bilateral Quadriceps Tendon Rupture Secondary to Parathyroid Carcinoma: A Case Report. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202311000-00002. [PMID: 37938921 PMCID: PMC10631610 DOI: 10.5435/jaaosglobal-d-23-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/15/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023]
Abstract
Simultaneous bilateral quadriceps tendon ruptures are a rare occurrence commonly associated with a traumatic event or systemic disease. A 31-year-old man presented with simultaneous bilateral quadriceps tendon ruptures with associated hyperparathyroidism secondary to parathyroid carcinoma. The injury occurred after the patient attempted to lift a small wooden log from the ground. We discussed the multidisciplinary management of this patient resulting in bilateral quadriceps tendon repairs, tumor resection, and oncological and endocrinological restoration. Clinical follow-up is reported at 15 years after surgery. Parathyroid carcinoma is an extremely rare cancer and rarely the cause of hyperparathyroidism. The systemic effects of the tumor eventually lead to the rupturing of both quadriceps tendons. Orthopaedic physicians must remain vigilant in identifying the root cause of injuries that are atypical in nature.
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Affiliation(s)
- Jason P. Farrah
- From the Ocala Health Trauma, Ocala Regional Medical Center, Ocala, FL (Dr. Farrah); the Department of Surgery, University of South Florida College of Medicine, Tampa, FL (Dr. Farrah); the Department of Surgery, University of Central Florida College of Medicine, Orlando, FL (Dr. Farrah); the Tallahassee Orthopedic Clinic, Tallahassee, FL (Dr. Zirgibel, Dr. Worts, and Dr. Wong); the Department of Clinical Sciences (Dr. Zirgibel and Dr. Wong); the Department of Nutrition and Integrative Physiology, The Florida State University, Tallahassee, FL (Dr. Worts); the Institute of Sports Sciences and Medicine, The Florida State University, Tallahassee, FL (Dr. Worts); and the Northwest Florida Diagnostic Endocrinology, Tallahassee, FL (Dr. Zapata)
| | - Brian J. Zirgibel
- From the Ocala Health Trauma, Ocala Regional Medical Center, Ocala, FL (Dr. Farrah); the Department of Surgery, University of South Florida College of Medicine, Tampa, FL (Dr. Farrah); the Department of Surgery, University of Central Florida College of Medicine, Orlando, FL (Dr. Farrah); the Tallahassee Orthopedic Clinic, Tallahassee, FL (Dr. Zirgibel, Dr. Worts, and Dr. Wong); the Department of Clinical Sciences (Dr. Zirgibel and Dr. Wong); the Department of Nutrition and Integrative Physiology, The Florida State University, Tallahassee, FL (Dr. Worts); the Institute of Sports Sciences and Medicine, The Florida State University, Tallahassee, FL (Dr. Worts); and the Northwest Florida Diagnostic Endocrinology, Tallahassee, FL (Dr. Zapata)
| | - Phillip R. Worts
- From the Ocala Health Trauma, Ocala Regional Medical Center, Ocala, FL (Dr. Farrah); the Department of Surgery, University of South Florida College of Medicine, Tampa, FL (Dr. Farrah); the Department of Surgery, University of Central Florida College of Medicine, Orlando, FL (Dr. Farrah); the Tallahassee Orthopedic Clinic, Tallahassee, FL (Dr. Zirgibel, Dr. Worts, and Dr. Wong); the Department of Clinical Sciences (Dr. Zirgibel and Dr. Wong); the Department of Nutrition and Integrative Physiology, The Florida State University, Tallahassee, FL (Dr. Worts); the Institute of Sports Sciences and Medicine, The Florida State University, Tallahassee, FL (Dr. Worts); and the Northwest Florida Diagnostic Endocrinology, Tallahassee, FL (Dr. Zapata)
| | - Carlos A. Zapata
- From the Ocala Health Trauma, Ocala Regional Medical Center, Ocala, FL (Dr. Farrah); the Department of Surgery, University of South Florida College of Medicine, Tampa, FL (Dr. Farrah); the Department of Surgery, University of Central Florida College of Medicine, Orlando, FL (Dr. Farrah); the Tallahassee Orthopedic Clinic, Tallahassee, FL (Dr. Zirgibel, Dr. Worts, and Dr. Wong); the Department of Clinical Sciences (Dr. Zirgibel and Dr. Wong); the Department of Nutrition and Integrative Physiology, The Florida State University, Tallahassee, FL (Dr. Worts); the Institute of Sports Sciences and Medicine, The Florida State University, Tallahassee, FL (Dr. Worts); and the Northwest Florida Diagnostic Endocrinology, Tallahassee, FL (Dr. Zapata)
| | - Andrew M. Wong
- From the Ocala Health Trauma, Ocala Regional Medical Center, Ocala, FL (Dr. Farrah); the Department of Surgery, University of South Florida College of Medicine, Tampa, FL (Dr. Farrah); the Department of Surgery, University of Central Florida College of Medicine, Orlando, FL (Dr. Farrah); the Tallahassee Orthopedic Clinic, Tallahassee, FL (Dr. Zirgibel, Dr. Worts, and Dr. Wong); the Department of Clinical Sciences (Dr. Zirgibel and Dr. Wong); the Department of Nutrition and Integrative Physiology, The Florida State University, Tallahassee, FL (Dr. Worts); the Institute of Sports Sciences and Medicine, The Florida State University, Tallahassee, FL (Dr. Worts); and the Northwest Florida Diagnostic Endocrinology, Tallahassee, FL (Dr. Zapata)
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Shi C, Lu N, Yong YJ, Chu HD, Xia AJ. Parathyroid carcinoma: Three case reports. World J Clin Cases 2023; 11:5934-5940. [PMID: 37727485 PMCID: PMC10506032 DOI: 10.12998/wjcc.v11.i25.5934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is a rare, slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid, with a highly variable clinical course, depending on the aggressiveness of the individual tumor and the degree of hypercalcemia. CASE SUMMARY The aim of this report is to summarize the diagnosis and treatment of three cases of PC and to review and conclude aspects regarding the three collected cases with reference to other relevant cases to explore the value of ultrasound in the diagnosis of PC. All three patients had hypercalcemia, consisting of a high serum calcium level and a high level of parathyroid hormone that was > 2-fold (even > 30-fold) of the normal upper limit. The ultrasonographic findings of the parathyroid gland showed that the glands were all > 30 mm, and the internal echo was uneven. All patients underwent surgery. PC in three cases was confirmed by routine histopathology and immunohistochemistry. CONCLUSION As clinical signs and laboratory results are nonspecific, it is difficult to diagnose PC preoperatively, so imaging examinations are often needed.
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Affiliation(s)
- Ce Shi
- Department of Ultrasound, Yantaishan Hospital, Yantai 264003, Shandong Province, China
| | - Ning Lu
- Department of Pathology, Yantaishan Hospital, Yantai 264003, Shandong Province, China
| | - Yan-Jie Yong
- Department of Ultrasound, Yantaishan Hospital, Yantai 264003, Shandong Province, China
| | - Hai-Di Chu
- Department of Thyroid Surgery, Yantaishan Hospital, Yantai 264003, Shandong Province, China
| | - Ai-Jun Xia
- Department of Ultrasound, Yantaishan Hospital, Yantai 264003, Shandong Province, China
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Sigdel B, Pokhrel A, Sabin KC. A parathyroid carcinoma mimicking thyroid carcinoma; A case report. Int J Surg Case Rep 2022; 92:106874. [PMID: 35276432 PMCID: PMC8917302 DOI: 10.1016/j.ijscr.2022.106874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Parathyroid carcinoma is an extremely rare endocrine neoplasm. Most of the patients present with severe hyperparathyroidism with altered serum calcium levels. Case presentation We describe a patient who presented with a neck mass and secondary hyperparathyroidism Ultrasound (USG) suggested a tumor located near the lower pole of the thyroid gland. USG guided FNAC suggested parathyroid neoplasm. CT scan showed tumor infiltration of the parathyroid gland. The patient underwent total resection of the tumor along with total thyroidectomy and right central compartment clearance. The biopsy of the mass confirmed the parathyroid carcinoma infiltrating the thyroid gland. Clinical discussion Parathyroid carcinoma is a rare endocrine carcinoma. Due to its location, it is often misdiagnosed as thyroid carcinoma. It can present with problems related to bones, kidney stones, psychiatric problems and many others. Serum calcium, Parathormone level, Ultrasound neck, CT scan and MIBI scan are the imaging study for early diagnosis of Parathyroid carcinoma. Complete removal of tumor followed by regular follow up with serum calcium and Parathormone level will help to improve the survival of Patient. Conclusion Diagnosis of parathyroid carcinoma is very challenging due to the limited contribution of imaging. It mimics thyroid carcinoma due to the origin of the tumor from the lower pole of the thyroid area. It is extremely important for suspicion of parathyroid tumor in case of neck mass who have an abnormality in serum calcium and parathormone level. Total resection of the tumor with a negative margin is important to control hyperparathyroidism and increase the survival. Parathyroid carcinoma is an extremely rare but aggressive type of cancer. Untreated, parathyroid carcinoma leads to severe life-threatening hyperparathyroidism. Diagnosis of parathyroid carcinoma is usually difficult prior to surgery. USG neck, CT scan and MIBI scan helps in early identification of Parathyroid neoplasm. Parathyroid carcinoma had propensity to infiltrate locally to thyroid gland and mimicking thyroid carcinoma. Radical excision is the best mode of cure of cancer and Subtotal parathyroidectomy is required to control secondary hyperparathyroidism. Chance of recurrence after removal of the tumor is common.
