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Kim E, Kalinchenko N, Eremkina A, Urusova L, Salimkhanov R, Mokrysheva N. Combination approach for CDC73-related parathyroid carcinoma in an adolescent female patient: a case report and literature review. Ther Adv Med Oncol 2024; 16:17588359241265222. [PMID: 39099848 PMCID: PMC11295221 DOI: 10.1177/17588359241265222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/13/2024] [Indexed: 08/06/2024] Open
Abstract
Parathyroid carcinoma (PC) is extremely rare in children and adolescent. PC is more often sporadic, but also it could be associated with germline mutations. The clinical features of primary hyperparathyroidism (PHPT) are nonspecific in children and adolescent, which delays the diagnosis for years. This case of PC in a pediatric patient, caused by germline heterozygous pathogenic variant in exon 1 of the CDC73 gene (c.70 G > T, p. Glu24Ter) is the first to be reported in Russia. Due to the rarity of pediatric parathyroid malignancy, the diagnosis of this endocrine neoplasm remains a challenge. The main difficulties that we faced in the management of the patient were the morphological confirmation of diagnosis, multiple surgical interventions, and disseminated PC metastases. We describe a 13-year-old girl with delayed diagnosis of PC and subsequent local recurrence after several surgeries, who underwent specific radiation therapy that allowed controlling hypercalcemia.
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Affiliation(s)
- Ekaterina Kim
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, Moscow 117036, Russia
| | - Natalia Kalinchenko
- Children’s Department of Thyroidology, Reproductive and Somatic Development, Endocrinology Research Centre, Moscow, Russia
| | - Anna Eremkina
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Moscow, Russia
| | - Liliya Urusova
- Department of Fundamental Pathomorphological, Endocrinology Research Centre, Moscow, Russia
| | - Rustam Salimkhanov
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Moscow, Russia
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Armstrong VL, Vaghaiwalla TM, Saghira C, Chen CB, Wang Y, Anantharaj J, Ackin M, Lew JI. A >50% Intraoperative Parathyroid Hormone Level Decrease Into Normal Reference Range Predicts Complete Excision of Malignancy in Patients With Parathyroid Carcinoma. J Surg Res 2024; 300:567-573. [PMID: 38155027 DOI: 10.1016/j.jss.2023.11.074] [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: 05/10/2023] [Revised: 10/05/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION The mainstay of successful treatment for parathyroid carcinoma remains complete surgical excision. Although intraoperative parathyroid hormone (ioPTH) monitoring is a useful adjunct during parathyroidectomy for benign primary hyperparathyroidism, its utility for parathyroid carcinoma remains unclear. METHODS A retrospective review of 796 patients who underwent parathyroidectomy with ioPTH monitoring for primary hyperparathyroidism revealed 13 patients with parathyroid carcinoma on final pathology from two academic institutions. A systematic review yielded 5 additional parathyroid carcinoma patients. Complete excision of malignancy, or operative success (eucalcemia ≥6 mo. after parathyroidectomy); operative failure (persistent hypercalcemia <6 mo. after parathyroidectomy); and perioperative complications were evaluated. Comparison of the >50% ioPTH decrease alone to >50% ioPTH decrease into normal reference range was analyzed using Chi-squared, Kolmogorov-Smirnov, Kruskal-Wallis tests. RESULTS All 18 parathyroid carcinoma patients achieved a >50% ioPTH decrease, and 14 patients also had a final ioPTH level decrease into normal reference range. 93% of patients who met normal parathyroid hormone reference range had operative success, whereas only two of the four (50%) patients with parathyroid carcinoma with a >50% ioPTH decrease alone demonstrated operative success. CONCLUSIONS Parathyroidectomy guided by a >50% ioPTH decrease into normal reference range may better predict complete excision of malignant tissue in patients with parathyroid carcinoma compared to >50% ioPTH decrease alone. IoPTH monitoring should be used in conjunction with clinical judgment and complete en bloc resection for optimal treatment and success.
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Affiliation(s)
| | - Tanaz M Vaghaiwalla
- Section of Endocrine Surgery, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Cima Saghira
- DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Cheng-Bang Chen
- DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Yujie Wang
- DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Johan Anantharaj
- Section of Endocrine Surgery, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Mehmet Ackin
- DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - John I Lew
- DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Zhao T, Huang J, Wang Y, Zhang D, Zhang T, Lu R, Gu H, Jin M, Shen H, Liu X, Feng D, Wang J, Wang Q, Wei B. Clinicopathological spectrum, management, and outcome of ectopic parathyroid carcinoma: Experience with 24 cases. Endocrine 2024:10.1007/s12020-024-03964-4. [PMID: 39003660 DOI: 10.1007/s12020-024-03964-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Ectopic parathyroid carcinoma (EPC) is a rare clinical entity with multiple diagnostic pitfalls, making surgical cures challenging. We assessed the clinicopathological spectrum and outcome of EPCs. METHODS In this retrospective cohort study, 24 EPCs were identified from 133 PC patients treated at a tertiary referral center. The relationship between clinicopathological findings and locations was analyzed. RESULTS The locations of EPCs were predominantly intrathyroidal (62.5%), followed by 16.7% in the mediastinum, 8.3% in the retropharyngeal space, 8.3% in the carotid sheath, and 4.2% in the upper neck. Intrathyroidal EPC patients experienced higher serum calcium (p = 0.020), a higher rate of vascular invasion (p = 0.040), and a slightly higher incidence of non-R0 initial resection (p = 0.092) than those in other ectopic locations. Intrathyroidal EPC patients also suffered a trend of higher upper aerodigestive tract (UAT) invasion rate (p = 0.070) and higher risks of distant metastasis (p = 0.037) than the other PC patients. The 5-year disease-free survival rate after surgery was slightly compromised at 41.5% in intrathyroidal EPC patients compared with 77.8% among those in other ectopic locations (p = 0.143) and 59.7% among the other PC patients (log-rank = 3.194; p = 0.074), though without statistical significance. CONCLUSION Intrathyroidal EPC might cause a more biochemically and invasively distinct PC picture compared with other PCs. Special caution should be exercised in the preoperative diagnosis and management of such cases.
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Affiliation(s)
- Teng Zhao
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jian Huang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuting Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dongxue Zhang
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Teng Zhang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruigang Lu
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua Gu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong Shen
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xing Liu
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dalin Feng
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiacheng Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qian Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bojun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Ying Y, Li H, Xia W, Cheng T, Li H, Fu Q, Ai T, Yang Y, Zhang N, Li X, Ao Q, Du Y, Yang Z. Long-term survival in a patient with metastatic parathyroid carcinoma harboring an EGFR sensitizing mutation: a case report. J Int Med Res 2024; 52:3000605241259669. [PMID: 39053452 PMCID: PMC11283662 DOI: 10.1177/03000605241259669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/20/2024] [Indexed: 07/27/2024] Open
Abstract
Parathyroid carcinoma (PC) is a rare and aggressive endocrine malignancy with limited treatment options. Current treatments such as chemotherapy and radiotherapy have demonstrated limited efficacy. Here, we report the case of a male patient who presented with symptoms including polydipsia, polyuria, and joint pain. Further examination revealed a neck lump, hypercalcemia, and hyperparathyroidism, leading to a diagnosis of PC after en bloc surgery. Seven months later, the patient developed local recurrence and lung metastases, which were resected via left lateral neck dissection and thoracoscopic wedge resection. A 422-gene panel test revealed the presence of epidermal growth factor receptor (EGFR) p.L858R (c. T2573G) mutation, which may sensitize the EGFR-tyrosine kinase inhibitor response, and phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) p.E545KV (c. G1633A) mutation. After multidisciplinary treatment discussions, the patient was treated with the multi-target tyrosine kinase inhibitor, anlotinib, resulting in survival benefits for 19 months. This case highlights the potential of targeted therapy in terms of long-term survival in patients with distant metastatic PC, as well as the importance of precision therapy guided by genome sequencing to identify potential therapeutic targets.
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Affiliation(s)
- Yushi Ying
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Hanning Li
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Wenfei Xia
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Teng Cheng
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Hui Li
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Qiang Fu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Yan Yang
- Division of Endocrinology and Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Xingrui Li
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Qilin Ao
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Yaying Du
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Zhifang Yang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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Zhao T, Yang W, Shen R, Chen Q, Jin M, Gu H, Shen H, Wang Q, Wang J, Liu X, Feng D, Zhao L, An G, Wei B. Risk Factors of Distant Metastatic Parathyroid Carcinoma and Insights into Therapeutic Perspectives. Ann Surg Oncol 2024:10.1245/s10434-024-15611-3. [PMID: 38879674 DOI: 10.1245/s10434-024-15611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Distant metastatic parathyroid carcinoma (DM-PC) is a rare but often lethal entity with limited data about prognostic indicators. We sought to investigate the risk factors, patterns, and outcomes of DM-PC. METHODS In this observational cohort study, 126 patients who underwent surgery for PC at a tertiary referral center from 2010 to 2023 were enrolled, among whom 38 had DMs. Univariate and multivariate Cox regression analyses were used to assess the effects of prognostic factors on DM. RESULTS The cumulative incidence of DM was 14.1%, 33.8%, and 66.9% at 5, 10, and 20 years in the duration of disease course, respectively. DM-PC patients suffered a worse 5-year overall survival of 37.1% compared with 89.8% in the non-DM patients (p < 0.001). DM-PC patients also suffered more previous operations (p < 0.001), higher preoperative serum calcium (p<0.001) and parathyroid hormone (PTH) levels (p < 0.001), lower frequencies of R0 resection (p < 0.001), higher rates of pathological vascular invasion (p = 0.020), thyroid infiltration (p = 0.027), extraglandular extension (p = 0.001), upper aerodigestive tract (UAT) invasion (p < 0.001), and lymph node metastasis (p < 0.001). Multivariate Cox regression revealed that non-R0 resection (HR 6.144, 95% CI 2.881-13.106, p < 0.001), UAT invasion (HR 3.718, 95% CI 1.782-7.756, p < 0.001), and higher preoperative PTH levels (HR 1.001, 95% CI 1.000-1.001, p = 0.012) were independent risk factors of DM. CONCLUSIONS Upper aerodigestive tract invasion and higher preoperative PTH levels might be risk factors for possible metastatic involvement of PC. R0 resection and closer surveillance should be considered in such cases to minimize the risk of DM and to optimize patient care.
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Affiliation(s)
- Teng Zhao
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenjing Yang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Rongfang Shen
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qirui Chen
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua Gu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong Shen
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qian Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiacheng Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xing Liu
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dalin Feng
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li Zhao
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guangyu An
- Department of Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Bojun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Tsukamoto S, Kawabata K, Kawamura H, Takata K, Hosono M. Differentiating Brown Tumor From Bone Metastasis in Parathyroid Cancer Using 18 F-FDG PET and 99m Tc-MIBI SPECT. Clin Nucl Med 2024; 49:444-446. [PMID: 38389211 DOI: 10.1097/rlu.0000000000005115] [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: 02/24/2024]
Abstract
ABSTRACT A 69-year-old woman presented with a right clavicle pain. CT revealed a pathological fracture of the right clavicle, multiple osteolytic lesions, and a left cervical mass. 18 F-FDG PET/CT demonstrated a marked FDG uptake in the cervical mass and osteolytic lesions indicative of metastatic parathyroid cancer. 99m Tc-MIBI SPECT/CT revealed either faint or no uptake in the osteolytic lesions. However, a histopathological analysis after a parathyroidectomy and right clavicle biopsy confirmed the diagnosis of parathyroid cancer and the presence of benign brown tumors secondary to hyperparathyroidism. Postoperative imaging showed sclerotic change and a decreased FDG uptake in the bone lesions.
