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Issa PP, Kandil E, Lee GS. Radiofrequency ablation as a treatment modality for primary hyperparathyroidism: a systematic literature review. Gland Surg 2024; 13:87-99. [PMID: 38323227 PMCID: PMC10839703 DOI: 10.21037/gs-22-546] [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: 09/21/2022] [Accepted: 05/19/2023] [Indexed: 02/08/2024]
Abstract
Background Primary hyperparathyroidism (pHPT) is an endocrine disorder typically characterized by elevated serum calcium and elevated parathyroid hormone (PTH). While parathyroidectomy is the standard treatment, non-operative intervention such as radiofrequency ablation (RFA) has been adopted as an alternative for the management of pHPT, as it has been utilized in other endocrine glands such as thyroid and adrenal. In this literature review, we aim to evaluate the current practice of RFA for pHPT. Methods A systematic literature search using PubMed, Web of Science, and Embase through June 2022 was conducted. Studies included in the review consisted of patient cohorts who had an unequivocal diagnosis of pHPT and underwent the treatment of pHPT with RFA. When more than one study was published from a similar cohort of patients, only the study with the most number of patients was considered. Studies included were assessed for bias using the critical appraisal instruments from the Joanna Briggs Institute (JBI) System. Results A total of 14 studies describing 167 parathyroid glands treated in 163 patients were reviewed. The overall cure rate was 91.2%, with 5 patients undergoing more than one ablation. The most common adverse effect encountered was temporary dysphonia. Incomplete ablation and missed multiglandular disease were the most common reasons for RFA treatment failure. Conclusions RFA may be an effective and safe alternative to parathyroidectomy in select patients with a well-localized, well-located parathyroid adenoma. Additional long-term data are needed to refine its role in the pHPT treatment algorithm.
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Affiliation(s)
- Peter P. Issa
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Grace S. Lee
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Gurrado A, Pasculli A, Avenia N, Bellantone R, Boniardi M, Merante Boschin I, Calò PG, Camandona M, Cavallaro G, Cianchi F, Conzo G, D’Andrea V, De Crea C, De Pasquale L, Del Rio P, Di Meo G, Dionigi G, Dobrinja C, Docimo G, Famà F, Galimberti A, Giacomelli L, Graceffa G, Iacobone M, Innaro N, Lombardi CP, Materazzi G, Medas F, Mullineris B, Oragano L, Palestini N, Perigli G, Pezzolla A, Prete FP, Raffaelli M, Renzulli G, Rosato L, Scerrino G, Sgaramella LI, Sorrenti S, Testini C, Veroux M, Gasparri G, Testini M, pTRANI Study Group. Parathyroid Retrospective Analysis of Neoplasms Incidence (pTRANI Study): An Italian Multicenter Study on Parathyroid Carcinoma and Atypical Parathyroid Tumour. J Clin Med 2023; 12:6297. [PMID: 37834940 PMCID: PMC10573774 DOI: 10.3390/jcm12196297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Parathyroid cancer (PC) is a rare sporadic or hereditary malignancy whose histologic features were redefined with the 2022 WHO classification. A total of 24 Italian institutions designed this multicenter study to specify PC incidence, describe its clinical, functional, and imaging characteristics and improve its differentiation from the atypical parathyroid tumour (APT). METHODS All relevant information was collected about PC and APT patients treated between 2009 and 2021. RESULTS Among 8361 parathyroidectomies, 351 patients (mean age 59.0 ± 14.5; F = 210, 59.8%) were divided into the APT (n = 226, 2.8%) and PC group (n = 125, 1.5%). PC showed significantly higher rates (p < 0.05) of bone involvement, abdominal, and neurological symptoms than APT (48.8% vs. 35.0%, 17.6% vs. 7.1%, 13.6% vs. 5.3%, respectively). Ultrasound (US) diameter >3 cm (30.9% vs. 19.3%, p = 0.049) was significantly more common in the PC. A significantly higher frequency of local recurrences was observed in the PC (8.0% vs. 2.7%, p = 0.022). Mortality due to consequences of cancer or uncontrolled hyperparathyroidism was 3.3%. CONCLUSIONS Symptomatic hyperparathyroidism, high PTH and albumin-corrected serum calcium values, and a US diameter >3 cm may be considered features differentiating PC from APT. 2022 WHO criteria did not impact the diagnosis.
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Affiliation(s)
- Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University Medical School of Bari, 70124 Bari, Italy; (A.G.); (G.D.M.); (A.P.); (F.P.P.); (L.I.S.); (M.T.)
| | - Alessandro Pasculli
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University Medical School of Bari, 70124 Bari, Italy; (A.G.); (G.D.M.); (A.P.); (F.P.P.); (L.I.S.); (M.T.)
| | - Nicola Avenia
- General and Endocrine Surgery Unit, S. Maria University Hospital, University of Perugia, 05100 Terni, Italy;
| | - Rocco Bellantone
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy;
| | - Marco Boniardi
- General Oncology and Mini-Invasive Surgery Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Isabella Merante Boschin
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35143 Padua, Italy; (I.M.B.); (M.I.)
