Preoperative inflammatory markers for predicting parathyroid carcinoma

Approach to the Patient With Parathyroid Carcinoma

Parathyroid carcinoma (PC) is usually associated with severe symptomatic primary hyperparathyroidism (PHPT) and accounts for less than 1% of all cases of PHPT and approximately 0.005% of all cancers. PC most commonly occurs as a sporadic disease and somatic CDC73 mutations can be detected in up to 80% of cases. Approximately 30% of patients harbor a germline mutation of the CDC73 gene. Preoperative diagnosis of PC is difficult because no disease-specific markers are available, and PC should be suspected in patients with severe hypercalcemia and end-organ complications. The diagnosis is based on the evidence of invasive tumor growth at histology and/or metastases. En bloc resection of the tumor, together with the ipsilateral thyroid lobe and adjacent structures, should be performed by an experienced surgeon when PC is suspected. This surgical approach reduces the risk of recurrence and metastasis and offers the highest chance of cure. Nonetheless, PC has a recurrence rate of 40% to 60% and, if feasible, multiple surgical procedures should be performed. When surgery is no longer an option, medical treatment is aimed to reduce hypercalcemia and target organ complications. Targeted agents have been effectively used in a few cases. We describe herein a patient with severe PHPT due to PC and provide a systematic diagnostic and treatment approach. A thorough review of the medical history, a typical clinical and biochemical phenotype and, in some cases, the revision of the histological examination provide the clues for the diagnosis of PC.

Predicting coexisting thyroid cancer with primary hyperparathyroidism in an endemic region of multinodular goiter: evaluating the effectiveness of preoperative inflammatory markers

Purpose

The aim is to examine the efficacy of inflammatory indicators to predict thyroid cancer in patients with primary hyperparathyroidism (PHPT) in an endemic region of nodular goiter.

Methods

The prospective database was reviewed to identify patients operated on with the diagnosis of PHPT and thyroid disease between April 2015 and June 2021. Permanent pathologic reports were used as the gold standard for diagnosis. Detailed imaging data with peripheral blood inflammation indices were analyzed to assess their predictive values for concomitant PHPT with thyroid cancer. Postoperative complications and the duration of hospitalization were also reviewed.

Results

Thyroid malignancy accompanying PHPT was found in 13 patients (26.0%) out of 50 who had concurrent surgery. The analysis regarding inflammatory indexes revealed nothing significant between thyroid cancer and preoperative blood biochemistry (P > 0.05). In the concurrent surgery group, recurrent laryngeal nerve injury was observed in 1 patient (2.0%) and the mean hospital stay was longer.

Conclusion

In endemic regions of nodular thyroid disease, thyroid cancer might accompany PHPT. The value of inflammatory indexes to predict thyroid malignancy in PHPT is controversial and should not be employed in the surgical decision-making process.

Primary hyperparathyroidism-induced brown tumors caused by parathyroid carcinoma: a case report and literature review

Brown tumors represent a benign disease that is induced by primary or secondary hyperparathyroidism, with the pathological feature of osteitis fibrosa cystica. Primary hyperparathyroidism caused by parathyroid carcinoma resulting in brown tumors is extremely rare. Herein, we report the case of a 60-year-old male patient who was admitted for giant cell tumors of the bone with local pain and limited movement of the left knee joint. With early detection of multifocal osteolytic bone lesions, hyperparathyroidism (parathyroid hormone: 2365.00 pg/mL), and parathyroid cancer, the diagnosis of brown tumors was confirmed without any unnecessary or harmful interventions. Thereafter, he underwent parathyroidectomy, from which postoperative pathology confirmed parathyroid carcinoma, and total knee arthroplasty to restore movement of the knee joint. Seven months after surgery, the left knee joint had good range of movement. This case emphasizes that detecting patients’ parathyroid hormone levels should not be neglected when diagnosing multifocal osteolytic bone lesions. A comprehensive analysis combining clinical symptoms, imaging, and laboratory tests is conducive to accurate disease assessments and avoiding unnecessary or even survival-impairing surgery. However, when the tumor involves a large joint or seriously affects joint movement, surgery may be worth considering.