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Affiliation(s)
- Suzune Tsukamoto
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Kazuna Kawabata
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Hitomi Kawamura
- Department of Diagnostic Radiology, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kuniaki Takata
- Department of Otolaryngology, Head and Neck Surgery, Tenri Hospital, Nara
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
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Wu C, Holland M, Song Z, Wang R, Gillis A, Zmijewski P, Lindeman B, Fazendin J, Chen H. Very elevated parathyroid hormone levels in patients with primary hyperparathyroidism: Is it cancer? Am J Surg 2024; 231:140-141. [PMID: 38155074 PMCID: PMC11180976 DOI: 10.1016/j.amjsurg.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 12/30/2023]
Affiliation(s)
| | | | | | | | | | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Gheorghe AM, Sima OC, Florescu AF, Ciuche A, Nistor C, Sandru F, Carsote M. Insights into Hyperparathyroidism-Jaw Tumour Syndrome: From Endocrine Acumen to the Spectrum of CDC73 Gene and Parafibromin-Deficient Tumours. Int J Mol Sci 2024; 25:2301. [PMID: 38396977 PMCID: PMC10889221 DOI: 10.3390/ijms25042301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
A total of 1 out of 10 patients with primary hyperparathyroidism (PHP) presents an underlying genetic form, such as multiple endocrine neoplasia types 1, 2A, etc., as well as hyperparathyroidism-jaw tumour syndrome (HJT). We aimed to summarise the recent data, thus raising more awareness regarding HJT, from the clinical perspective of PHP in association with the challenges and pitfalls of CDC73 genetic testing and parafibromin staining. This narrative review included a sample-focused analysis from the past decade according to a PubMed search. We identified 17 original human studies (≥4 patients per article). The mean age at disease onset was between 20.8 and 39.5 years, while the largest study found that 71% of patients had HJT recognised before the age of 30. Males and females seemed to be equally affected, in contrast with sporadic PHP. PHP represented the central manifestation of HJT, occurring as the first manifestation in up to 85% of HJT cases. A biochemistry panel found a mean serum calcium level above the level of 12 mg/dL in PHP. PTH was elevated in HJT as well, with average values of at least 236.6 pg/mL. The most frequent pathological type in PHP was a parathyroid adenoma, but the incidence of a parathyroid carcinoma was much higher than in non-HJT cases (15% of all parathyroid tumours), with the diagnosis being established between the age of 15 and 37.5. In some families up to 85% of carriers suffered from a parathyroid carcinoma thus indicating that certain CDC73 pathogenic variants may harbour a higher risk. An important issue in HJT was represented by the parafibromin profile in the parathyroid tumours since in HJT both parathyroid adenomas and carcinomas might display a deficient immunoreactivity. Another frequent manifestation in HJT was ossifying fibromas of the jaw (affecting 5.4% to 50% of patients; the largest study found a prevalence of 15.4%). HJT was associated with a wide variety of kidney lesion (mostly: kidney cysts, with a prevalence of up to 75%, and renal tumours involved in 19% of patients). The risk of uterine lesions seemed increased in HJT, especially with concern to leiomyomas, adenofibromas, and adenomyosis. The underlying pathogenic mechanisms and the involvement of CDC73 pathogenic variants and parafibromin expression are yet to be explored. Currently, the heterogeneous expression of parafibromin status and, the wide spectrum of CDC73 mutations including the variety of clinical presentations in HJT, make it difficult to predict the phenotype based on the genotype. The central role of HJT-PHP is, however, the main clinical element, while the elevated risk of parathyroid carcinoma requires a special awareness.
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Affiliation(s)
- Ana-Maria Gheorghe
- PhD Doctoral School of “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.-M.G.); (O.-C.S.)
| | - Oana-Claudia Sima
- PhD Doctoral School of “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.-M.G.); (O.-C.S.)
| | - Alexandru Florin Florescu
- Endocrinology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania;
- Endocrinology Department, “Sf. Spiridon” Emergency County Clinical Hospital, 700111 Iasi, Romania
| | - Adrian Ciuche
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Claudiu Nistor
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatovenerology, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 020021 Bucharest, Romania
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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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10
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Kotliarevskaia J, Siebolts U, Dralle H, Schuppert F. Late recurrence of a single gland primary hyperparathyroidism-Atypical parathyroid adenoma or misdiagnosed parathyroid carcinoma. Clin Case Rep 2024; 12:e8440. [PMID: 38197066 PMCID: PMC10774546 DOI: 10.1002/ccr3.8440] [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: 10/26/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
Key Clinical Message This case report aims to raise awareness of differential diagnoses of hypercalcemia and primary hyperparathyroidism, including parathyroid carcinoma and atypical adenoma, and to highlight the diagnostic challenges. Abstract Parathyroid carcinoma is a rare and often fatal cause of primary hyperparathyroidism and hypercalcemia. To date, there is still no clear-cut diagnostic pathway for parathyroid carcinoma established, which results in major diagnostic ambiguity and complexity. Clinical differentiation between benign parathyroid adenoma and carcinoma is challenging and ultimately the diagnosis remains histopathological. We present a case of a 58-year-old female patient with parathyroid tumor recurrence after parathyroidectomy because of primary hyperparathyroidism. The first tumor was histologically classified as an atypical parathyroid adenoma by a specialized endocrine pathologist. Eleven years after the primary tumor resection a new tumor recurred. Retrospectively, after the tumor recurrence, the primary diagnosis of the atypical adenoma was questioned, and the tumor was temporarily classified to rather be a parathyroid carcinoma. This case aims to raise awareness for the diagnostic challenge of parathyroid carcinomas as a rare cause of primary hyperparathyroidism and therewith to improve treatment and prognosis.
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Affiliation(s)
- Jessica Kotliarevskaia
- Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum KasselKasselGermany
- Department of Gastroenterology and Oncology, Vivantes Klinikum SpandauBerlinGermany
| | - Udo Siebolts
- Institute of Pathology, Martin Luther UniversityHalleGermany
- Germany and Institute of Pathology Cologne UniversityCologneGermany
| | - Henning Dralle
- Department of SurgeryMartin Luther UniversityHalleGermany
- Department of Endocrine SurgeryUniversity Hospital EssenEssenGermany
| | - Frank Schuppert
- Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum KasselKasselGermany
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11
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Jin S, Cho WC, Yang J, Xia K, Zhou C. Comparison of prognosis after partial and total surgical resection for parathyroid carcinoma: an inverse probability of treatment weighting analysis of the SEER database. Front Endocrinol (Lausanne) 2023; 14:1167508. [PMID: 37916151 PMCID: PMC10617024 DOI: 10.3389/fendo.2023.1167508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
Background Complete resection of the tumor and the ipsilateral thyroid lobe at the primary surgery is the "gold standard" for the treatment of parathyroid carcinoma (PC). However, differences in the overall survival (OS) of patients with PC who underwent partial and total surgical resection remain to be determined. Methods Data on patients with PC who underwent partial and total surgical resection were extracted from the Surveillance, Epidemiology and End Results (SEER) database (2000-2018). The X-tile software (https://medicine.yale.edu/lab/rimm/research/software/) was used to define the optimal cut-off values for continuous variables. The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare the OS of patients with PC in the partial and total surgical resection groups. Results A total of 334 patients with PC were included in this study (183 and 151 in the partial and total surgical resection groups, respectively). The optimal cut-off values for age at diagnosis were 53 and 73 years, respectively, while that for tumor size was 34 mm. In both the Kaplan-Meier analysis and univariable Cox proportional hazards regression analysis before IPTW, the difference in OS between the partial and total surgical resection groups was not statistically significant (p>0.05). These findings were confirmed in the IPTW-adjusted Kaplan-Meier analysis and multivariate Cox proportional hazards regression analysis (p>0.05). Subgroup analysis revealed that total surgical resection was beneficial for OS only in the subgroup with unknown tumor size. Conclusion There was no significant difference in the prognosis of patients who underwent partial and total surgical resection. This finding may provide a useful reference for the treatment of PC.
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Affiliation(s)
- Shuai Jin
- School of Biology and Engineering (School of Health and Medicine Modern Industry), Guizhou Medical University, Guiyang, China
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong SAR, China
| | - Jiaxi Yang
- Guiyang Maternal and Child Health Care Hospital, Guiyang Children’s Hospital, Guiyang, China
| | - Kaide Xia
- Guiyang Maternal and Child Health Care Hospital, Guiyang Children’s Hospital, Guiyang, China
| | - Changxi Zhou
- National Clinical Research Center for Geriatric Diseases, People’s Liberation Army General Hospital, Beijing, China
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12
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Yang J, Lu X, Zhou P, Liu H, Wang J, Su X. Recurrence hyperparathyroidism caused by synchronous parathyroid carcinoma and parathyromatosis in a patient with long-term hemodialysis. BMC Nephrol 2023; 24:293. [PMID: 37794407 PMCID: PMC10552215 DOI: 10.1186/s12882-023-03328-6] [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: 07/14/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Parathyroid carcinoma and parathyromatosis are very rare diseases in patients on hemodialysis. Its pathogenesis, clinical features, preoperative diagnosis, and surgery are challenging. We describe a rare case of recurrent hyperparathyroidism due to synchronous parathyroid carcinoma and parathyromatosis. CASE PRESENTATION A 46-year-old Chinese woman was diagnosed with end-stage renal disease and received regular hemodialysis. Four years later, she experienced discomfort due to itching and was diagnosed with drug-resistant secondary hyperparathyroidism. Parathyroidectomy was performed, and her parathyroid hormone (PTH) levels were reduced. The pathology also revealed that the four nodules were parathyroid nodular hyperplasia without evidence of malignancy. Five years after surgery, the right subcutaneous nodule and left inferior nodule were detected by multiple imaging modalities, and the nodules were accompanied by recurrence itching and elevation of PHT. A complete resection of two nodules was performed, and the patient was diagnosed with parathyroid carcinoma and parathyromatosis. At 8 months postsurgery, her PHT and serum calcium levels were stable, and there were no signs of recurrence. CONCLUSIONS This is a rare case of synchronous parathyroid carcinoma and parathyromatosis in a patient with secondary hyperparathyroidism after parathyroidectomy. We suggest meticulous handling of parathyroid hyperplasia to avoid rupture and spillage during surgery, and precise pro-operation location by multiple imaging modalities is crucial for successful parathyroidectomy.
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Affiliation(s)
- Jun Yang
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Xili Lu
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Pingping Zhou
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Hao Liu
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Jili Wang
- The Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Xinhui Su
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China.
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13
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Yu KM, Trimble DJ, Conner CR, Sheinberg DL, Low GMI, Saluja K, Schmitt KM, Karni RJ. Oligometastatic Parathyroid Carcinoma Presenting as Neck Pain: A Case Report. EAR, NOSE & THROAT JOURNAL 2023; 102:635-639. [PMID: 34041944 DOI: 10.1177/01455613211016703] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is an exceedingly rare, slow-growing but progressive endocrine malignancy that represents a diagnostic and therapeutic challenge. Vertebral metastasis of PC is remarkable, with only 3 prior cases of spinal metastasis reported in the literature. CASE DESCRIPTION A 62-year-old woman presented with 1 week of neck pain radiating down her right arm. Cervical x-ray revealed a lytic lesion of the C4 vertebral body. Lab work revealed hypercalcemia with an elevated parathyroid hormone level. Computed tomography and magnetic resonance imaging revealed frank destruction of the C4 vertebral body and pedicles by PC. She was treated with corpectomy, mass excision, anterior cervical discectomy and fusion, postoperative radiotherapy, and nonspecific inhibitors of active tumor pathways. Her symptoms resolved postoperatively, and she has remained negative for reoccurrence at 15-month follow-up. CONCLUSIONS To the authors' knowledge, we report the first described cervical spine metastasis of PC. Additionally, we review the treatment of this rare neoplasm in an extremely rare location in the age of tumor sequencing and morphoproteomic analysis.