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Affiliation(s)
- Brihaspati Sigdel
- Department of Otolaryngology & Head and Neck Surgery, Gandaki Medical College, Pokhara, Nepal; Metrocity Hospital, Pokhara, Nepal.
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Giant parathyroid tumours in primary hyperparathyroidism: a systematic review. Langenbecks Arch Surg 2022; 407:501-516. [PMID: 35039921 DOI: 10.1007/s00423-021-02406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Giant parathyroid adenoma (GPA) can present with severe biochemical derangement similar to the clinical presentation of parathyroid carcinoma (PC). This study aims to present the current evidence on surgical management of GPAs in primary hyperparathyroidism. METHODS A systematic review of the literature on GPAs was conducted following the PRISMA guidelines. Data on clinical, biochemical, preoperative diagnostic, and surgical methods were analysed. RESULTS Sixty-one eligible studies were included reporting on 65 GPAs in eutopic, ectopic mediastinal, and intrathyroidal locations (61.5%, 30.8%, and 7.7%, respectively). A palpable neck mass was present in 58% of GPAs. A total of 90% of patients had symptoms including fatigue, skeletal pain, pathological fracture, nausea, and abdominal pain. Ninety percent of patients had significant hypercalcaemia (mean 3.51 mmol/L; range: 2.59-5.74 mmol/L) and hyperparathyroidism with PTH levels on average 14 times above the upper limit of the normal reference. There was no correlation between the reported GPA size and PTH nor between GPA weight and PTH (p = 0.892 and p = 0.363, respectively). Twenty-four percent had a concurrent thyroidectomy for suspicious features, intrathyroidal location of GPA, or large goitre. Immunohistochemistry such as Ki-67, parafibromin, and galectin-3 was used in 18.5% of cases with equivocal histology. Ninety-five percent of GPAs were benign with 5% reported as atypical adenomas. CONCLUSION The reported data on GPAs are sparse and heterogeneous. In GPAs with suspicious features for malignancy, en bloc resection with concurrent thyroidectomy may be considered. In the presence of equivocal histological features, ancillary immunohistochemistry is advocated to differentiate GPAs from atypical adenomas and PCs.
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Tremolada G, Schaffer P, Pitt K. Non‐secreting parathyroid carcinoma in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Giovanni Tremolada
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Ohio State University Columbus Ohio USA
- Flint Animal Cancer Centre College of Veterinary Medicine and Biological Sciences Colorado State University Fort Collins Colorado USA
| | - Paula Schaffer
- Veterinary Diagnostic Laboratory Department of Microbiology, Immunology and Pathology College of Veterinary Medicine and Biological Sciences Colorado State University Fort Collins Colorado USA
| | - Kathryne Pitt
- Flint Animal Cancer Centre College of Veterinary Medicine and Biological Sciences Colorado State University Fort Collins Colorado USA
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Bollen H, Decallonne B, Nuyts S. Radiation Treatment for Inoperable Local Relapse of Parathyroid Carcinoma With Symptomatic Hypercalcemia: A Case Report. Front Oncol 2021; 11:733772. [PMID: 34900684 PMCID: PMC8656308 DOI: 10.3389/fonc.2021.733772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/10/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is an extremely rare malignancy, characterized by slow progression, frequent recurrences and difficult-to-control hypercalcemia which is typically the main contributor to the morbidity and mortality of these patients. Patients often undergo repeated surgical resections, whether or not in combination with adjuvant radiation treatment. The role of radiation therapy within the symptomatic treatment of PC currently remains unclear. CASE DESCRIPTION We describe a 30-year-old male patient with an inoperable local relapse of PC and secondary symptomatic hypercalcemia, maximally pharmacologically treated. After a local radiation treatment to a total dose of 70 Gray in 35 fractions serum calcium and parathyroid hormone (PTH) levels decreased, accompanied by improvement of the severe gastro-intestinal disturbances. CONCLUSION For patients with inoperable symptomatic PC despite maximal medical treatment who are in a good overall condition, radiation treatment can be considered in well-defined cases to decrease symptoms and improve quality of life.
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Affiliation(s)
- Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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De Pasquale L, Bulfamante AM, Felisati G, Castellani L, Ghilardi G, Saibene AM. Management and Outcome of Parathyroid Carcinoma-Induced Primary Hyperparathyroidism: A Single-Centre Experience. Int J Endocrinol 2021; 2021:5397941. [PMID: 34659402 PMCID: PMC8516565 DOI: 10.1155/2021/5397941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is the rarest endocrine cancer and an infrequent cause of primary hyperparathyroidism (PHPT), responsible for less than 1% of cases. Due to its rarity, treatment is challenging. METHODS A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. We identified and individually described the patients affected with PC. Then, we split all patients treated for PHPT into four groups based on the cause: PC, adenoma, atypical adenoma, and hyperplasia. Patients' demographics, preoperative evaluation results, intraoperative findings, and outcomes for the PC group were compared with groups of PHPT due to benign causes. RESULTS Eight cases of PC were identified, five males and three females. Seven cases presented with symptoms of hypercalcemia and one with a neck mass. Five underwent en bloc resections and three local excisions. Histopathological features showed capsular invasion in four patients, capsular and soft tissue invasion in three patients, and vascular invasion in one case. No patients had distant metastasis. One patient was classed as high risk based on the Schulte classification system. All patients treated for PC were alive and disease-free at a mean follow-up of 38.4 months. When compared with other PHPT patients, PC patients were more frequently male and had higher preoperative blood calcium and PTH and lower phosphate levels, larger and heavier parathyroids excised, lower postoperative calcium, and a higher rate of postoperative hypoparathyroidism. CONCLUSION Our study highlights some aspects valuable to suspect PC and differentiate PHPT-PC from benign causes of PHPT preoperatively. Preoperative suspicion of malignancy is essential to guarantee the best course of treatment for patients. Although limited for size and follow-up, the excellent outcome of our series seems to support the value of both surgery extension and risk class according to the Schulte classification as possible prognostic factors for recurrence.
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Affiliation(s)
- Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Antonio Mario Bulfamante
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Luca Castellani
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Giorgio Ghilardi
- Department of Health Sciences, Clinica Chirurgica Generale, Università Degli Studi di Milano, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via Antonio di Rudinì 8, 20142 Milan, Italy
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Surgical Disparities of Parathyroid Carcinoma: Long-Term Outcomes and Deep Excavation Based on a Large Database. JOURNAL OF ONCOLOGY 2021; 2021:8898926. [PMID: 34135961 PMCID: PMC8178016 DOI: 10.1155/2021/8898926] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/10/2021] [Accepted: 05/18/2021] [Indexed: 01/18/2023]
Abstract
Purpose Parathyroid carcinoma (PC) is an uncommon endocrine disease, and surgery is considered the only potential cure. PC does not have a mature staging system because of the small number of PC patients. Our aim is to further investigate the prognostic factors associated with PC and explore the optimal extent of resection for PC patients. Methods Univariate and multivariate Cox regression analyses were conducted to explore the influence of relevant factors on cancer-specific survival (CSS) and overall survival (OS). Survival curves were generated using the Kaplan–Meier method and analyzed using the log-rank test. The mortality rates per 1,000 person-years were calculated to evaluate patients' follow-up data. We also performed subgroup analysis based on the extent of resection. Results The extent of resection was related to both CSS and OS, whereas race and extent of disease had a significant positive correlation with OS (all P < 0.05). Patients who underwent parathyroidectomy had remarkably better CSS and OS than patients who did not undergo definitive treatment. Conclusion The extent of resection is related to CSS and OS in patients with PC. No significant difference in prognosis was observed between patients who underwent parathyroidectomy and those who underwent en bloc resection, which may provide useful parameters for the treatment of PC.