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Affiliation(s)
- Katherine M Yu
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Duncan J Trimble
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Christopher R Conner
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dallas L Sheinberg
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Garren M I Low
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Karan Saluja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Karl M Schmitt
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ron J Karni
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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14
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Pluta AJ, Studniarek C, Murphy S, Norbury CJ. Cyclin-dependent kinases: Masters of the eukaryotic universe. WILEY INTERDISCIPLINARY REVIEWS. RNA 2023; 15:e1816. [PMID: 37718413 PMCID: PMC10909489 DOI: 10.1002/wrna.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023]
Abstract
A family of structurally related cyclin-dependent protein kinases (CDKs) drives many aspects of eukaryotic cell function. Much of the literature in this area has considered individual members of this family to act primarily either as regulators of the cell cycle, the context in which CDKs were first discovered, or as regulators of transcription. Until recently, CDK7 was the only clear example of a CDK that functions in both processes. However, new data points to several "cell-cycle" CDKs having important roles in transcription and some "transcriptional" CDKs having cell cycle-related targets. For example, novel functions in transcription have been demonstrated for the archetypal cell cycle regulator CDK1. The increasing evidence of the overlap between these two CDK types suggests that they might play a critical role in coordinating the two processes. Here we review the canonical functions of cell-cycle and transcriptional CDKs, and provide an update on how these kinases collaborate to perform important cellular functions. We also provide a brief overview of how dysregulation of CDKs contributes to carcinogenesis, and possible treatment avenues. This article is categorized under: RNA Interactions with Proteins and Other Molecules > RNA-Protein Complexes RNA Processing > 3' End Processing RNA Processing > Splicing Regulation/Alternative Splicing.
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Affiliation(s)
| | | | - Shona Murphy
- Sir William Dunn School of PathologyUniversity of OxfordOxfordUK
| | - Chris J. Norbury
- Sir William Dunn School of PathologyUniversity of OxfordOxfordUK
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15
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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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16
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Esteves-Ferreira S, Rodrigues L, Dantas R, Alves M, Guimarães J. A Giant Parathyroid Adenoma Presenting With Parathyroid Crisis. Cureus 2023; 15:e43129. [PMID: 37565177 PMCID: PMC10410678 DOI: 10.7759/cureus.43129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/12/2023] Open
Abstract
Giant parathyroid adenomas (GPA) are a benign cause of primary hyperparathyroidism (PHPT) that might present similarly to parathyroid carcinomas (PC). Rarely, PHPT can present with a parathyroid crisis, a life-threatening decompensation with severe hypercalcemia. A 77-year-old woman presented with lethargy and muscle weakness. Investigation revealed parathyroid hormone-dependent hypercalcemia and an enlarged parathyroid measuring 31x24 mm. The patient was submitted for parathyroidectomy. Histology showed no evidence of malignancy, confirming a GPA. We report a GPA presenting with a parathyroid crisis. The clinical picture mimicked that of a PC. There are no clinical, analytical, or imagiological features pathognomonic of PC.
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Affiliation(s)
| | - Leonor Rodrigues
- Endocrinology Department, Centro Hospitalar do Baixo Vouga, Aveiro, PRT
| | - Rosa Dantas
- Endocrinology Department, Centro Hospitalar do Baixo Vouga, Aveiro, PRT
| | - Márcia Alves
- Endocrinology Department, Centro Hospitalar do Baixo Vouga, Aveiro, PRT
| | - Joana Guimarães
- Endocrinology Department, Centro Hospitalar do Baixo Vouga, Aveiro, PRT
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17
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Boro H, Sharma H, Mittal D, Pareek M, Chugh S, Jakhar MS, Nagar N, Bhatia L, Saini S, Joshi V, Vaid S, Mannar V, Nagendra L, Dalvi M, Bundela V. Parathyroid Carcinoma Presenting as Recurrent Primary Hyperparathyroidism and Neck Mass: A Case Report. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:80-85. [PMID: 38046185 PMCID: PMC10688562 DOI: 10.17925/ee.2023.19.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 12/05/2023]
Abstract
Parathyroid carcinoma is a rare endocrine neoplasm that accounts for <1% of cases of primary hyperparathyroidism. The management of parathyroid carcinoma is a challenge due to the high rate of local recurrence of the tumour. We report the case of a middle-aged north Indian woman who presented with recurrent primary hyperparathyroidism due to parathyroid carcinoma. She presented with a recurrent palpable hard neck mass and underwent radical dissection of the neck six times. At the time of writing this report, she was referred for external beam radiotherapy to the neck. Parathyroid carcinoma is a rare malignancy with an indolent but tenacious course. Complete resection at the time of initial surgery determines the prognosis of the neoplasm. Chemotherapy and radiotherapy are usually ineffective. Hypercalcaemia needs to be aggressively managed. A multidisciplinary team is required to effectively manage parathyroid carcinoma.
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Affiliation(s)
- Hiya Boro
- Department of Endocrinology and Metabolism, Aadhar Health Institute, Hisar, Haryana, India
| | - Harish Sharma
- Department of Surgery, Aadhar Health Institute, Hisar, Haryana, India
| | - Deepak Mittal
- Department of Surgery, Aadhar Health Institute, Hisar, Haryana, India
| | - Mohit Pareek
- Department of Otorhinolaryngology, Aadhar Health Institute, Hisar, Haryana, India
| | - Shilpa Chugh
- Department of Pathology, Aadhar Health Institute, Hisar, Haryana, India
| | - Mohar Singh Jakhar
- Department of Anaesthesiology and Critical Care, Aadhar Health Institute, Hisar, Haryana, India
| | - Neeraj Nagar
- Department of Anaesthesiology and Critical Care, Aadhar Health Institute, Hisar, Haryana, India
| | - Lovekesh Bhatia
- Department of Radiodiagnosis, Aadhar Health Institute, Hisar, Haryana, India
| | - Sanjay Saini
- Department of Surgery, Aadhar Health Institute, Hisar, Haryana, India
| | - Vashishth Joshi
- Department of Surgery, Aadhar Health Institute, Hisar, Haryana, India
| | - Sahil Vaid
- Department of Anaesthesiology and Critical Care, Aadhar Health Institute, Hisar, Haryana, India
| | - Velmurugan Mannar
- Department of Endocrinology, Aster Clinic, Dubai, United Arab Emirates
| | - Lakshmi Nagendra
- Department of Endocrinology, Jagadguru Sri Shivarathreeshwara Medical College, Mysuru, India
| | - Mazhar Dalvi
- Department of Endocrinology, Al Noor Mediclinic, Abu Dhabi, United Arab Emirates
| | - Vikash Bundela
- Department of Gastroenterology, Aadhar Health Institute, Hisar, Haryana, India
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18
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Jo SY, Hong N, Lee S, Jeong JJ, Won J, Park J, Kim GJ, Kim SK, Kim S, Rhee Y. Genomic and transcriptomic profiling reveal molecular characteristics of parathyroid carcinoma. Exp Mol Med 2023:10.1038/s12276-023-00968-4. [PMID: 37121965 DOI: 10.1038/s12276-023-00968-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 05/02/2023] Open
Abstract
Genomic and transcriptomic profiling has enhanced the diagnostic and treatment options for many cancers. However, the molecular characteristics of parathyroid cancer remain largely unexplored, thereby limiting the development of new therapeutic interventions. Herein, we conducted genomic and transcriptomic sequencing of 50 parathyroid tissues (12 carcinomas, 28 adenomas, and 10 normal tissues) to investigate the intrinsic and comparative molecular features of parathyroid carcinoma. We confirmed multiple two-hit mutation patterns in cell division cycle 73 (CDC73) that converged to biallelic inactivation, calling into question the presence of a second hit in other genes. In addition, allele-specific repression of CDC73 in copies with germline-truncating variants suggested selective pressure prior to tumorigenesis. Transcriptomic analysis identified upregulation of the expression of E2F targets, KRAS and TNF-alpha signaling, and epithelial-mesenchymal transition pathways in carcinomas compared to adenomas and normal tissues. A molecular classification model based on carcinoma-specific genes clearly separated carcinomas from adenomas and normal tissues, the clinical utility of which was demonstrated in two patients with uncertain malignant potential. A deeper analysis of gene expression and functional prediction suggested that Wilms tumor 1 (WT1) is a potential biomarker for CDC73-mutant parathyroid carcinoma, which was further validated through immunohistochemistry. Overall, our study revealed the genomic and transcriptomic profiles of parathyroid carcinoma and may help direct future precision diagnostic and therapeutic improvements.
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Affiliation(s)
- Se-Young Jo
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Seunghyun Lee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong Ju Jeong
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongsoo Won
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jiho Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Jeong Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kyum Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sangwoo Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
- Postech Biotech Center, Pohang University of Science and Technology (POSTECH), Pohang, Korea.
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
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19
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A Nomogram for Relapse/Death and Contemplating Adjuvant Therapy for Parathyroid Carcinoma. Surg Oncol Clin N Am 2023; 32:251-269. [PMID: 36925183 DOI: 10.1016/j.soc.2022.10.003] [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: 03/17/2023]
Abstract
Parathyroid carcinoma (PC) is a rare endocrine malignancy with an increased incidence in the last decade. There is no reliable prognostic staging system for PC. Several hosts, tumors, and tumor microenvironment factors have been negatively correlated with survival in the last decade. Surgical resection with negative margins is still the standard of treatment in PC. Chemo and radiotherapy have no proven beneficial effect. A new promising approach with molecular profiling could lead to adjuvant therapies.
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20
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Krupinova J, Kim E, Eremkina A, Urusova L, Voronkova I, Slaschuk K, Dobreva E, Mokrysheva N. Multiple Metastases of Parathyroid and Papillary Thyroid Carcinoma in a Female Patient Treated with Long-Term Hemodialysis. J Pers Med 2023; 13:jpm13030548. [PMID: 36983729 PMCID: PMC10053015 DOI: 10.3390/jpm13030548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Parathyroid cancer is a rare, clinically aggressive malignancy with a prevalence of approximately 0.005% relative to all carcinoma cases and 1-5% among patients with primary hyperparathyroidism. Prognosis largely depends on the extent of the primary surgery. Non-radical surgical treatment increases the risk of local and distant metastases of the parathyroid cancer associated with limited treatment options. The combination of thyroid and parathyroid disorders has been described rather well for the general population; however, cases of parathyroid and thyroid carcinoma in the same patient are extremely rare (1 case per 3000 patients with parathyroid disorders). We present a rare clinical case of combination of parathyroid and thyroid cancers with metastases of both tumors to the neck lymph nodes in a woman with a mutation in the MEN1 gene (NM_130799.2): c.658T > C p.Trp220Arg (W220R), who has been exposed to radiation for 20 years before diagnosis of thyroid cancer and received renal replacement therapy with long-term hemodialysis before the diagnosis of parathyroid cancer. The patient underwent several surgeries because of metastases of the parathyroid cancer in the neck lymph nodes. Surgeons used intraoperative navigation methods (single-channel gamma detection probe, Gamma Probe 2, and fluorescence angiography with indocyanine green (ICG)) to clarify the volume of surgery. Currently, the patient is still in laboratory remission, despite the structural recurrence of tumors.
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Affiliation(s)
- Julia Krupinova
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia
| | - Ekaterina Kim
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia
| | - Anna Eremkina
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia
| | - Lilia Urusova
- Department of Pathology, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia
| | - Iya Voronkova
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia
| | - Konstantin Slaschuk
- Nuclear Medicine Department, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia
| | - Ekaterina Dobreva
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia
| | - Natalia Mokrysheva
- Department of the Parathyroid Glands Pathology and Mineral Metabolism Disorders, Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia
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21
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Gowrishankar SV, Bidaye R, Das T, Majcher V, Fish B, Casey R, Masterson L. Intrathyroidal parathyroid adenomas: Scoping review on clinical presentation, preoperative localization, and surgical treatment. Head Neck 2023; 45:706-720. [PMID: 36563301 PMCID: PMC10108101 DOI: 10.1002/hed.27287] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/26/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Intrathyroidal parathyroid adenomas (IPAs) are a rare cause of primary hyperparathyroidism. They are often difficult to localize preoperatively and intraoperatively, making diagnosis and treatment challenging. Current data on IPAs are sparse and fragmented in the literature. This makes it difficult to compare the effectiveness of different imaging and surgical techniques. To address this issue, this scoping review maps the literature on IPAs, focusing on four domains: clinical presentation, current localization methods, different surgical techniques, and histopathological features. A search of MEDLINE, Embase, and the Cochrane Library was conducted, with 19 studies meeting the inclusion criteria. The characteristics of IPAs on ultrasound, fine-needle aspiration, CT, MRI, sestamibi-based techniques, and selective venous sampling are summarized. Emerging imaging modalities, including autofluorescence, are introduced. Surgical methods and intraoperative factors that correlate with high success rates for removal are highlighted. This review also identifies gaps in knowledge to guide further research into this area.
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Affiliation(s)
| | - Rohan Bidaye
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tilak Das
- Department of Neuroradiology and Head & Neck Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Veronika Majcher
- Department of Neuroradiology and Head & Neck Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian Fish
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ruth Casey
- Department of Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Liam Masterson
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Morishita A, Hozumi Y, Ishii H, Hokazono Y, Manuel Yosei Kikuchi C, Shimasaki M, Itaya M, Oura M, Kuriki K, Hishida A, Seki G. Effect of early dose increase of evocalcet for intractable hypercalcemia caused by parathyroid carcinoma. Endocrinol Diabetes Metab Case Rep 2023; 2023:22-0269. [PMID: 36602916 PMCID: PMC9875064 DOI: 10.1530/edm-22-0269] [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: 04/08/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Summary Hypercalcemia due to parathyroid carcinoma (PC) is safely and quickly controlled with rapidly increasing evocalcet doses. Most parathyroid carcinomas are detected because of hypercalcemia due to primary hyperparathyroidism (PHPT). Hypercalcemia becomes more severe in patients with PC than those with parathyroid adenoma or hyperplasia. Hypercalcemia often causes renal dysfunction, gastrointestinal symptoms, and psychiatric symptoms. Consequently, the serum calcium level needs to be promptly corrected. Here, we report a case of PC with remarkably persistent hypercalcemia, which we safely and quickly controlled with rapidly increasing evocalcet doses. A 77-year-old female presented with renal dysfunction. Her serum calcium (Ca) and intact parathyroid hormone serum levels were 13.9 mg/dL and 1.074 pg/mL, respectively. Her renal function worsened because of hypercalcemia due to PHPT. Technetium-99 m methoxy-isobutyl-isonitrile parathyroid scintigraphic examination revealed an accumulation below the right thyroid lobe. CT examination showed a 35-mm mass. Hypercalcemia needed to be immediately corrected because of the patient's worsening renal function. Evocalcet treatment at a gradually increasing dose of up to 20 mg over 3 weeks allowed her serum Ca level to be maintained below 11 mg/dL. Only mild nausea was observed at the beginning of the treatment. The mass was suspected as PC because the hypercalcemia was refractory to high-dose evocalcet. The patient was treated with parathyroidectomy and ipsilateral thyroidectomy. PC was diagnosed based on the pathological findings of capsular and venous invasion. The patient's renal function improved and surgery could be safely performed by promptly correcting hypercalcemia. Learning points Hypercalcemia due to parathyroid carcinoma (PC) is often more severe than that caused by parathyroid adenoma or hyperplasia. PC is a rare disease, but it should be considered if the patient has intractable hypercalcemia due to primary hyperparathyroidism (PHPT). Evocalcet, which is used to treat hypercalcemia due to PHPT, does not interact with P450 (CYP) and causes few side effects. Complications, including renal dysfunction, were improved and the surgery could be safely performed by promptly correcting hypercalcemia. PC has a high recurrence rate. En-block excision is necessary when PC is suspected.
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Affiliation(s)
- Azusa Morishita
- Department of Nephrology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
| | - Yasuo Hozumi
- Department of Breast and Endocrine Surgery, Ibaraki Prefectural Central Hospital, Koibuchi, Kasama, Ibaraki, Japan
| | - Hiroaki Ishii
- Department of Nephrology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
| | - Yukio Hokazono
- Department of Pathology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
| | | | - Megumi Shimasaki
- Department of Nephrology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
| | - Mikiko Itaya
- Department of Nephrology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
| | - Masaharu Oura
- Department of Nephrology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
| | - Ken Kuriki
- Department of Pathology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
| | - Akira Hishida
- Department of Nephrology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
| | - George Seki
- Department of Nephrology, Yaizu City Hospital, Dobara, Yaizu, Shizuoka, Japan
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Toyoda M, Suganuma N, Takahashi A, Masuda T, Goda M, Yoshida T, Yukawa N, Yamanaka S, Rino Y, Masuda M. Parathyroid carcinoma with pancreatitis causing hypercalcaemic emergency treated with extracorporeal membrane oxygenation-assisted parathyroid resection. Endocrinol Diabetes Metab Case Rep 2023; 2023:22-0323. [PMID: 36606579 PMCID: PMC9874956 DOI: 10.1530/edm-22-0323] [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: 07/01/2022] [Accepted: 10/27/2022] [Indexed: 01/07/2023] Open
Abstract
Summary Emergencies due to malignancies usually have a severe clinical course and require urgent treatment. These scenarios are dubbed 'oncologic emergencies'. Parathyroid tumours often cause hypercalcaemia but not oncologic emergencies. We present a case of parathyroid carcinoma with severe hypercalcaemia and pancreatitis, resolved by surgical resection of the tumour assisted by extracorporeal membrane oxygenation (ECMO). A 66-year-old woman presented to our hospital because of haematuria. Laboratory findings were as follows: white blood cell count: 30 000, C-reactive protein: 17.7, calcium: 21.9, creatine kinase: 316, creatine kinase-myoglobin binding: 20, troponin I: 1415.8, amylase: 1046, lipase: 499, blood urea nitrogen: 57, and creatinine: 2.42. ECG was unremarkable. CT revealed a 4-cm low-density irregular tumour in the left lobe of the thyroid gland and severe pancreatitis. We diagnosed hypercalcaemia and pancreatitis due to parathyroid carcinoma. Volume expansion with isotonic saline was started immediately. Calcitonin, followed by denosumab, calcimimetic agents, and continuous hemodiafiltration were administered. The patient's general condition worsened due to uncontrolled hypercalcaemia. Urgent tumour resection was planned, assisted with ECMO for cardiopulmonary support and surgical field venous pressure reduction. Tumour histology was suggestive of parathyroid carcinoma. Hypercalcaemia and the patient's general condition improved gradually postoperatively. Hypercalcaemia is one of the oncologic emergency symptoms, commonly occurring because of lytic bone metastasis. However, reports about parathyroid carcinoma-causing life-threatening hypercalcaemia and pancreatitis are scarce; the fatality of this condition is estimated to be 30-70%. We report a case of survival of hypercalcaemia of malignancy. Learning points Parathyroid carcinoma is relatively rare and sometimes causes emergent conditions such as hypercalcaemia and severe pancreatitis. General therapy for hypercalcaemia including aggressive saline dehydration, administration of furosemide, calcitonin, zoledronic acid, and evocalcet, and dialysis is sometimes ineffective for parathyroid carcinoma. Therefore, careful planning of therapy in case of exacerbation is important. During an emergency, rapid surgical treatment despite high calcium level is the best potential therapeutic strategy.
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Affiliation(s)
- Madoka Toyoda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | | | - Akari Takahashi
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Taku Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masami Goda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tatsuya Yoshida
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Surgical Pathology, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Goldner E, Fingeret A. Parathyroid Carcinoma: A National Cancer Database Analysis. J Surg Res 2023; 281:57-62. [PMID: 36116208 DOI: 10.1016/j.jss.2022.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Parathyroid carcinoma is a rare diagnosis. The association of clinical and pathologic factors as well as treatment on overall survival (OS) is not well established. METHODS A retrospective review of patients with parathyroid carcinoma was performed using the National Cancer Database for patients diagnosed from 2004 through 2017. Clinical and demographic variables were assessed. A Cox proportional hazards model was used to assess for factors associated with survival. OS rates were determined for 5 and 10 y. RESULTS Data for 1057 patients were analyzed. The mean age at diagnosis was 57.5 y (standard deviation [SD] 14.0), and 542 (51.3%) were male. The median tumor size was 2.7 cm (interquartile range 2.0-3.7 cm). For the extent of surgery, 38 (3.6%) had no surgery, 568 (53.7%) had incomplete resection, 359 (34.0%) had complete resection, 58 (5.5%) had radical resection, and 34 (3.2%) did not have specified and were not used in the Cox proportional hazard regression model. For the cohort, 488 (46.2%) had lymph nodes resected with a mean of 5.5 (SD 6.6) removed. Of these, 32 (8.3%) had nodal metastases with one to six positive nodes. For adjuvant therapy, 159 (15.0%) had external beam radiation with a mean dose of 5463 cGy (SD 1464). Overall, 214 patients died (21.55%), and the estimated 5- and 10-y OS were 82.9% and 57.0%, respectively. In a Cox proportional hazard regression model, age at diagnosis as a continuous variable with hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.06, P = 0.003, and extent of surgery as a categorical variable with no surgery as the referent group: incomplete surgery HR 0.05, 95% CI 0.01-0.19, P < 0.001; complete surgery HR 0.04, 95% CI 0.01-0.19, P < 0.001; radical surgery HR 0.10, 95% CI 0.02-0.45, P < 0.001; and tumor size as a continuous variable was not associated with OS with an HR of 1.00, 95% CI 0.99-1.00, P = 0.738. CONCLUSIONS Patient age and extent of surgery are modestly associated with survival for parathyroid carcinoma but not patient sex, nodal metastases, or adjuvant therapy in this cohort.
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Affiliation(s)
- Ethan Goldner
- University of Washington College of Engineering, Seattle, Washington
| | - Abbey Fingeret
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
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25
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Makino H, Notsu M, Asayama I, Otani H, Morita M, Yamamoto M, Yamauchi M, Nakao M, Miyake H, Araki A, Uchino S, Kanasaki K. Successful Control of Hypercalcemia with Sorafenib, Evocalcet, and Denosumab Combination Therapy for Recurrent Parathyroid Carcinoma. Intern Med 2022; 61:3383-3390. [PMID: 35370235 PMCID: PMC9751735 DOI: 10.2169/internalmedicine.9261-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Parathyroid carcinoma (PC) is a rare type of endocrine cancer. Recurrence and metastasis are common after surgery, and refractory hypercalcemia often leads to a poor prognosis. However, there are currently no specific strategies for PC recurrence. We herein report a 61-year-old Japanese man with metastatic PC who was treated with sorafenib, a multikinase inhibitor. In this case, the serum calcium level was under control for 10 months after the initiation of sorafenib. This case suggests that combination therapy with sorafenib, evocalcet, and denosumab may be an alternative, stronger management option for refractory hypercalcemia in recurrent PC.