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Rahimi A, Shahbazi R, Nikuei P, Soleimani S, Moradkhani A, Atashabparvar A, Khajehrahimi F, Zoghi G, Kheirandish M. A Pediatric Parathyroid Carcinoma: An Unusual Clinical Presentation and Mini-review. Int J Endocrinol Metab 2021; 19:e110234. [PMID: 33815520 PMCID: PMC8010565 DOI: 10.5812/ijem.110234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is a rare condition in the pediatric population. Parathyroid carcinoma (PC) is a very uncommon cause of PHPT, accounting for < 1% of pediatric PHPT cases. It is challenging to distinguish between parathyroid adenoma (PA), the most common cause of PHPT, and PC. In this report, we described a young female who presented with a history of progressive limping and was finally diagnosed with PC. CASE PRESENTATION A 15-year-old girl presented with progressive limping and bone pain for 8 years. She was referred by an orthopedic surgeon because of elevated intact parathyroid hormone (iPTH) for further evaluation. Physical examination revealed a large, firm, and non-tender neck mass, left hip tenderness, and limited range of motion. The initial biochemistry tests showed a borderline high calcium level of 10.8 mg/dl, an elevated iPTH level of 2876 pg/mL, and a decreased phosphorus level of 2.4 mg/dL. The 99mTechnetium (Tc) sestamibi scan displayed early intense activity in the right thyroid lobe persisting in the three-hour repeat scan, compatible with a parathyroid lesion. The patient underwent right-sided neck exploration and parathyroidectomy. Intraoperative and pathology findings confirmed the diagnosis of PC. Immunohistochemistry (IHC) staining revealed creatine kinase (CK) and CD31 in endothelial cells of the tumor. Ki67 staining was also positive in 2% - 3% of tumor cells. The whole exome sequencing (WES) study was negative for cell division cycle 73 (CDC73) and multiple endocrine neoplasia 1 (MEN1) genes. CONCLUSIONS PC should be considered as a differential diagnosis of PHPT in the pediatric population, even in the presence of mild hypercalcemia.
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Affiliation(s)
- Abbas Rahimi
- Department of General Surgery, Faculty of Medicine, University of Medical Sciences, Bandar Abbas, Iran
| | - Roghayeh Shahbazi
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Pooneh Nikuei
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sanaz Soleimani
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azadeh Moradkhani
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Atashabparvar
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farnaz Khajehrahimi
- Department of Nuclear Medicine, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Corresponding Author: Endocrinology and Metabolism Research Center, Hormoz-gan University of Medical Sciences, Bandar Abbas, Iran.
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12
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Sali AP, Motghare P, Bal M, Mittal N, Rane S, Kane S, Patil A. Parathyroid Carcinoma: A Single-Institution Experience with an Emphasis on Histopathological Features. Head Neck Pathol 2020; 15:544-554. [PMID: 33151464 PMCID: PMC8134611 DOI: 10.1007/s12105-020-01244-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/22/2020] [Indexed: 11/29/2022]
Abstract
Parathyroid carcinoma (PC) is a rare malignancy that poses a diagnostic challenge on histologic examination. We analyzed various clinicopathologic features of PC. Pathology reports and slides were reviewed to evaluate the diagnostic histopathologic features of archived cases of PC from the years of 2004-2018. The study cohort comprised twenty cases of PC. The median age was 49 years (range 21-73 years) with equal gender distribution (M:F = 1:1). Most patients presented with symptoms of hypercalcemia (n = 7, 54%). Serum calcium and serum parathyroid hormone were elevated in all but one patient. The right inferior parathyroid was commonly involved (n = 8/14, 57%). The mean tumor size was 2.4 cm (range 0.8-3.5 cm). On frozen section examination, PC was diagnosed in 8 out of 9 cases. Vascular (n = 19/20, 95%) and soft tissue invasion (n = 10/20, 50%) were the most common characteristic histologic findings. Capsular invasion was identified in all cases. Perineural invasion or metastasis at presentation was absent in all cases. Other histological features noted were intratumoral fibrous bands (70%), nodular growth pattern (70%), moderate nuclear atypia (30%), prominent nucleoli (20%), and necrosis (20%). Regional lymph nodes were negative for metastatic disease in all cases (n = 10). Eight out of 16 patients received adjuvant radiotherapy. Follow-up was available in 16 cases (median 21.5 months). Two patients died of disease. Vascular and soft tissue invasion are the most common diagnostic histologic features of PC. Capsular invasion is important to distinguish PC from its benign counterparts. Intraoperative frozen section examination can be used for accurate diagnosis and surgical management.
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Affiliation(s)
- Akash Pramod Sali
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, 8th Floor, Annexe Building, Dr. E. Borges Road, Parel, Mumbai, 400012 India ,Department of Pathology, Homi Bhabha Cancer Hospital (A Unit of Tata Memorial Centre), Sangrur, Punjab 148001 India
| | - Priyal Motghare
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, 8th Floor, Annexe Building, Dr. E. Borges Road, Parel, Mumbai, 400012 India ,Department of Pathology, SRL Diagnostic Lab, Fortis Hospital, Mumbai, 400078 India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, 8th Floor, Annexe Building, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, 8th Floor, Annexe Building, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Swapnil Rane
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, 8th Floor, Annexe Building, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Shubhada Kane
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, 8th Floor, Annexe Building, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, 8th Floor, Annexe Building, Dr. E. Borges Road, Parel, Mumbai, 400012 India
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13
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Zhang Q, Shan KS, Gopisetti N, Yoon T, Iqbal I. A Mysterious Paratracheal Mass: Parathyroid Carcinoma. Cureus 2020; 12:e9126. [PMID: 32789067 PMCID: PMC7417119 DOI: 10.7759/cureus.9126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022] Open
Abstract
Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. We detail a 60-years-old gentleman who was otherwise healthy presented to the hospital due to acute encephalopathy. He was subsequently found to have parathyroid carcinoma as the cause of the acute encephalopathy with impressive serum calcium and parathyroid hormone levels. The parathyroid carcinoma was later surgically resected with the diagnosis confirmed via pathology specimen. The patient was safely discharged from the hospital with recommendations of close routine outpatient followup.
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Affiliation(s)
- Qian Zhang
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Khine S Shan
- Internal Medicine, University of Maryland Medical Center, Baltimore, USA
| | | | - Thomas Yoon
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Iqra Iqbal
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
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14
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Čolović Z, Krnić M, Kljajić Z, Kontić M, Poljak NK, Tafra R, Ivanišević P. Surgical Treatment of Recurrent Metastatic Parathyroid Gland Carcinoma. Acta Clin Croat 2020; 59:96-101. [PMID: 34219890 PMCID: PMC8212600 DOI: 10.20471/acc.2020.59.s1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim We present the case of a 48-year-old male patient who underwent surgery for a recurrent metastatic parathyroid gland carcinoma in the patient’s right paratracheal space of the neck. The patient had undergone surgery for lower right parathyroid gland carcinoma 28 months earlier. Results The metastases were resected en bloc with an ipsilateral central neck dissection and with the removal of the enlarged lower left parathyroid gland. After exploration of the remnant parathyroid glands we noticed that lower left parathyroid gland was macroscopically enlarged so we decided to remove it to prevent possible hypercalcemia in future and to also prevent possible recurrence of cancer or development of a new primary, considering the identical embryological origin of the lower parathyroid glands and possibility of synchronous, multiple tumors, which generally follow the same embryological origin if they occur. The patient was also treated with radiation therapy after the surgery. Conclusion With the present surgical approach to recurrent metastatic parathyroid gland carcinoma, we aimed to prevent the recurrence of cancer or development of new primary and prevent or delay hypercalcemia in the future with all severe adverse metabolic states associated with high serum calcium levels.
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Affiliation(s)
| | - Mladen Krnić
- 1University of Split, Split University Hospital Center, Department of Otorhinolaryngology, Split, Croatia; 2University of Split, Split University Hospital Center, Department of Endocrinology, Split, Croatia
| | - Zlatko Kljajić
- 1University of Split, Split University Hospital Center, Department of Otorhinolaryngology, Split, Croatia; 2University of Split, Split University Hospital Center, Department of Endocrinology, Split, Croatia
| | - Mirko Kontić
- 1University of Split, Split University Hospital Center, Department of Otorhinolaryngology, Split, Croatia; 2University of Split, Split University Hospital Center, Department of Endocrinology, Split, Croatia
| | - Nikola Kolja Poljak
- 1University of Split, Split University Hospital Center, Department of Otorhinolaryngology, Split, Croatia; 2University of Split, Split University Hospital Center, Department of Endocrinology, Split, Croatia
| | - Robert Tafra
- 1University of Split, Split University Hospital Center, Department of Otorhinolaryngology, Split, Croatia; 2University of Split, Split University Hospital Center, Department of Endocrinology, Split, Croatia
| | - Petar Ivanišević
- 1University of Split, Split University Hospital Center, Department of Otorhinolaryngology, Split, Croatia; 2University of Split, Split University Hospital Center, Department of Endocrinology, Split, Croatia
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15
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Nayyar SS, Thiagarajan S, Chaukar D, Laskar SG, Patil A, Mahajan A, Shah S. Parathyroid Carcinoma-An Experience of the Enigma Over 10 Years. Indian J Endocrinol Metab 2020; 24:137-142. [PMID: 32699779 PMCID: PMC7333759 DOI: 10.4103/ijem.ijem_588_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/05/2019] [Accepted: 12/26/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Parathyroid carcinoma (PC) is an uncommon clinical entity. Identification and appropriate treatment of PC remains a challenge. In this study, we explore clinico-radiological features suggestive of PC, the utility of Castleman's histopathological criteria for the diagnosis of PC and discuss the MD-Anderson prognostic stratification system for PC. METHODS Retrospective analysis (case series) of patients who were treated at our tertiary oncology institution between January 2009 and December 2018 with an eventual diagnosis of PC. RESULTS The study group comprised 15 patients. The most common presentation was related to the musculoskeletal system (n = 9, 60%). In one of the cases, ultrasound features were recorded to be suspicious of PC. The highest histopathological correlation with PC was found with capsular and vascular invasion (n = 12, 80%). The primary tumor was found in inferior parathyroid glands in most cases (n = 12, 80%). The average tumor size was 2.47 cm. Six patients (40%) received adjuvant radiotherapy (RT). Three patients (20%) developed recurrence, all having distant metastasis. Overall survival (OS) at 3 years was 92.31% and disease-free survival (DFS) of 76.61%. CONCLUSION The presence of certain features on ultrasonography might suggest PC preoperatively. Among Castleman's criteria, capsular invasion and vascular invasion had a maximum association with PC in our series. At present, there is no evidence to routinely give adjuvant RT to all patients with PC.
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Affiliation(s)
- Supreet Singh Nayyar
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devendra Chaukar
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Asawari Patil
- Department of Pathology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Mahajan
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Snehal Shah
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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16
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Lenherr-Taube N, Lam CK, Vali R, Shammas A, Campisi P, Zawawi F, Somers GR, Stimec J, Mete O, Wong AK, Sochett E. Severe Primary Hyperparathyroidism Caused by Parathyroid Carcinoma in a 13-Year-Old Child; Novel Findings From HRpQCT. JBMR Plus 2020; 4:e10324. [PMID: 32161840 PMCID: PMC7059826 DOI: 10.1002/jbm4.10324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/12/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
Primary hyperparathyroidism is a condition that occurs infrequently in children. Parathyroid carcinoma, as the underlying cause of hyperparathyroidism in this age group, is extraordinarily rare, with only a few cases reported in the literature. We present a 13-year-old boy with musculoskeletal pain who was found to have brown tumors from primary hyperparathyroidism caused by parafibromin-immunodeficient parathyroid carcinoma. Our patient had no clinical, biochemical, or radiographic evidence of pituitary adenomas, pancreatic tumors, thyroid tumors, pheochromocytoma, jaw tumors, renal abnormalities, or testicular lesions. Germline testing for AP2S1, CASR, CDC73/HRPT2, CDKN1B, GNA11, MEN1, PTH1R, RET, and the GCM2 gene showed no pathological variants, and a microarray of CDC73/HRPT2 did not reveal deletion or duplication. He was managed with i.v. fluids, calcitonin, pamidronate, and denosumab prior to surgery to stabilize hypercalcemia. After removal of a single parathyroid tumor, he developed severe hungry bone syndrome and required 3 weeks of continuous i.v. calcium infusion, in addition to oral calcium and activated vitamin D. Histopathological examination identified an angioinvasive parathyroid carcinoma with global loss of parafibromin (protein encoded by CDC73/HRPT2).HRpQCT and DXA studies were obtained prior to surgery and 18-months postsurgery. HRpQCT showed a resolution of osteolytic lesions combined with structural improvement of cortical porosity and an increase in both cortical thickness and density compared with levels prior to treatment. These findings highlight the added value of HRpQCT in primary hyperparathyroidism. In addition to our case, we have provided a review of the published cases of parathyroid cancer in children. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Nina Lenherr-Taube
- Department of Pediatrics, Division of Endocrinology Toronto Canada.,University of Toronto Toronto Canada
| | - Carol Kl Lam
- Department of Pediatrics, Division of Endocrinology Toronto Canada.,University of Toronto Toronto Canada
| | - Reza Vali
- University of Toronto Toronto Canada.,Department of Diagnostic Imaging, Division of Nuclear Medicine Hospital for Sick Children Toronto Canada
| | - Amer Shammas
- University of Toronto Toronto Canada.,Department of Diagnostic Imaging, Division of Nuclear Medicine Hospital for Sick Children Toronto Canada
| | - Paolo Campisi
- University of Toronto Toronto Canada.,Department of Otolaryngology - Head & Neck Surgery Hospital for Sick Children Toronto Canada
| | - Faisal Zawawi
- University of Toronto Toronto Canada.,Department of Otolaryngology - Head & Neck Surgery Hospital for Sick Children Toronto Canada
| | - Gino R Somers
- University of Toronto Toronto Canada.,Department of Laboratory Medicine & Pathology Hospital for Sick Children Toronto Canada
| | - Jennifer Stimec
- University of Toronto Toronto Canada.,Department of Diagnostic Imaging Hospital for Sick Children Toronto Canada
| | - Ozgur Mete
- University of Toronto Toronto Canada.,Department of Pathology University Health Network, Princess Margaret Cancer Centre Toronto Canada
| | - Andy Ko Wong
- University of Toronto Toronto Canada.,Joint Department of Medical Imaging, Toronto General Research Institute University Health Network Toronto Canada.,Department of Epidemiology Dalla Lana School of Public Health Toronto Canada
| | - Etienne Sochett
- Department of Pediatrics, Division of Endocrinology Toronto Canada.,University of Toronto Toronto Canada
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17
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Jiajue R, Song A, Wang O, Li W. Persistent Hypercalcemia Crisis and Recurrent Acute Pancreatitis Due to Multiple Ectopic Parathyroid Carcinomas: Case Report and Literature Review of Mediastinal Parathyroid Carcinoma. Front Endocrinol (Lausanne) 2020; 11:647. [PMID: 33013712 PMCID: PMC7511513 DOI: 10.3389/fendo.2020.00647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
Mediastinal parathyroid carcinoma (PC) is a rare entity in primary hyperparathyroidism. The aim of this report is to demonstrate a case of mediastinal PC, and to provide a systemic literature review of this rare condition. A 34-year-old woman who had already undergone two cervical operations for hyperparathyroidism suffered from another recurrence, presenting with recurrent acute pancreatitis and persistent hypercalcemic crisis. Technetium-99 methoxyisobutylisonitrile imaging (MIBI) and computed tomography scanning (CT) identified three possible parathyroid tumors, one of which was the recurrence of residual tumor locating in the thyroid region, while the other two were ectopic tumors locating in the suprasternal fossa and thymus region, respectively. Pathological examination confirmed the diagnosis of PC. We conducted a systemic literature review by searching the PubMed MEDLINE from 1951 to 2019 for studies of all types in the English language only, using terms "mediastinal, mediastinum, parathyroid, carcinoma." Including our reported case, a total of 21 cases with ectopic mediastinal PCs were assessed for demographic data, tumor location and size, biochemical findings, and symptomatology, etc. Two thirds of the patients were men, with a mean age of 44 years old, a mean serum calcium of 14.2 mg/dl, and a mean serum intact parathyroid hormone of 1,216 pg/ml. We identified 89.5% of carcinomas in the anterosuperior mediastinum, and 10.5% in the middle mediastinum, with a mean diameter of 54 mm, and a mean weight of 216 g. MIBI and CT were the most commonly used methods to localize these mediastinal tumors, with 69.2 and 100% sensitivity, respectively. Half of the patients underwent more than one operation. Diagnosis and treatment of mediastinal PCs represent a challenge. Early suspicion, appropriate preoperative localization studies, and the cooperation of endocrinologists and surgeons are crucial in the effective management.