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Affiliation(s)
- Hirofumi Makino
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | - Masakazu Notsu
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | - Itsuko Asayama
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | - Hazuki Otani
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | - Miwa Morita
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | | | - Mika Yamauchi
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
- Research Institute for Metabolic Bone Diseases, Eikokai Ono Hospital, Japan
| | - Mika Nakao
- Cancer Genome Medical Center, Shimane University Faculty of Medicine, Japan
| | - Hitomi Miyake
- Department of Internal Medicine, Unnan City Hospital, Japan
| | - Asuka Araki
- Organ Pathology Unit, Department of Pathology, Shimane University Faculty of Medicine, Japan
| | - Shinya Uchino
- Noguchi Thyroid Clinic and Hospital Foundation, Japan
| | - Keizo Kanasaki
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
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26
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Muacevic A, Adler JR, Lourenço MH, Marques B, Duarte S. Multiple Brown Tumors Secondary to Parathyroid Carcinoma: A Challenging Diagnosis. Cureus 2022; 14:e31757. [PMID: 36569718 PMCID: PMC9771659 DOI: 10.7759/cureus.31757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Parathyroid carcinoma is an extremely rare endocrine neoplasm that accounts for less than 1% of the cases of primary hyperparathyroidism (PHPT). Continuous exposure to high levels of parathyroid hormone (PTH) induces an increase in bone remodeling and patients may present with osteitis fibrosa cystica, which is characterized by subperiosteal resorption of the phalanges, diffuse osteopenia, salt and pepper appearance of the skull, bone cysts, and brown tumors. Brown tumors occur in less than 5% of all patients with any form of hyperparathyroidism. Due to similar clinical, radiographic, and histological appearance, differential diagnosis of brown tumors includes primary and secondary bone tumors. We report a case of a 67-year-old female diagnosed with multiple osteolytic lesions initially thought to be bone metastasis of thyroid carcinoma. Further work-up led to the diagnosis of brown tumors due to parathyroid carcinoma. We want to emphasize the inclusion of osteitis fibrosa cystic in the differential diagnosis of osteolytic lesions and the need to perform serum calcium and PTH measurements when investigating these lesions.
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27
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Dirikoc A, Baser H, Polat B, Aydin C, Yazgan AK, Kilic M, Ozdemir D, Cakir B. Can Biochemical Markers and Ultrasonographical Diameters Be Used to Predict Histopathological Diagnosis in Patients with Primary Hyperparathyroidism? Indian J Surg 2022. [DOI: 10.1007/s12262-022-03586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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28
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Dematapitiya C, Perera C, Pathmanathan S, Subasinghe V, Anandagoda G, Dissanayaka V, Wijenayake U, Dissanayake P, Gamage K, Wijewickrama P, Sumanatilleke M. Parathyroid carcinoma during pregnancy: a novel pathogenic CDC73 mutation - a case report. BMC Endocr Disord 2022; 22:259. [PMID: 36284286 PMCID: PMC9594882 DOI: 10.1186/s12902-022-01169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Parathyroid carcinoma is an uncommon cause of PTH-dependent hypercalcemia. Only a handful of cases have been reported of parathyroid carcinoma during pregnancy. CASE PRESENTATION Twenty-four - Year - old female presented with proximal myopathy was found to have hypercalcemia. Her serum corrected total calcium was - 15 mg/dl (8.5 - 10.3), serum phosphate - 2.3 mg/dl (2.5 - 4.5), intact PTH - 118 pg/ml (20 - 80), Vitamin D - 15 ng/ml and Urine Ca/Cr ratio - 2.1 (0.1 - 0.2). Her CECT-neck revealed a well-defined mass lesion posterior to the right lobe of the thyroid - 2.6 cm × 2.5 cm × 2.9 cm in size. She was started on vitamin D supplementation, and she underwent right lower focal parathyroidectomy. Her PTH levels normalized following surgery. Her histology revealed an atypical parathyroid adenoma. She was treated with calcium and vitamin D. Her follow up was uneventful. One year following initial surgery the patient became pregnant and at 16 weeks of POA, the patient presented with a rapidly enhancing neck mass for one week duration. Her biochemical investigations were suggestive of a recurrence of primary hyperparathyroidism. Her ultrasound scan of the neck revealed a well-defined discreate hypoechoic nodule, superior to the thyroid isthmus which was confirmed by a non-contrast MRI scan of the neck. She underwent an uncomplicated second trimester parathyroid tumour excision with normalization of post op PTH. Her histology revealed a parathyroid carcinoma with vascular and capsular invasion. Her genetic studies revealed a novel frameshift mutation of the CDC73 gene. She was treated with calcium and vitamin D supplementation and closely followed up with ionized calcium and PTH levels which were normal throughout the pregnancy. She had an uncomplicated caesarean section at a POA of 37 weeks. Currently she is twelve weeks post-partum, in remission of disease. CONCLUSION This case shows the importance of stringent follow up of atypical parathyroid adenoma patients, the benefit of second trimester surgery in management of hypercalcemia due to parathyroid carcinoma during pregnancy and the importance of identifying the novel CDC73 gene mutation.
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Affiliation(s)
| | - Chiara Perera
- Provincial Directorate of Health Services-Western Province, Colombo, Sri Lanka
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29
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Ryang S, Yi W, Kim M, Song SH, Lee BJ, Kim BH. Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.22.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Parathyroid carcinoma (PC) in cases of secondary or tertiary hyperparathyroidism is relatively uncommon, and only a few case reports have described this entity. Although some papers have reported patients with one or two parathyroid malignancies, multiple PC–especially three or more–have been even more rarely reported. Herein, we report a case of secondary hyperparathyroidism due to multiple PCs in a chronic hemodialysis patient. A 54-year-old man with end-stage kidney disease was referred for hyperparathyroidism. He had been diagnosed with chronic kidney disease in 2001 and had begun hemodialysis in 2009. In laboratory tests, intact parathyroid hormone (iPTH) was markedly elevated to 1,144.1 pg/mL (normal range: 15.0–68.3 pg/mL) and serum calcium was mildly elevated to 10.56 mg/dL (normal range: 8.5–10.3 mg/dL). Ultrasonography showed hypoechoic nodules in the posterior part of both thyroid glands. All three nodules showed increased uptake on a 99mTc sestamibi scan. The patient underwent total parathyroidectomy with autotransplantation to the right forearm. Histopathology findings showed three PCs with capsular invasion and one parathyroid hyperplasia. In the immediate postoperative period, the iPTH level dropped from 1,446.8 to 82.4 pg/dL and, after 1 month, to 4.0 pg/dL. This patient needed oral calcium carbonate and active vitamin D to maintain appropriate serum calcium levels. Although multiple PCs are rare, they can cause secondary hyperparathyroidism. Therefore, clinicians should suspect multiple PCs when patients’ serum iPTH levels are exceptionally high. Additionally, since PCs could occur in multiple glands, autotransplantation of the parathyroid gland after parathyroidectomy should be done carefully.
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30
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Yazdian A, Minuk J, Hemenway G, Upadhyaya N, Vaz CL. Occult Pulmonary Neuroendocrine Tumor Causing Severe Hyperparathyroidism: Diagnostic Challenges and Clinical Outcomes. AACE Clin Case Rep 2022; 8:210-216. [PMID: 36189140 PMCID: PMC9508597 DOI: 10.1016/j.aace.2022.06.002] [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: 01/23/2022] [Revised: 05/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background/Objective Ectopic tumoral production of parathyroid hormone (PTH) is rare. The incidence of hyperparathyroidism and osteitis fibrosa cystica (OFC) secondary to ectopic PTH secretion has only been reported in case reports, although infrequent. Case Report We report a case of a well-differentiated pulmonary neuroendocrine tumor (NET) producing PTH that presented with severe hypercalcemia and OFC. Surgical removal of the pulmonary tumor resulted in resolution of hypercalcemia. Immunocytochemical analysis of the tumor tissue revealed PTH-positive staining. Recovery was complicated by severe hypocalcemia due to hungry bone syndrome. Discussion To the best of our knowledge, this is the first documented case of a pulmonary NET causing OFC via PTH. We further describe the successful identification and resection of a rare NET and restoration of calcium homeostasis with aggressive calcium and vitamin D repletion. Conclusion Although a rare cause of severe hypercalcemia and OFC, ectopic tumoral production of PTH must be considered in the differential diagnosis. Furthermore, resection of these tumors secreting PTH can lead to a protracted and severe high risk of hungry bone syndrome, which requires aggressive treatment to maintain calcium homeostasis.
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31
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Cunha C, Pinheiro SL, Donato S, Tavares Bello C, Simões H, Nunes Silva T, Prazeres S, Doutel D, Cavaco BM, Leite V. Parathyroid carcinoma: Single centre experience. Clin Endocrinol (Oxf) 2022; 97:250-257. [PMID: 35120263 DOI: 10.1111/cen.14684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Parathyroid Carcinoma is a rare malignant neoplasm, accounting for less than 1% of primary hyperparathyroidism cases. Parathyroid carcinomas are characterized by markedly elevated levels of PTH, severe hypercalcemia and established target organ damage. The authors report the experience of a single centre regarding the management and outcome of patients with parathyroid carcinomas and revise relevant literature. DESIGN Retrospective review of all patients with parathyroid carcinoma evaluated at a tertiary oncologic centre from 1991 until 2021. RESULTS Seventeen patients were identified (10 males), with a mean age at diagnosis of 53 ± 16 years and a median follow-up of 16.5 years. Most patients presented with hypercalcemia (n = 15), with a mean serum calcium concentration of 13.5 mg/dl (9.6-16.5) and mean PTH of 1173 pg/ml (276-2500). Hyperparathyroidism-mediated organ damage was observed in most patients (n = 16), with predominant renal (n = 12) and skeletal (n = 9) complications. En bloc surgical resection was performed in nine patients. Three patients underwent adjuvant radiotherapy. Recurrence was observed in 8 cases (47.1%) after a median of 24 months following surgery and no independent predictors of recurrence were identified. The overall survival and disease specific survival at 5-year was 88% and 94%, respectively. CDC73 mutations were present in 38.5% of analysed patients and one patient was diagnosed with MEN1. CONCLUSION Parathyroid carcinoma is associated with a significant rate of recurrence and limited effective treatment beyond initial complete surgical resection. Therefore, preoperatively high index of suspicion is paramount to optimize patient care. This is, to our knowledge, the largest Portuguese cohort published so far.
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Affiliation(s)
- Clara Cunha
- Department of Endocrinology, Hospital de Egas Moniz, Lisboa, Portugal
| | - Sara Lomelino Pinheiro
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Sara Donato
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Helder Simões
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Tiago Nunes Silva
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Molecular Pathobiology Research Unit (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Susana Prazeres
- Laboratory of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Delfim Doutel
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca M Cavaco
- Molecular Pathobiology Research Unit (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Valeriano Leite
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Molecular Pathobiology Research Unit (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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32
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Ben Nacef I, Khelifi D, Kalthoum M, Rojbi I, Riahi I, Mekni S, Ben Salah M, Mchirgui N, Khiari K. Synchronous parathyroid carcinoma and papillary thyroid carcinoma. Clin Case Rep 2022; 10:e06369. [PMID: 36188029 PMCID: PMC9508800 DOI: 10.1002/ccr3.6369] [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: 04/19/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 12/04/2022] Open
Abstract
The simultaneous occurrence of parathyroid carcinoma and nonmedullary thyroid carcinoma is unusual. We report the case of 60‐year‐old woman who was found to have concurrent parathyroid carcinoma with severe clinical manifestations of primary hyperparthyroidism in addition to an incidental papillary thyroid carcinoma. Parathyroid hormone level was 569 pg/ml (normal range 10–65), and the serum calcium concentration was 13.83 mg/dl (normal range, 8.8–10.4). Preoperative investigation found a large 3 cm anterior cervical nodule suggestive of parathyroid adenoma. Total thyroidectomy and left parathyroidectomy were performed, and the final anatomopathological examination of the operative specimen concluded the coexistence of papillary microcarcinoma and parathyroid carcinoma. Although parathyroid carcinoma is an uncommon cause of hypercalcemia, it should be considered when severe hypercalcemia is observed, and in case of coexistence of thyroid nodules. The possibility of both malignancies must also be considered since parathyroid and nonmedullary thyroid carcinoma rare cases have previously been reported.