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18
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Cao H, Wang W. Case report: a camouflaged parathyroid carcinoma with initial misdiagnosis. BMC Surg 2019; 19:175. [PMID: 31752786 PMCID: PMC6873516 DOI: 10.1186/s12893-019-0638-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022] Open
Abstract
Background Parathyroid carcinoma is a rare malignancy with an increasing incidence. Most patients are characterized by the presence of severe primary hyperparathyroidism, especially hypercalcemia, while patients with normal level of serum calcium are extremely rare. Unfortunately, patients free of hypercalcemia are usually diagnosed at a later stage and suffer from a rather poor prognosis. Case presentation We describe a patient diagnosed with intrathyroidal normocalcemic parathyroid carcinoma, whose preoperative ultrasonography suggests that the tumor is located inside the thyroid gland and present without obvious clinical manifestations, which makes it more challenging for diagnosis. Conclusions Preoperative suspicion of malignancy is of great importance for advanced management while preoperative diagnosis is rather challenging with the limited contribution of imaging examinations. Any abnormality in serum level of calcium or parathormone may help to make an initial diagnosis especially when the level is extremely high. We introduce this case of initial misdiagnosis of an intrathyroidal parathyroid carcinoma, mimicking a suspicious thyroid nodule, to focus on the possible anomalous presentations of this rare condition and on its optimal management.
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Affiliation(s)
- Hongtao Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100730, China
| | - Weibin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100730, China.
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19
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Wächter S, Holzer K, Manoharan J, Brehm C, Mintziras I, Bartsch DK, Maurer E. [Surgical treatment of parathyroid carcinoma : Does the initial en bloc resection improve the prognosis?]. Chirurg 2019; 90:905-912. [PMID: 31359113 DOI: 10.1007/s00104-019-1007-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Radical en bloc resection of the tumor with ipsilateral hemithyroidectomy and central lymphadenectomy (PTX+HTX) is currently the generally recommended treatment strategy for parathyroid carcinoma (PC) in Germany; however, it remains unclear whether the en bloc resection leads to a prognostic benefit compared to parathyroidectomy (PTX) alone, especially considering disease-free and overall survival. OBJECTIVE This study analyzed the survival of patients with PC after PTX+HTX compared to patients with PTX. METHODS Patients with PC were identified from a prospective database and retrospectively analyzed regarding clinicopathological features, surgical treatment, disease-free interval and overall survival. RESULTS Out of 1705 patients who were operated on because of primary hyperparathyroidism (pHPT), 18 (1.1%) had histologically confirmed PC. In nine patients PTX+HTX was initially performed and the other nine patients received only PTX. After PTX, all of the nine patients developed a recurrence after a median of 18 months (range 7-84 months), while only one patient had a recurrence after PTX+HTX. After PTX a median three (range 2-18) reoperations were indicated for relapse but after PTX+HTX only one patient had to undergo two relapse surgeries (p < 0.001). The recurrence-free survival after PTX+HTX was significantly longer than after PTX (143 vs. 18 months, p = 0.01), while the overall survival of both groups after a median follow-up of 107.5 months did not significantly differ. DISCUSSION If there is any clinical suspicion of PC, an en bloc resection should be performed to prolong recurrence-free survival and avoid reoperations.
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Affiliation(s)
- S Wächter
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - K Holzer
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - J Manoharan
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - C Brehm
- Klinik für Pathologie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - I Mintziras
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - D K Bartsch
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - E Maurer
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
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20
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Abstract
Parathyroid cancer is one of the rarest causes of primary hyperparathyroidism and tends to present with more severe symptoms than its more benign counterparts. This article details various aspects of the disease process, including epidemiology, clinical presentation, and a step-wise diagnostic process for parathyroid cancer. This includes laboratory assessments as well as a proposed staging system. The en bloc principle of surgical intervention is detailed, as well as the current role of adjuvant treatments. A general guide to surveillance and the natural history of the disease is also outlined.
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Affiliation(s)
- Nikita N Machado
- Department of Surgery, University Hospitals Conneaut, Conneaut, OH 44030, USA.
| | - Scott M Wilhelm
- Department of Surgery, Endocrine Surgery, University Hospitals Cleveland, University Hospitals, Cleveland, OH 44106, USA.
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21
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Machado NN, Wilhelm SM. Parathyroid Cancer: A Review. Cancers (Basel) 2019; 11:E1676. [PMID: 31661917 PMCID: PMC6896123 DOI: 10.3390/cancers11111676] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
Parathyroid cancer is one of the rarest causes of primary hyperparathyroidism and tends to present with more severe symptoms than its more benign counterparts. This article details various aspects of the disease process, including epidemiology, clinical presentation, and a step-wise diagnostic process for parathyroid cancer. This includes laboratory assessments as well as a proposed staging system. The en bloc principle of surgical intervention is detailed, as well as the current role of adjuvant treatments. A general guide to surveillance and the natural history of the disease is also outlined.
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Affiliation(s)
- Nikita N Machado
- Department of Surgery, University Hospitals Conneaut, Conneaut, OH 44030, USA.
| | - Scott M Wilhelm
- Department of Surgery, Endocrine Surgery, University Hospitals Cleveland, University Hospitals, Cleveland, OH 44106, USA.
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22
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Abdulla S, Shamil E, Wilsher M, Jacob A. Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma. BMJ Case Rep 2019; 12:12/9/e231373. [PMID: 31492732 DOI: 10.1136/bcr-2019-231373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Parathyroid carcinoma is the rarest endocrine malignancy. Definitive diagnosis is challenging as it is difficult to distinguish malignant from benign disease. A 71-year-old man presented with weight loss and hypercalcaemia. CT scans revealed multiple lung nodules and lytic bone lesions that were consistent with metastatic dissemination. Technetium-99m-sestamibi-single-photon emission computed tomography scan showed an abnormal uptake in the right thyroid lobe. Fine-needle aspiration (FNA) was performed on three occasions. The patient underwent parathyroidectomy with ipsilateral hemithyroidectomy without postoperative complications. Microscopic examination showed a parathyroid neoplasm with fibrosis and intravascular tumour on a background of unremarkable thyroid parenchyma. This resulted in an initial impression of parathyroid carcinoma. Further review by two independent pathologists provided a final diagnosis of oncocytic parathyroid adenoma. This case highlights the subjectivity and interobserver variation with endocrine histological examination. FNA can induce changes that mimic parathyroid carcinoma on histology. An index of suspicion for benign parathyroid adenomas should be maintained.
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Affiliation(s)
- Suha Abdulla
- School of Medical Education, King's College London, London, UK
| | - Eamon Shamil
- Department of ENT Surgery, University Hospital Lewisham, London, UK
| | - Mark Wilsher
- Department of Pathology, University Hospital Lewisham, London, UK
| | - Antony Jacob
- Department of ENT Surgery, University Hospital Lewisham, London, UK
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Coronary Heart Disease and an Incidental Parathyroid Carcinoma. Case Rep Pathol 2019; 2019:7159395. [PMID: 31355036 PMCID: PMC6637673 DOI: 10.1155/2019/7159395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
A 71-year-old woman was admitted with angina pectoris. During hospitalization she developed a myocardial infarction (NSTEMI). Laboratory results revealed a mild elevated troponin and an elevated calcium level (3.35 mmol/l). Subsequently, there was a decreased phosphate (0.36 mmol/l [normal 0.81-1.62 mmol/l]) as well as 16-fold elevated serum level of parathyroid hormone (PTH, 1156 ng/l [normal 10-73 ng/l]), indicating a primary hyperparathyroidism. Sonographically a thyroidal node was detected, not clearly demarcated (TIRADS 5). FNA showed a monomorphic, partial follicular cell population with an immunohistochemical positivity for PTH. Magnetic resonance imaging (MRI) showed a 5 cm large tumor at the right caudal pole of the thyroid with compression of the dorsolateral trachea without infiltration. Surgical removal with en bloc resection of the right hemithyroid with parathyroidectomy was performed. Postoperatively the PTH level dropped to 12.1 ng/l. Pathological examination revealed a 5 cm tumor with infiltration of the thyroid and a perineural invasion. The diagnosis of a presymptomatic parathyroid carcinoma could be established. The affirmative histopathological diagnosis of a parathyroid carcinoma can be challenging and is limited to tumors with evidence of invasive growth in adjacent structures such as the thyroid and/or soft tissue, perineural spaces, angioinvasion of capsular and/or extracapsular vessels, and/or documented metastases.