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Affiliation(s)
- Ibtissem Ben Nacef
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Dayssem Khelifi
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Mehdi Kalthoum
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Imen Rojbi
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Ines Riahi
- Department of Otorhinolaryngology‐Head and Neck Surgery University Hospital of Charles Nicolle Tunis Tunisia
| | - Sabrine Mekni
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Mamia Ben Salah
- Department of Otorhinolaryngology‐Head and Neck Surgery University Hospital of Charles Nicolle Tunis Tunisia
| | - Nadia Mchirgui
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
| | - Karima Khiari
- Department of Endocrinology University Hospital of Charles Nicolle Tunis Tunis Tunisia
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Merrill AL, Sims SS, Dedhia P, Rossfeld K, Limbach AL, Duh QY, Phay J. Near-Infrared Autofluorescence Features of Parathyroid Carcinoma. J Endocr Soc 2022; 6:bvac090. [PMID: 35795811 PMCID: PMC9249374 DOI: 10.1210/jendso/bvac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Parathyroid carcinoma is very rare, and intraoperative definitive diagnosis can be elusive with currently available diagnostics. Near-infrared (NIR) autofluorescence is an emerging tool that identifies parathyroid glands in real time. It is not known whether NIR autofluorescence can detect parathyroid carcinoma intraoperatively. Methods Patients with preoperative suspicion for parathyroid carcinoma were identified from ongoing studies examining parathyroid autofluorescence with a NIR camera and probe. Specimens from these patients were examined intraoperatively to determine their autofluorescence patterns. Results Three patients with suspected parathyroid carcinoma were identified preoperatively. Intraoperative NIR autofluorescence imaging showed a relative lack of autofluorescence for all cases, in contrast to parathyroid adenomas and normal parathyroid glands, which typically exhibit significant autofluorescence. Final pathology confirmed parathyroid carcinoma in all cases. Conclusion Parathyroid carcinoma can be difficult to confirm prior to final pathology review. Our 3 cases suggest that absence of NIR autofluorescence may suggest the likelihood of parathyroid carcinoma, but more studies are needed to investigate this experience.
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Affiliation(s)
- Andrea L Merrill
- The Ohio State University , Department of Surgery
- Boston Medical Center , Department of Surgery
| | - Sarah S Sims
- University of California , San Francisco, Department of Surgery
| | - Priya Dedhia
- The Ohio State University , Department of Surgery
| | - Kara Rossfeld
- The Ohio State University , Department of Surgery
- Ohiohealth, Columbus , OH, Department of Surgery
| | | | - Quan-Yang Duh
- University of California , San Francisco, Department of Surgery
| | - John Phay
- The Ohio State University , Department of Surgery
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Sun XM, Pang F, Zhuang SM, Xie LE, Zhong QY, Liu TR. Tumor size rather than the thyroid invasion affects the prognosis of parathyroid carcinoma without lymph node or distant metastasis. Eur Arch Otorhinolaryngol 2022; 279:4587-4594. [PMID: 35596806 DOI: 10.1007/s00405-022-07403-w] [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: 12/20/2021] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to explore the prognostic value of thyroid invasion of parathyroid carcinoma without lymph node or distant metastasis. METHODS Two hundred and nine cases of parathyroid carcinoma from the SEER (1989-2014) were eligible for this study. A Chi-squared test, t test, X-tile, Kaplan-Meier curves, and multivariate Cox proportional hazard regression were used for analysis. RESULTS Thyroid invasion, sex, race, age, radiation, and surgery were not significantly associated with cancer-specific survival by multivariate analysis. However, tumor size ≥ 4 cm was significantly associated with worse cancer-specific survival (P < 0.001). CONCLUSION Thyroid invasion, which was the criterion for T1 and T2 staging criteria of parathyroid carcinoma according to the AJCC, did not affect the prognosis of patients with parathyroid carcinoma without local lymph node or distant metastasis. Our study indicates that a tumor size ≥ 4 cm may be an appropriate indicator of T1 and T2 cancer staging.
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Affiliation(s)
- Xiao-Mei Sun
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China.,Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China
| | - Feng Pang
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China.,Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China
| | - Shi-Min Zhuang
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China.,Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China
| | - Liang-En Xie
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China.,Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China
| | - Qian-Yi Zhong
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China.,Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China
| | - Tian-Run Liu
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China. .,Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, People's Republic of China.
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Kaur J, Drake T. Ectopic Pleural Parathyroid Adenoma Causing Recurrent Primary Hyperparathyroidism. Cureus 2022; 14:e25101. [PMID: 35733476 PMCID: PMC9205085 DOI: 10.7759/cureus.25101] [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] [Accepted: 05/17/2022] [Indexed: 11/05/2022] Open
Abstract
Ectopic parathyroid glands can cause primary hyperparathyroidism (PHPT) in up to 16% of cases. These can lead to recurrent/persistent PHPT, and multiple cases have been described in the literature. We present a case of a pleural parathyroid adenoma leading to persistent PHPT. The ectopic location of the parathyroid glands is a result of their migration during development and is next to tissues they share a common embryologic origin with. The pleural location of the parathyroid adenoma in our patient was highly unusual, as the pleura have an embryologically distinct origin from the parathyroids. This was likely the result of incomplete removal of a previous mediastinal adenoma or seeding of abnormal cells in the surrounding tissue due to capsular breach (parathyromatosis). These can lead to recurrent/persistent PHPT. Parathyromatosis can lead to the presence of adenomas in highly unusual locations, making diagnosis and treatment difficult. To our knowledge, this is the first reported case in the literature of pleural adenoma causing persistent PHPT.
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Tsai WH, Zeng YH, Lee CC, Tsai MC. Mortality factors in recurrent parathyroid cancer: a pooled analysis. J Bone Miner Metab 2022; 40:508-517. [PMID: 35184206 DOI: 10.1007/s00774-021-01305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Parathyroid cancer is a rare disease with high recurrence rate. The prognostic factors for recurrent parathyroid cancer are yet to be ascertained. We aimed to establish the association between recurrent parathyroid cancer and previously reported prognostic factors. MATERIALS AND METHODS We conducted a PubMed search using the keywords 'parathyroid cancer', 'parathyroid neoplasm', and 'hypercalcemia' during 1966-2019 and included 3272 articles. We focused on 73 patients with recurrent parathyroid cancer from 55 studies. We conducted a survival analysis using the Cox proportional hazards model with 95% confidence interval. RESULTS For the 73 patients included in the analysis, the mean age (± standard deviation) was 44 ± 13.2 years, wherein 36 patients were women (49.3%). During the 5236 person-months at risk (mean follow-up 71.7 months, range 3-264), 38 patients died. The incidence of local recurrence, lymph-node metastasis, lung metastasis, and bone metastasis were 60.3, 12.3, 56.2, and 24.7, respectively. Bone metastasis, disease-free interval < 1 year, and total surgeries < 3 were significant prognostic factors in univariate analysis (log-rank test P = 0.0063, P = 0.0006, and P = 0.0056, respectively). In the multivariate-adjusted analysis, the mortality risk was significantly increased in patients with bone metastasis with a hazard ratio (HR) of 4.83 (95% CI 1.16-20.2; P = 0.03), disease-free interval <=1 year of 5.92 (95% CI 1.85-18.99; P = 0.003), and total surgeries <3 of 11.29 (95% CI 2.82-45.22; P = 0.001), considering these as possible predictive prognostic factors. CONCLUSION Bone metastasis, duration of disease-free interval, and total number of surgeries predict survival in recurrent parathyroid cancer.
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Affiliation(s)
- Wen-Hsuan Tsai
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
| | - Yi-Hong Zeng
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC)
| | - Chun-Chuan Lee
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC)
| | - Ming-Chieh Tsai
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC).
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC).
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Erkmen C, Unal DN, Kurbanoglu S, Eren G, Uslu B. Evaluation of the Interaction of Cinacalcet with Calf Thymus dsDNA: Use of Electrochemical, Spectrofluorimetric, and Molecular Docking Methods. BIOSENSORS 2022; 12:bios12050278. [PMID: 35624577 PMCID: PMC9138790 DOI: 10.3390/bios12050278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
The binding of drugs to DNA plays a critical role in new drug discovery and is important for designing better drugs. In this study, the interaction and binding mode of calf-thymus double-stranded deoxyribonucleic acid (ct-dsDNA) with cinacalcet (CIN) from the calcimimetic drug that mimics the action of calcium on tissues group were investigated. The interaction of CIN with ct-dsDNA was observed by the differential pulse voltammetry (DPV) technique by following the decrease in electrochemical oxidation signals to deoxyguanosine and adenosine. A competitive study was performed on an indicator, methylene blue, to investigate the interaction of the drug with ct-dsDNA by fluorescence spectroscopy. Interaction studies have shown that the binding mode for the interaction of CIN with ct-dsDNA could be groove-binding. According to the results obtained, the binding constant values were found to be 6.30 × 104 M−1 and 3.16 × 105 M−1, respectively, at 25 °C as obtained from the cyclic voltammetry (CV) and spectroscopic techniques. Possible molecular interactions of CIN with dsDNA were explored via molecular docking experiments. The docked structure indicated that CIN could fit well into the minor groove of the DNA through H-bonding and π-π stacking contact with CIN.
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Affiliation(s)
- Cem Erkmen
- Department of Analytical Chemistry, Faculty of Pharmacy, Ankara University, Ankara 06560, Turkey; (C.E.); (D.N.U.); (S.K.)
- The Graduate School of Health Sciences, Ankara University, Ankara 06110, Turkey
| | - Didem Nur Unal
- Department of Analytical Chemistry, Faculty of Pharmacy, Ankara University, Ankara 06560, Turkey; (C.E.); (D.N.U.); (S.K.)
- The Graduate School of Health Sciences, Ankara University, Ankara 06110, Turkey
| | - Sevinc Kurbanoglu
- Department of Analytical Chemistry, Faculty of Pharmacy, Ankara University, Ankara 06560, Turkey; (C.E.); (D.N.U.); (S.K.)
| | - Gokcen Eren
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Gazi University, Etiler, Ankara 06330, Turkey;
| | - Bengi Uslu
- Department of Analytical Chemistry, Faculty of Pharmacy, Ankara University, Ankara 06560, Turkey; (C.E.); (D.N.U.); (S.K.)
- Correspondence:
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Ullah A, Khan J, Waheed A, Sharma N, Pryor EK, Stumpe TR, Velasquez Zarate L, Cason FD, Kumar S, Misra S, Kavuri S, Mesa H, Roper N, Foroutan S, Karki NR, Del Rivero J, Simonds WF, Karim NA. Parathyroid Carcinoma: Incidence, Survival Analysis, and Management: A Study from the SEER Database and Insights into Future Therapeutic Perspectives. Cancers (Basel) 2022; 14:cancers14061426. [PMID: 35326576 PMCID: PMC8946517 DOI: 10.3390/cancers14061426] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction: Parathyroid carcinoma (PC) is an extremely rare entity, with a frequency of 0.005% of all malignancies. Most data related to this rare disease are limited to case series and a few database studies. We present a large database study that aims to investigate the demographic, clinical, and pathological factors, prognosis, and survival of PC. Methods: Data of parathyroid carcinoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) diagnosed between 1975 and 2016. Results: PC had a slightly higher incidence in men (52.2%, p < 0.005), the majority of cases affected Caucasians (75.4%, p < 0.005), and the mean age at diagnosis was 62 years. Histologically, 99.7% were adenocarcinomas not otherwise specified (p < 0.005), well-differentiated (p < 0.005), and 2−4 cm (p < 0.001) in size among the patients with available data. In cases with staging provided, most PC were organ-confined (36.8%, p < 0.001). Lymph nodes were positive in 25.2% of cases where lymph node status was reported. The main treatment modality was surgery (97.2%), followed by radiation alone (2%), and very few received chemotherapy alone (0.8%), p < 0.005. Five-year follow-up was available for 82.7% of the cases. Those who underwent surgery only or radiation alone had 5-year survivals of 83.8% and 72.2%, respectively (p < 0.037). Multivariable analysis identified tumor size >4 cm, age > 40 years, male sex, Caucasian race, distant spread, and poorly differentiated grade as independent risk factors for mortality (p < 0.001). Conclusion: PC is a very rare tumor mostly affecting Caucasian individuals in the fifth decade. Older age, poor histologic differentiation, and distant metastasis are associated with a worse prognosis. Surgical resection offers the best survival outcome. To better understand the pathogenesis and factors affecting survival, all PC patients should be enrolled in national and international registries.