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Ferraro V, Sgaramella LI, Di Meo G, Prete FP, Logoluso F, Minerva F, Noviello M, Renzulli G, Gurrado A, Testini M. Current concepts in parathyroid carcinoma: a single Centre experience. BMC Endocr Disord 2019; 19:46. [PMID: 31142320 PMCID: PMC6541564 DOI: 10.1186/s12902-019-0368-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parathyroid carcinoma is a rare neoplasm that may present sporadically or in the context of a genetic syndrome. Diagnosis and management are challenging due to the lack of clinical and pathological features that may reliably distinguish malignant from benign disease. METHODS From January 2013 to December 2017, from 358 consecutive patients affected by parathyroid diseases, 3 patients with parathyroid carcinoma were treated at our academic Department of General Surgery. We present our experience as illustrative of the different features of clinical presentation of parathyroid carcinoma and review its management considering the recent relevant literature. RESULTS Case 1: A 62-year-old man was hospitalized for left-sided palpable neck mass, hypercalcemia and elevated PTH. US-guided FNA was suspect for parathyroid carcinoma. A large cystic mass was excised in bloc with total thyroidectomy and central neck dissection. Genetic studies framed a pathologically confirmed parathyroid carcinoma within MEN1 syndrome. Case 2: A 48-year-old woman with hypothyroidism had total thyroidectomy performed for a suspect for right follicular thyroid lesion. Pathology revealed parathyroid carcinoma. Case 3: A 47 year-old man was admitted for hypercalcaemic crisis and renal failure in the context of PHPT. A lesion suggestive on US and MIBI scan for parathyroid adenoma in the right lower position was removed by mini-invasive approach. Pathology revealed parathyroid cancer and patient had completion hemythyroidectomy and central neck dissection. CONCLUSION Parathyroid cancer is a particularly rare endocrine malignancy, however it should be suspected in patients with primary hyperparathyroidism when severe hypercalcemia is associated to cervical mass, renal and skeletal disease. Parathyroid surgery remains the mainstay of treatment. Radical tumour resection and expedited treatment in a dedicated endocrine Center represent crucial prognostic factors.
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Affiliation(s)
- Valentina Ferraro
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Lucia Ilaria Sgaramella
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Giovanna Di Meo
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Francesco Paolo Prete
- Department of Emergency and Organ Transplant, University Medical School of Bari, Bari, Italy
| | - Francesco Logoluso
- Department of Emergency and Organ Transplant, University Medical School of Bari, Bari, Italy
| | - Francesco Minerva
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Marica Noviello
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Giuseppina Renzulli
- Interdisciplinary Department of Medicine, University Medical School of Bari, Bari, Italy
| | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
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Pramanik S, Ray S, Bhattacharjee R, Chowdhury S. Parathyroid Carcinoma and Persistent Hypercalcemia: A Case Report and Review of Therapeutic Options. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 6:115-118. [PMID: 30787833 PMCID: PMC6196698 DOI: 10.4103/sjmms.sjmms_104_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Parathyroid carcinomas are very uncommon, accounting for 0.1% to 5% of all causes of primary hyperparathyroidism. Parathyroid–jaw tumor syndrome, with a mutation in HRPT2 that encodes parafibromin, is the most common genetic association. Unique features include aggressive clinical course and a lack of preoperative definitive diagnostic criteria. The authors report a case of a 33-year-old male with bilateral nephrocalcinosis, a left-sided neck mass, high calcium, very high parathormone level and a history of parathyroid adenectomy. Computed tomography and 99m-technetium methoxyisobutylisonitrile scan revealed a localized tumor in the left inferior parathyroid region. The patient underwent radical surgery, and histopathology revealed characteristic features of parathyroid carcinoma. Preoperative identification with clinical clues is very important to plan a more radical surgical approach, as both radiotherapy and chemotherapy are ineffective. Recurrence is common and mostly occurs within 2–3 years after surgery. Patient's age, histology and tumor DNA aneuploidy are predictors of survival. Hypercalcemia is controlled with calcimimetics, bisphosphonates and denosumab in inoperable cases. Furthermore, biologic therapy with parafibromin and telomerase inhibitors is under development.
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Affiliation(s)
- Subhodip Pramanik
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sayantan Ray
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Lo WM, Good ML, Nilubol N, Perrier ND, Patel DT. Tumor Size and Presence of Metastatic Disease at Diagnosis are Associated with Disease-Specific Survival in Parathyroid Carcinoma. Ann Surg Oncol 2018; 25:2535-2540. [PMID: 29971678 DOI: 10.1245/s10434-018-6559-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The incidence of parathyroid carcinoma is reported to be rising. There is minimal data on prognostic variables associated with cancer-specific survival. The objectives of this study were to evaluate the trends in incidence and assess prognostic factors. METHODS A retrospective review of the SEER database between 1973 and 2014 was performed, identifying 520 patients with parathyroid carcinoma. Population-adjusted incidence rates were calculated in 4-year intervals. A Cochrane-Armitage test was performed to analyze changes in trend in incidence, tumor size, and extent of disease. Age, year of diagnosis, race, gender, extent of disease, surgical resection, treatment with radiation, tumor size, and lymph node status were assessed using Mantel-Cox log rank test. Multivariate analysis was performed by Cox regression analysis. RESULTS The incidence of parathyroid carcinoma has been increasing since 1974 from 2 to 11 cases per 10 million people but has since stabilized at 11 cases per 10 million people since 2001. The increasing incidence was attributed to locoregional disease and tumor size < 3 cm. The presence of metastatic disease [hazard ratio (HR) 111.4, 95% confidence interval (CI) 20.6-601.8, p < 0.0001) and tumor size > 3 cm (HR 5.6, 95% CI 1.5-21.2, p = 0.011] were associated with worse cancer-specific survival by univariate and multivariate analyses. CONCLUSIONS The incidence of parathyroid carcinoma has remained stable over the past decade. Tumor size < 3 cm and regional disease have increased in incidence. Patients with metastatic disease and tumors > 3 cm have worse cancer-specific survival. These findings can be incorporated in the development of a staging system for parathyroid carcinoma.
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Affiliation(s)
- Winifred M Lo
- Thoracic and GI Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Meghan L Good
- Thoracic and GI Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Naris Nilubol
- Endocrine Oncology Branch, National Institutes of Health, Center for Cancer Research, 10 Center Drive, Building 10/CRC 4 W-5950, Bethesda, MD, USA
| | - Nancy D Perrier
- Section of Surgical Endocrinology, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dhaval T Patel
- Endocrine Oncology Branch, National Institutes of Health, Center for Cancer Research, 10 Center Drive, Building 10/CRC 4 W-5950, Bethesda, MD, USA.
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27
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Fang C, Konstantatou E, Mulholland NJ, Baroncini S, Husainy MA, Schulte KM, Sidhu PS. A retrospective review of the role of B-mode and color Doppler ultrasonography in the investigation of primary hyperparathyroidism: Features that differentiate benign from malignant lesions. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:110-117. [PMID: 30013611 DOI: 10.1177/1742271x18758516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/10/2018] [Indexed: 11/15/2022]
Abstract
Purpose To identify the variant features encountered in parathyroid abnormalities and document those suggesting malignant change. Materials and methods Data were collected from a cohort of patients who underwent investigation for primary hyperparathyroidism over a 10-year period. Ultrasonographic features: shape, presence of calcification, cystic changes, heterogeneous echogenicity, vascularity, capsular thickening, local invasion, and vascularity were reviewed retrospectively and were used to correlate with final histological findings. Results One hundred forty-seven patients with histology and concurrent ultrasonographic scans were reviewed, and divided into benign parathyroid lesions (nodular hyperplasia (n = 44), adenoma (n = 93)) and parathyroid carcinoma (n = 10). Parathyroid carcinomas were significantly larger than benign parathyroid lesions (P = 0.030). Benign parathyroid lesions showed variant sonographic features: irregular shape (16.8%), heterogenous echogenicity (24.1%), calcification (1.5%), capsular thickening (1.5%), and cystic change (19.7%). A significantly higher proportion of parathyroid carcinomas demonstrated heterogenous echogenicity (P = 0.022), capsular thickening (P = 0.023), and infiltrative margin (P < 0.0001) than benign parathyroid lesions. Of the 137 benign parathyroid lesions, 38 (27.7%), 76 (55.5%), 23 (16.8%) were avascular, vascular, and hypervascular, respectively. Of the 10 parathyroid carcinomas, 4 (40%), 3 (30%), and 3 (30%) of lesions were avascular, vascular, and hypervascular, respectively. The vascularity of the lesions did not differ significantly between the parathyroid carcinoma and benign parathyroid lesions (P = 0.281). Conclusion Ultrasonographic features such as irregular shape, heterogeneous echogenicity, cystic change, and vascularity are nondiscriminatory features between benign or malignant lesions. Large lesion size together with the presence of calcification, capsular thickening, or infiltrative margin strongly raises the suspicion of a malignant parathyroid lesion, and management should be altered.