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Affiliation(s)
- Asad Ullah
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Jaffar Khan
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (J.K.); (H.M.)
| | - Abdul Waheed
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (N.S.); (F.D.C.); (S.F.)
| | - Nitasha Sharma
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (N.S.); (F.D.C.); (S.F.)
| | - Elizabeth K. Pryor
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Tanner R. Stumpe
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Luis Velasquez Zarate
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Frederick D. Cason
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (N.S.); (F.D.C.); (S.F.)
| | - Suresh Kumar
- National Cancer Institute, NIH, Bethesda, MD 20892, USA; (S.K.); (N.R.); (J.D.R.)
| | - Subhasis Misra
- Department of Surgery, Brandon Regional Hospital, Brandon, FL 33511, USA;
| | - Sravan Kavuri
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Hector Mesa
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (J.K.); (H.M.)
| | - Nitin Roper
- National Cancer Institute, NIH, Bethesda, MD 20892, USA; (S.K.); (N.R.); (J.D.R.)
| | - Shahin Foroutan
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (N.S.); (F.D.C.); (S.F.)
| | - Nabin Raj Karki
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Jaydira Del Rivero
- National Cancer Institute, NIH, Bethesda, MD 20892, USA; (S.K.); (N.R.); (J.D.R.)
| | - William F. Simonds
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA;
| | - Nagla Abdel Karim
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
- Correspondence: ; Tel.: +513-375-2554
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Chandran M, Bilezikian JP, Salleh NM, Ying H, Lau J, Lee J, deJong MC, Chan Maung A, Parameswaran R. Hungry bone syndrome following parathyroidectomy for primary hyperparathyroidism in a developed country in the Asia Pacific. A cohort study. Osteoporos Sarcopenia 2022; 8:11-16. [PMID: 35415277 PMCID: PMC8987324 DOI: 10.1016/j.afos.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives We sought to assess the incidence of hungry bone syndrome (HBS) following parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT) in a cohort of multi-ethnic patients from a developed country in the Asia Pacific. Methods One hundred and sixty-four patients who underwent PTX for PHPT between 2012 and 2019 at the 2 largest public hospitals in Singapore were identified. HBS was defined as serum albumin-adjusted calcium ≤ 2.1 mmol/L with normal or raised serum intact parathyroid hormone (iPTH) levels, manifesting on or after the 3rd day, or persisting for more than 3 days post-operatively. Results Chinese constituted 73.8%, Malays 12.2%, Indians 9.8%, and other races 4.3%. HBS developed in 4 patients (2.4%) (95% CI, 0.8%–6.5%). HBS patients had significantly longer in-hospital stays; 20 days [IQR:15–22] vs 2 days [IQR:1–3]; P < 0.001in those who did not develop HBS. There was no difference in the incidence of HBS stratifying for age, sex, vitamin D status, or use of preoperative anti-resorptive medication use. For every 10 unit increase in iPTH and alkaline phosphatase (ALP) levels, the risk of HBS increased by 14% and 11%; RR (95% CI), 1.14 (1.05–1.21) and 1.11 (1.03–1.18), respectively. Conclusions The low incidence of HBS in multi-ethnic patients undergoing PTX by multiple surgeons for PHPT at the 2 largest public hospitals that see the most such patients in Singapore, a developed country, is consistent with the asymptomatic/milder form of presentation of PHPT in the developed world.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Complicated Metabolic Bone Disorders Unit, Department of Endocrinology, Singapore General Hospital, Singapore
- Corresponding author. Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, 20 College Road, ACADEMIA, 169856, Singapore.
| | - John P. Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Hao Ying
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | - Joel Lau
- Department of Endocrine Surgery, National University Hospital, Singapore
| | - James Lee
- Department of Endocrine Surgery, National University Hospital, Singapore
| | - Mechteld C. deJong
- Department of Endocrine Surgery, National University Hospital, Singapore
| | - Aye Chan Maung
- Department of Endocrinology, Singapore General Hospital, Singapore
- Department of Endocrinology, Ealing Hospital, London North West Healthcare NHS Trust, United Kingdom
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Sawhney S, Vaish R, Jain S, Mittal N, Ankathi SK, Thiagarajan S, Chaukar D. Parathyroid Carcinoma: a Review. Indian J Surg Oncol 2022; 13:133-142. [PMID: 35462650 PMCID: PMC8986943 DOI: 10.1007/s13193-021-01343-3] [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: 11/29/2020] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
Parathyroid cancer is a rare endocrine malignancy with only a few thousand cases reported worldwide. As a result, there exists considerable controversy regarding the various aspects of this disease, viz., etiology, diagnosis, and management. We hereby attempt to review the literature on parathyroid carcinoma (PC) and summarize the practices based on the current evidence available. The majority of the PC are sporadic although an association with hyperparathyroidism-jaw tumor syndrome, multiple endocrine neoplasia (MEN) 1 and 2, and isolated familial hyperparathyroidism has been shown. As preoperative diagnosis is challenging, PC should be suspected in patients presenting with a neck mass with signs and symptoms of invasion to surrounding structures. Skeletal and renal symptoms are often associated with PC as presenting complaints. The biochemical parameters are more pronounced in the case of PC compared with benign countpart. Due to its rarity, the American Joint Committee of cancer control (AJCC) acknowledges that as yet a clear distinct staging system to prognosticate the disease would be premature. Complete excision with negative margins at first surgery offers the best chance of cure. The role of radiotherapy (RT) is still unclear; however few series have suggested a better locoregional control with adjuvant RT. Recurrences are common and are most significantly associated with an incomplete clearance at initial surgery. Surgical salvage of recurrent/metastatic disease with medical management of hypercalcemia is the treatment of choice. Large prospective studies and trials need to be conducted to understand the pathology better and improve management protocols; however this is a challenge due to rarity of cases.
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Affiliation(s)
- Shikhar Sawhney
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Room No 621, 6th floor Homi Bhabha Block, Parel, Mumbai, 400012 India
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra 400094 India
| | - Richa Vaish
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Room No 621, 6th floor Homi Bhabha Block, Parel, Mumbai, 400012 India
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra 400094 India
| | - Siddhanth Jain
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Room No 621, 6th floor Homi Bhabha Block, Parel, Mumbai, 400012 India
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra 400094 India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Mumbai, 400012 India
- Department of Pathology, Homi Bhabha National Institute, Mumbai, Maharashtra 400094 India
| | - Suman Kumar Ankathi
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, 400012 India
- Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, Maharashtra 400094 India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Room No 621, 6th floor Homi Bhabha Block, Parel, Mumbai, 400012 India
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra 400094 India
| | - Devendra Chaukar
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Room No 621, 6th floor Homi Bhabha Block, Parel, Mumbai, 400012 India
- Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra 400094 India
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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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Case Report of Rare Parathyroid Tumor with Atypical Presentation and Early Diagnosis. Case Rep Endocrinol 2022; 2022:1675256. [PMID: 35059224 PMCID: PMC8766190 DOI: 10.1155/2022/1675256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/18/2021] [Indexed: 11/22/2022] Open
Abstract
Parathyroid carcinoma is a rare condition, accounting for 1% of cases of hyperparathyroidism. Other causes of hyperparathyroidism main group are single adenoma and parathyroid hyperplasia. The clinics presented by the patients are typical of hyperparathyroidism (fatigue, weakness, weight loss, and anorexia), bone impairment, pain, and fractures, in addition to affecting the renal system The diagnosis of parathyroid carcinoma is most often done postoperatively by means of a histological study. The case report is a 49-year-old male patient who came to the emergency room of Mackenzie Evangelical University Hospital complaining of progressive “muscle weakness” and “joint” that started about 2 months ago. To raise the suspicion of parathyroid carcinoma, it is essential to perform the correlation of the clinical picture, biochemical values, and imaging exams, but to obtain the definitive diagnosis, intraoperative recognition of the tumor and the result of the histopathological examination of the resected tumor are necessary.
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Morotti A, Cetani F, Passoni G, Borsari S, Pardi E, Guarnieri V, Verdelli C, Tavanti GS, Valenti L, Bianco C, Ferrero S, Corbetta S, Vaira V. The Long Non-Coding BC200 Is a Novel Circulating Biomarker of Parathyroid Carcinoma. Front Endocrinol (Lausanne) 2022; 13:869006. [PMID: 35586620 PMCID: PMC9108332 DOI: 10.3389/fendo.2022.869006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/04/2022] [Indexed: 01/10/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) are an important class of epigenetic regulators involved in both physiological processes and cancer development. Preliminary evidence suggested that lncRNAs could act as accurate prognostic and diagnostic biomarkers. Parathyroid cancer is a rare endocrine neoplasia, whose management represents a clinical challenge due to the lack of accurate molecular biomarkers. Our previous findings showed that human parathyroid tumors are characterized by a different lncRNAs signature, suggesting heterogeneity through the different histotypes. Particularly, we found that the lncRNA BC200/BCYRN1 could represent a candidate biomarker for parathyroid carcinomas (PCas). Here we aimed to extend our preliminary data evaluating whether BC200 could be an accurate non-invasive biomarker of PCas to support the clinical management of patients affected by parathyroid tumors at diagnosis, prognosis and follow-up. To provide a non-invasive point-of-care for parathyroid carcinoma diagnosis and follow-up, we analyzed BC200 expression in patients' serum through digital PCR. Our results show that BC200 counts are higher in serum from patients harboring PCa (n=4) compared to patients with parathyroid adenoma (PAd; n=27). Further, in PAd patients circulating BC200 levels are positively correlated with serum total calcium. Then, we found that BC200 is overexpressed in metastatic PCas (n=4) compared to non-metastatic ones (n=9). Finally, the lncRNA expression in PCa patients' serum drops are reduced after parathyroidectomy, suggesting its possible use in the post-operative setting for patients follow-up. Overall, these findings extend the knowledge on BC200 in parathyroid tumors, supporting its role as a useful biomarker for management of PCa.