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Affiliation(s)
- Cheng Fang
- Department of Radiology, King's College Hospital NHS Foundation Trust London, London, UK
| | - Eleni Konstantatou
- Department of Radiology, King's College Hospital NHS Foundation Trust London, London, UK
| | - Nicola J Mulholland
- Department of Radiology, King's College Hospital NHS Foundation Trust London, London, UK
| | - Serena Baroncini
- Department of Radiology, King's College Hospital NHS Foundation Trust London, London, UK
| | - Mohammad A Husainy
- Department of Radiology, King's College Hospital NHS Foundation Trust London, London, UK
| | - Klaus-Martin Schulte
- Department of Radiology, King's College Hospital NHS Foundation Trust London, London, UK
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital NHS Foundation Trust London, London, UK
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Cocorullo G, Scerrino G, Melfa G, Raspanti C, Rotolo G, Mannino V, Richiusa P, Cabibi D, Giannone AG, Porrello C, Gulotta G. Non-functioning parathyroid cystic tumour: malignant or not? Report of a case. G Chir 2017; 38:243-249. [PMID: 29280705 DOI: 10.11138/gchir/2017.38.5.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parathyroid carcinoma (PC) is a very rare endocrine tumour, usually characterized by symptoms such as a neck mass, dysphonia, severe hypercalcemia exceeding 140 mg/L and elevated serum parathyroid hormone levels, even more than 5 times the upper limit of normal. Non-functioning parathyroid cancer is extremely rare and, in this case, its pre-operative diagnosis is often difficult. A 54-year old female patient, referring dysphagia and dysphonia, underwent neck ultrasound and neck CT. A left thyroid nodule, probably cystic, was found. It presented caudal extent on anterior mediastinum causing compression of the left lateral wall of the trachea. The preoperative calcemia was into the normal range. The patient underwent left thyroid lobectomy. Histological exam showed a cystic lesion, immunohistochemically originating from parathyroid that oriented for carcinoma. The 18 months follow-up did not show a residual-recurrent disease. The parathyroid origin of a neck lesion could not be suspected before surgery when specific laboratory tests are not available and clinical effects of hyperparathyroidism syndrome are not present. Histological features are not always sufficient for the differential diagnosis between the parathyroid adenoma and carcinoma. The immunohistochemistry is an useful tool that can aid to reach the definite diagnosis.
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29
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Wang P, Xue S, Wang S, Lv Z, Meng X, Wang G, Meng W, Liu J, Chen G. Clinical characteristics and treatment outcomes of parathyroid carcinoma: A retrospective review of 234 cases. Oncol Lett 2017; 14:7276-7282. [PMID: 29344163 PMCID: PMC5754841 DOI: 10.3892/ol.2017.7076] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/27/2017] [Indexed: 12/20/2022] Open
Abstract
Parathyroid carcinoma (PC) is one of the rarest known types of cancer and has a moderate prognosis, with estimated 5- and 10-year overall survival rates between 78–85% and between 49–70%, respectively. To raise awareness of this disease, and to optimize its diagnosis, clinical management and prognosis, the present study retrospectively reviewed 234 cases of PC. A total of 226 cases of PC, which were archived between 1984 and 2015 in the three major databases of the Chinese population, were retrieved and pooled with the 8 cases diagnosed and treated at the Department of Thyroid Surgery of The First Hospital of Jilin University (Changchun, China) between June 2008 and December 2015. The clinicopathological features, diagnosis, surgical procedures and outcomes of these cases of PC were investigated. The review revealed that misdiagnosis has been a considerable issue, with >80% of the patients misdiagnosed prior to surgery, and the accuracy of intraoperative diagnosis based on frozen sections was only 15.04%. The use of radical resection as first-line therapy significantly improved the disease-free survival by ~8 years (log-rank, 20.956; P<0.001); and, at relapse, reoperation prolonged patient survival by ~7 years (log-rank, 35.322; P<0.001). Consistently, a Cox proportional hazards analysis indicated that radical resection as a first-line therapy reduced the risk of postoperative recurrence (P=0.030), and that reoperation following recurrence significantly improved patient survival (P=0.030). The 5- and 10-year cumulative disease-specific survival rates of the cases of PC were 83 and 67%, respectively. Notably, an increased mortality rate was observed among males with PC compared with female patients with PC. In summary, in the past 32 years (1984–2015), the majority of patients with PC have been misdiagnosed. Performing radical resection as the first-line therapy significantly reduces recurrence and improves patient survival time; and, following relapse, subsequent surgery has also been demonstrated to be an effective approach.
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Affiliation(s)
- Peisong Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shuo Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi Lv
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xianying Meng
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Guimin Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wei Meng
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jia Liu
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Guang Chen
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Libánský P, Adámek S, Broulík P, Fialová M, Kubinyi J, Lischke R, Naňka O, Pafko P, Šedý J, Bobek V. Parathyroid Carcinoma in Patients that Have Undergone Surgery for Primary Hyperparathyroidism. ACTA ACUST UNITED AC 2017; 31:925-930. [PMID: 28882960 DOI: 10.21873/invivo.11148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Parathyroid carcinoma is a rare clinical entity, which represents one of the main reasons, why surgery should be performed in specialized centres. Preoperatively, it is very difficult to distinguish between benign and malignant hyperparathyroidism. PATIENTS AND METHODS During the years 1996-2016, we performed 2,220 operations in 2,075 patients with a diagnosis of primary hyperparathyroidism. RESULTS Among these 2,220 operations, there were 16 operations for parathyroid carcinoma. These 16 operations, including reoperations, were performed in four patients. Two patients had no reoperation, but another 2 patients required 14 reoperations in total. Parathyroid carcinoma was described in 0.2% of all patients with a diagnosis of primary hyperparathyroidism. The number of operations was 0.73% of all operations of primary hyperparathyroidism in years 1996-2016. CONCLUSION Prognosis of parathyroid carcinoma is quite favourable, patients evidence a long-term survival rate after the primary operation. However, every reoperation increases the number of possible complications, including recurrent laryngeal nerve injury.
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Affiliation(s)
- Petr Libánský
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Svatopluk Adámek
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Petr Broulík
- Third Department of Medicine, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Martina Fialová
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Josef Kubinyi
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Robert Lischke
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Pafko
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Jiří Šedý
- Department of Anatomy, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Vladimír Bobek
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic .,Department of Laboratory Genetics, University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Department of Thoracic Surgery, Masaryk's Hospital in Usti nad Labem, Labem, Czech Republic.,Department of Histology and Embryology, Wroclaw Medical University, Wroclaw, Poland
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31
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Karrasch T, Walmrath HD, Kampschulte M, Steiner D, Seeger W, Padberg W, Sibelius U, Gattenlöhner S, Schäffler A. [Disseminated osteolytic lesions in a 28-year-old refugee]. Internist (Berl) 2017; 59:486-493. [PMID: 28748250 DOI: 10.1007/s00108-017-0300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A 28-year-old Syrian refugee presented with right-sided knee pain and progressive deterioration of the general condition over the past months. Laboratory diagnostics revealed severe hypercalcemia due to primary hyperparathyroidism, and computed tomography (CT) scanning demonstrated disseminated osteolytic lesions throughout the skeleton. Histologically, these lesions were characterized by multinuclear giant cells (defining these lesions as so-called brown tumors). Finally, surgical removal of a jugular mass allowed the histopathologic diagnosis of a sporadic parathyroid carcinoma. In the patient, this condition was associated with a mutation in the HPRT2 gene locus.
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Affiliation(s)
- T Karrasch
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Gießen und Marburg, Standort Gießen, 35392, Gießen, Deutschland.
| | - H D Walmrath
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - M Kampschulte
- Institut für Radiologie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - D Steiner
- Klinik für Nuklearmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - W Seeger
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - W Padberg
- Klinik und Poliklinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - U Sibelius
- Klinik und Poliklinik für Innere Medizin IV/V, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - S Gattenlöhner
- Institut für Pathologie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - A Schäffler
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Gießen und Marburg, Standort Gießen, 35392, Gießen, Deutschland
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Ennazk L, El Mghari G, El Ansari N. Jaw tumor in primary hyperparathyroidism is not always a brown tumor. ACTA ACUST UNITED AC 2016; 13:64-6. [PMID: 27252751 DOI: 10.11138/ccmbm/2016.13.1.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary hyperparthyrodism (PHPT) is a common endocrine disease. It results from an inappropriate parathyroid hormone (PTH) secretion relative to serum ionized calcium level. Clinical manifestation of severe PHPT include bone disease called osteitis fibrosa cystica which reflects an increase osteoclastic resorption and osteoblastic activity. This high bone turnover is responsible of the occurrence of osteoclastomas, also named "brown tumors" (1). Rarely, PHPT may occur in inherited forms with association to fibrous jaw tumor that are unrelated to hyperparathyroidism. In this uncommon disease: hyperparathyroidism-jaw tumor (HPT-JT) syndrome, parathyroid tumor is frequently malignant and usually associated with nonendocrine malignancies (2). We report a case of a HPT-JT syndrome to focus on the differential diagnosis with brown tumors.
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Affiliation(s)
- Laila Ennazk
- Department of Endocrinology and Diabetology, Mohammed VI University Medical Hospital of Marrakech, Medecine School of Marrakech, University Caddi Ayyad of Marrakech, Morocco
| | - Ghizlane El Mghari
- Department of Endocrinology and Diabetology, Mohammed VI University Medical Hospital of Marrakech, Medecine School of Marrakech, University Caddi Ayyad of Marrakech, Morocco
| | - Nawal El Ansari
- Department of Endocrinology and Diabetology, Mohammed VI University Medical Hospital of Marrakech, Medecine School of Marrakech, University Caddi Ayyad of Marrakech, Morocco
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Wang L, Han D, Chen W, Zhang S, Wang Z, Li K, Gao Y, Zou S, Yang A. Non-functional parathyroid carcinoma: a case report and review of the literature. Cancer Biol Ther 2015; 16:1569-76. [PMID: 26408508 DOI: 10.1080/15384047.2015.1070989] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Non-functional parathyroid carcinoma is an exceedingly rare disease with 31 reported cases since 1909. Because of the scarce number of cases of non-functional parathyroid carcinoma, there are no evidence-based recommendations for its optimal treatment. Surgery, including en bloc resection of the carcinoma, ipsilateral thyroid lobe and isthmus together with a neck dissection only in case of lymph node involvement, is the main treatment for non-functioning parathyroid carcinoma. The patient usually has a poorer prognosis because of detection at advanced stages, the relative ineffectiveness of adjuvant treatment modalities and the lack of adequate parameters for clinical follow-up. In this report, we present a case of non-functional parathyroid carcinoma at our institution, and we review the previous literature to discuss the latest advances in the diagnosis and treatment of this rare disease.
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Affiliation(s)
- Liang Wang
- a Department of Head and Neck Surgery ; Shandong Cancer Hospital & Institute ; Jinan , China.,b Department of Medicine and Life Sciences College of Shandong Academy of Medical Sciences ; Jinan University ; Jinan , China
| | - Dali Han
- c Department of Radiation Oncology ; Shandong Cancer Hospital & Institute ; Jinan , China
| | - Wanjun Chen
- a Department of Head and Neck Surgery ; Shandong Cancer Hospital & Institute ; Jinan , China
| | - Shuguang Zhang
- a Department of Head and Neck Surgery ; Shandong Cancer Hospital & Institute ; Jinan , China
| | - Zhiqi Wang
- a Department of Head and Neck Surgery ; Shandong Cancer Hospital & Institute ; Jinan , China
| | - Ke Li
- a Department of Head and Neck Surgery ; Shandong Cancer Hospital & Institute ; Jinan , China
| | - Yongsheng Gao
- d Department of Pathology ; Shandong Cancer Hospital & Institute ; Jinan , China
| | - Shujuan Zou
- a Department of Head and Neck Surgery ; Shandong Cancer Hospital & Institute ; Jinan , China
| | - Aiju Yang
- a Department of Head and Neck Surgery ; Shandong Cancer Hospital & Institute ; Jinan , China
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Hsu KT, Sippel RS, Chen H, Schneider DF. Is central lymph node dissection necessary for parathyroid carcinoma? Surgery 2014; 156:1336-41; discussion 1341. [PMID: 25456903 DOI: 10.1016/j.surg.2014.08.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Parathyroid carcinoma is a rare cancer. Unlike other more common malignancies, the importance of lymph node (LN) status remains controversial. The purpose of this study was to determine the relative importance of LN metastases in disease-specific survival (DSS). METHODS A retrospective review of the Surveillance, Epidemiology, and End Result database was performed on parathyroid carcinoma cases diagnosed between 1988 and 2010. RESULTS We identified 405 parathyroid carcinoma patients. Among 114 patients with LNs examined at operation, only 12 (10.5%) had positive LNs. Sensitivity analysis found that a tumor size threshold of 3 cm best divided the cohort by DSS. Only tumors ≥ 3 cm and distant metastasis but not LN metastases were independent prognostic factors on multivariate analysis. When examining factors associated with LN status, only tumors ≥ 3 cm predicted LN metastasis. LN metastases were 7.5 times more likely in patients with tumors ≥ 3 cm than those with tumors <3 cm. CONCLUSION Tumors ≥ 3 cm were associated with LN metastases in parathyroid carcinoma, but positive LN status was not associated with DSS. Tumor size can potentially risk stratify patients by their risk of LN metastases.
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Affiliation(s)
- Kun-Tai Hsu
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Rebecca S Sippel
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Herbert Chen
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - David F Schneider
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
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STURNIOLO G, GAGLIANO E, TONANTE A, TARANTO F, PAPALIA E, CASCIO R, DAMIANO C, VERMIGLIO F, STURNIOLO G. Parathyroid carcinoma: case report. G Chir 2013; 34:170-2. [PMID: 23837957 PMCID: PMC3915582 DOI: 10.11138/gchir/2013.34.5.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors present a case of parathyroid carcinoma in a patient with primary hyperparathyroidism. Following a literature review, the clinical and diagnostic profile, treatment and prognosis of this rare disease are discussed.
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Bae JH, Choi HJ, Lee Y, Moon MK, Park YJ, Shin CS, Park DJ, Jang HC, Kim SY, Kim SW. Preoperative predictive factors for parathyroid carcinoma in patients with primary hyperparathyroidism. J Korean Med Sci 2012; 27:890-5. [PMID: 22876055 PMCID: PMC3410236 DOI: 10.3346/jkms.2012.27.8.890] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 05/21/2012] [Indexed: 11/20/2022] Open
Abstract
This study was conducted to review the clinical characteristics of parathyroid carcinoma (PC) and to evaluate potential preoperative predictive factors for PC in patients with primary hyperparathyroidism (PHPT). We performed a retrospective review of electronic medical records of 194 patients with pathologically confirmed PHPT in affiliated teaching hospitals of Seoul National University from January 2000 to March 2011. Adenoma was diagnosed in 171 patients, hyperplasia in 12, and carcinoma in 11. Several biochemical measurements were higher in patients with PC than in patients with benign disease, including serum total calcium (P < 0.001), intact parathyroid hormone (P = 0.003), and alkaline phosphatase (ALP) (P < 0.001). Tumors were larger in PC than in benign disease (P < 0.001). Multivariate analysis revealed that serum ALP level (P < 0.001) and tumor size were associated with PC (P = 0.03). Tumor size and serum ALP level were evaluated as preoperative predictive factors for PC using ROC analyses: a tumor size of 3.0 cm (sensitivity 90.9%, specificity 92.1%) and serum ALP level of 285 IU/L (83.3%, 97.0%) had predictive value for the diagnosis of PC in patients with PHPT. In conclusion, elevated serum ALP and a large parathyroid mass at the time of diagnosis can be helpful to predict PC in patients with PHPT.
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Affiliation(s)
- Jae Hyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Jin Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yenna Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Min Kyong Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Borame Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Soo Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Do Jun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chul Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Wan Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Borame Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Digonnet A, Carlier A, Willemse E, Quiriny M, Dekeyser C, de Saint Aubain N, Lemort M, Andry G. Parathyroid carcinoma: a review with three illustrative cases. J Cancer 2011; 2:532-7. [PMID: 22043238 PMCID: PMC3204402 DOI: 10.7150/jca.2.532] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 10/20/2011] [Indexed: 11/29/2022] Open
Abstract
Parathyroid carcinoma is a rare disease, which accounts for less than 1% of all case of primary hyperparathyroidism and is usually not detected until the time of surgery or thereafter. For most patients preoperative staging is not available. A radical excision remains the standard management; the place of adjuvant radiotherapy is not well established yet. Local recurrence and/or the metastases are unfortunately frequent. The present paper presents an up to date review of the literature illustrated by three clinical cases.
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Affiliation(s)
- Antoine Digonnet
- 1. Department of Head and Neck Surgery, Free University of Brussels. Jules Bordet institute, 1000 Brussels, Belgium
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Owen RP, Chou KJ, Silver CE, Beilin Y, Tang JJ, Yanagisawa RT, Rinaldo A, Shaha AR, Ferlito A. Thyroid and parathyroid surgery in pregnancy. Eur Arch Otorhinolaryngol 2010; 267:1825-35. [PMID: 20878196 DOI: 10.1007/s00405-010-1390-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/06/2010] [Indexed: 11/29/2022]
Abstract
The consideration of surgery during pregnancy requires weighing the benefit of urgent surgery against the risk to mother and fetus. Surgery during pregnancy involves an increase in both maternal and fetal risks. Thyroid and parathyroid surgery involves physiological risks to both mother and fetus specific to the disease and function of these endocrine glands. Evaluation of a thyroid mass is similar in pregnant patients with ultrasound and fine-needle aspiration biopsy providing the most important information, while the use of radiographic imaging is severely constrained except when specifically required. In general, thyroid surgery can be delayed until after delivery except in cases of airway compromise or aggressive cancer. In contrast, parathyroid surgery is recommended during pregnancy to avoid adverse effects to the neonate.
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Affiliation(s)
- Randall P Owen
- Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Mount Sinai School of Medicine, New York, NY, USA
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