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Affiliation(s)
- Annamaria Morotti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Pathology, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giulia Passoni
- Division of Pathology, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Borsari
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Pardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vito Guarnieri
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | - Chiara Verdelli
- Laboratory of Experimental Endocrinology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giulia Stefania Tavanti
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Precision Medicine – Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristiana Bianco
- Precision Medicine – Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Sabrina Corbetta
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- *Correspondence: Valentina Vaira, ; Sabrina Corbetta,
| | - Valentina Vaira
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Pathology, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Valentina Vaira, ; Sabrina Corbetta,
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Su C, Zhang J, Yang H, Xu Y, Lu X. Diagnosis and treatment of liver metastases of parathyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:982972. [PMID: 36303876 PMCID: PMC9592764 DOI: 10.3389/fendo.2022.982972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Parathyroid carcinoma (PC) is a very rare endocrine malignancy occurring in less than 1% of all cases of primary hyperparathyroidism (pHPT). The liver is the second most common target organ for distant metastases of PC, but no guidelines are available for the diagnosis and treatment of liver metastases. In this study, we attempted to summarize the characteristics of the diagnosis and treatment of liver metastases based on our patients and other cases reported in the literature. MATERIALS AND METHODS The files of all patients diagnosed with PC with liver metastases summarized at our center between 2000 and 2022 were reviewed, and three datasets from Medline, Web of Science, and Embase were systematically searched to identify relevant articles. RESULTS Three patients with liver metastases from our center and 11 patients from the literature were included in the study. All patients had pHPT with borderline remission of hypercalcemia after each operation. A total of 71.4% of the patients' liver lesions were found by abdominal CT scans, while 35.7% were found by MRI, PET-CT, and fine-needle aspiration biopsy (FNAB), which were also helpful for diagnosis. Eight of nine patients (88.9%) who underwent surgery, radiofrequency ablation (RFA), or transcatheter arterial embolization (TAE) were alive, and only one postoperative patient died after a follow-up of 60 months. CONCLUSIONS PC is a rare malignant tumor prone to recurrence and metastasis, and postoperative reviews should be carried out routinely. Abnormally elevated parathyroid hormone (PTH) and serum calcium can indicate recurrence or metastasis. Enhanced CT and MRI can provide valuable support for the diagnosis of liver metastases, but whether [18F]FDG-PET-CT, [18F]FCH-PET-CT, or [11C]choline-PET-CT can be used as a diagnostic basis requires further study. Resection of liver metastases, segmental hepatectomy, or RFA can significantly improve patients' symptoms.
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Affiliation(s)
- Chaoyun Su
- Department of General Surgery, Beijing Aerospace General Hospital, Beijing, China
| | - Junwei Zhang
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huayu Yang
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yiyao Xu
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yiyao Xu, ; Xin Lu,
| | - Xin Lu
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yiyao Xu, ; Xin Lu,
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Walker M, Silverberg SJ. Nontraditional Aspects of Sporadic Primary Hyperparathyroidism. Endocrinol Metab Clin North Am 2021; 50:629-647. [PMID: 34774238 DOI: 10.1016/j.ecl.2021.07.007] [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] [Indexed: 11/18/2022]
Abstract
Nontraditional aspects of primary hyperparathyroidism refer to the condition's rheumatic, gastrointestinal, cardiovascular, and neuropsychological effects. Although gastrointestinal and rheumatic symptomatology were features of classical primary hyperparathyroidism, they do not seem to be a part of the modern presentation of primary hyperparathyroidism. In contrast, neuropsychological symptoms such as altered mood and cognition, as well as cardiovascular disease, have been associated with the form of primary hyperparathyroidism seen today, but the relationship is not clearly causal. Evidence does not support reversibility after parathyroidectomy and therefore none of the nontraditional manifestations are considered sole indications for recommending surgery at this time.
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Affiliation(s)
- Marcella Walker
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Shonni J Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University, Columbia University Irving Medical Center, New York, NY 10032, USA.
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Erickson AK, Regier PJ, Watt MM, Ham KM, Marvel SJ, Wallace ML, Colopy SA, Scharf VF, Zheng J, Dugat DR, Sumner JP, Howard J, Skinner OT, Mickelson MA, Thieman-Mankin KM, Colee JC. Incidence, survival time, and surgical treatment of parathyroid carcinomas in dogs: 100 cases (2010-2019). J Am Vet Med Assoc 2021; 259:1309-1317. [PMID: 34727057 DOI: 10.2460/javma.20.06.0335] [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: 11/20/2022]
Abstract
OBJECTIVE To evaluate outcomes of dogs with parathyroid carcinoma (PTC) treated by surgical excision and to describe the incidence of postoperative hypocalcemia, degree of hypocalcemia, duration of hospitalization, duration of calcium supplementation, and survival time. ANIMALS 100 client-owned dogs with PTC admitted to academic, referral veterinary institutions. PROCEDURES In a retrospective multi-institutional study, medical records of dogs undergoing surgical excision of PTC between 2010 to 2019 were reviewed. Signalment, relevant medical history, clinical signs, clinicopathologic testing, imaging, surgical findings, intraoperative complications, histologic examination, and survival time were recorded. RESULTS 100 dogs with PTC were included, and 96 dogs had clinical or incidental hypercalcemia. Common clinical signs included polyuria (44%), polydipsia (43%), hind limb paresis (22%), lethargy (21%), and hyporexia (20%). Cervical ultrasonography detected a parathyroid nodule in 91 of 91 dogs, with a single nodule in 70.3% (64/91), 2 nodules in 25.3% (23/91), and ≥ 3 nodules in 4 (4/91)% of dogs. Hypercalcemia resolved in 89 of 96 dogs within 7 days after surgery. Thirty-four percent of dogs developed hypocalcemia, on the basis of individual analyzer ranges, within 1 week after surgery. One dog had metastatic PTC to the prescapular lymph node, and 3 dogs were euthanized for refractory postoperative hypocalcemia. Estimated 1-, 2-, and 3-year survival rates were 84%, 65%, and 51% respectively, with a median survival time of 2 years. CONCLUSIONS AND CLINICAL RELEVANCE Excision of PTC results in resolution of hypercalcemia and excellent long-term tumor control. Surgical excision of PTC is recommended because of resolution of hypercalcemia and a good long-term prognosis. Future prospective studies and long-term follow-up are needed to further assess primary tumor recurrence, metastasis, and incidence of postoperative hypocalcemia.
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Liu R, Gao L, Xia Y, Shi X, Lv K, Xia W, Qiu L, Hu Y, Jiang Y. Locoregional recurrence of parathyroid carcinoma: how to identify this rare but fatal condition using ultrasonography. Endocr J 2021; 68:1179-1186. [PMID: 33967164 DOI: 10.1507/endocrj.ej21-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Parathyroid carcinoma (PC) is a rare condition with propensity to relapse. The purpose of this study was to evaluate the sonographic findings of locoregional recurrences of parathyroid carcinoma, in order to facilitate diagnosis of this condition using ultrasound (US). This was a retrospective observational study including 21 patients confirmed with pathologically confirmed locoregional recurrence of parathyroid carcinoma. All patients had undergone preoperative US examination at a tertiary center. The imaging, clinical and laboratory data of each case were collected. Sonographic appearance of the largest lesion at each recurrence was evaluated by two experienced radiologists according to a pre-agreed protocol. Overall, 29 relapses occurred in 21 patients. The median age of the patients was 45 years (range 24-71 years). The median size of the largest recurrent lesion at each relapse was 1.8 cm (range 0.8-3.8 cm). Ultrasound images showed hypoechoic solid nodules in 28 relapses (96.6%), inhomogeneous echo-texture in 28 relapses (96.6%), intralesional echogenic septa-like structures in 21 relapses (72.4%), intralesional cystic change in two relapses (6.9%), infiltrative or blurred boundary in 20 relapses (69.0%), irregular shape in 22 relapses (75.9%), marked vascularization on color Doppler imaging in 19 relapses (65.5%), multiple lesions in 26 relapses (89.7%), contralateral recurrence in 3 relapses (10.3%), and subcutaneous recurrence in 10 relapses (34.5%). None of the recurrent lesions exhibited calcification. The total size of all the recurrent lesions at each relapse fairly correlated with the serum intact parathyroid hormone levels (r = 0.450; p = 0.014).
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Affiliation(s)
- Ruifeng Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xinlong Shi
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ke Lv
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Weibo Xia
- Department of endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ling Qiu
- Department of Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ya Hu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Wei B, Zhao T, Shen H, Jin M, Zhou Q, Liu X, Wang J, Wang Q. Extended En Bloc Reoperation for Recurrent or Persistent Parathyroid Carcinoma: Analysis of 31 Cases in a Single Institute Experience. Ann Surg Oncol 2021; 29:1208-1215. [PMID: 34694522 DOI: 10.1245/s10434-021-10962-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Parathyroid carcinoma (PC) is a rare malignancy that is difficult to eradicate completely after recurrence. We assessed the efficiency of extended en bloc resection (EEBR) in the management of recurrent or persistent PC. METHODS In this observational cohort study, 31 patients who underwent reoperations for recurrent or persistent PC were enrolled after 2-9 surgeries by other medical teams. EEBRs, which provided the oncologic resection by removing all possible tumor-bearing scar tissues, were adopted in 25 patients. The other 6 with gross infiltration into the upper aerodigestive tract (UAT) underwent less radical procedures for unwillingness to sacrifice laryngeal function. RESULTS The 5-year overall survival (OS) rate after EEBR was 59.6% compared with 16.7% after less radical procedures, with an improved median expected survival time of 90.0 months compared with 13.0 months after local excision. EEBR exhibited a favorable local control of relapses in 84.0% of patients after a median follow-up period of 27.0 months, 40.0% even achieved disease-free survival, although 56.0% had subsequent distant metastases (DMs) and suffered a worse 5-year OS of 36.7% in contrast with 100.0% in the absence of DM (p = 0.011). UAT invasion, rather than age, number of previous operations, or preoperative PTH levels, was the unique independent factor associated with both DM (HR = 5.466, p = 0.006) and mortality (HR = 7.606, p = 0.011). CONCLUSION EEBRs provide better outcomes than other conventional surgical approaches and might offer a second chance of cure for patients with recurrent or persistent PC in the absence of DM.
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Affiliation(s)
- Bojun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Teng Zhao
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Hong Shen
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Quan Zhou
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing Liu
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Jiacheng Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Qian Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
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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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50
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Medina JE, Randolph GW, Angelos P, Zafereo ME, Tufano RP, Kowalski LP, Montenegro FLM, Owen RP, Khafif A, Suárez C, Shaha AR, Rodrigo JP, Krempl GA, Rinaldo A, Silver CE, Ferlito A. Primary hyperparathyroidism: Disease of diverse genetic, symptomatic, and biochemical phenotypes. Head Neck 2021; 43:3996-4009. [PMID: 34541734 DOI: 10.1002/hed.26861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/08/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Genetic, symptomatic, and biochemical heterogeneity of patients with primary hyperparathyroidism (PHPT) has become apparent in recent years. An in-depth, evidence-based review of the phenotypes of PHPT was conducted. This review was intended to provide the resulting information to surgeons who operate on patients with hyperparathyroidism. This review revealed that the once relatively clear distinction between familial and sporadic PHPT has become more challenging by the finding of various germline mutations in patients with seemingly sporadic PHPT. On the one hand, the genetic and clinical characteristics of some syndromes in which PHPT is an important component are now better understood. On the other hand, knowledge is emerging about novel syndromes, such as the rare multiple endocrine neoplasia type IV (MEN4), in which PHPT occurs frequently. It also revealed that, currently, the classical array of symptoms of PHPT is seen rarely upon initial presentation for evaluation. More common are nonspecific, nonclassical symptoms and signs of PHPT. In areas of the world where serum calcium levels are checked routinely, most patients today are "asymptomatic" and they are diagnosed after an incidental finding of hypercalcemia; however, some of them have subclinical involvement of bones and kidneys, which is demonstrated on radiographs, ultrasound, and modern imaging techniques. Last, the review points out that there are three distinct biochemical phenotypes of PHPT. The classical phenotype in which calcium and parathyroid hormone levels are both elevated, and other disease presentations in which the serum levels of calcium or intact parathyroid hormone are normal. Today several, distinct phenotypes of the disease can be identified, and they have implications in the diagnostic evaluation and treatment of patients, as well as possible screening of relatives.
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Affiliation(s)
- Jesus E Medina
- Department of Otolaryngology and Head and Neck Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Mark E Zafereo
- Head and Neck Endocrine Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, USA
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, São Paulo, Brazil.,Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Fabio L M Montenegro
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Randall P Owen
- Division of Surgical Oncology, Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Juan P Rodrigo
- University of Oviedo, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Greg A Krempl
- Department of Otolaryngology and Head and Neck Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | | | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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