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (P.G.C.); (F.M.)
| | - Michele Camandona
- Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy; (M.C.); (G.G.)
| | - Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, 00185 Rome, Italy;
| | - Fabio Cianchi
- Digestive Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.C.); (G.P.); (C.T.)
| | - Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Medical and Traslational Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University, 00185 Rome, Italy;
| | - Carmela De Crea
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (C.D.C.); (M.R.)
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Paolo Del Rio
- Department of General and Specialist Surgery, Parma University Hospital, University of Parma, 43126 Parma, Italy;
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University Medical School of Bari, 70124 Bari, Italy; (A.G.); (G.D.M.); (A.P.); (F.P.P.); (L.I.S.); (M.T.)
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Chiara Dobrinja
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34125 Trieste, Italy;
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy;
| | - Fausto Famà
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, 98125 Messina, Italy;
| | | | - Laura Giacomelli
- Department of General and Speciality Surgery, Sapienza University, 00185 Rome, Italy;
| | - Giuseppa Graceffa
- Department of Surgical Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.G.); (G.S.)
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35143 Padua, Italy; (I.M.B.); (M.I.)
| | - Nadia Innaro
- Unit of Endocrine Surgery, AOU “Dulbecco”, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Celestino Pio Lombardi
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy;
| | - Gabriele Materazzi
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, 56121 Pisa, Italy;
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (P.G.C.); (F.M.)
| | - Barbara Mullineris
- Unit of General Surgery, Emergency and New Technologies, Modena Hospital, 41126 Modena, Italy;
| | - Luigi Oragano
- Surgical Unit of General Surgery, “San Biagio” Hospital, 28845 Domodossola, Italy;
| | - Nicola Palestini
- Candiolo Cancer Institute, Fondazione Piemontese per l’Oncologia, 10060 Candiolo, Italy;
| | - Giuliano Perigli
- Digestive Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.C.); (G.P.); (C.T.)
| | - Angela Pezzolla
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University Medical School of Bari, 70124 Bari, Italy; (A.G.); (G.D.M.); (A.P.); (F.P.P.); (L.I.S.); (M.T.)
| | - Francesco Paolo Prete
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University Medical School of Bari, 70124 Bari, Italy; (A.G.); (G.D.M.); (A.P.); (F.P.P.); (L.I.S.); (M.T.)
| | - Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (C.D.C.); (M.R.)
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppina Renzulli
- Unit of Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University Medical School of Bari, 70124 Bari, Italy;
| | - Lodovico Rosato
- Department of Surgery-ASL TO4, Ivrea Hospital, 10015 Ivrea, Italy;
| | - Gregorio Scerrino
- Department of Surgical Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.G.); (G.S.)
| | - Lucia Ilaria Sgaramella
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University Medical School of Bari, 70124 Bari, Italy; (A.G.); (G.D.M.); (A.P.); (F.P.P.); (L.I.S.); (M.T.)
| | | | - Carlotta Testini
- Digestive Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.C.); (G.P.); (C.T.)
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, 95100 Catania, Italy;
| | - Guido Gasparri
- Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy; (M.C.); (G.G.)
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University Medical School of Bari, 70124 Bari, Italy; (A.G.); (G.D.M.); (A.P.); (F.P.P.); (L.I.S.); (M.T.)
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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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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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Chen CC, Chen HL, Chiang PL, Luo SD, Chang YH, Chen WC, Wang CK, Lin AN, Chen YS, Chi SY, Lin WC. Efficacy and safety of radiofrequency ablation for primary and secondary hyperparathyroidism with or without previous parathyroidectomy: a retrospective study. Int J Hyperthermia 2022; 39:907-917. [PMID: 35848429 DOI: 10.1080/02656736.2022.2097324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION This study aimed to investigate and compare the therapeutic efficacy and safety of ultrasound-guided radiofrequency ablation (RFA), between primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) patients, with or without previous parathyroidectomy (PTX). SUBJECTS AND METHODS A total of 21 patients (7 PHPT, 14 SHPT) underwent RFA for hyperparathyroidism (HPT) at Kaohsiung Chang Gung Memorial Hospital, Taiwan. Five of the 14 SHPT patients had previously received PTX. The laboratory data, volume change of each parathyroid nodule, symptomatic scores, and complications were analyzed and compared between all groups at 1 and 7 days, and at 1, 3, 6, and 12 months after RFA. RESULTS After RFA, the volume reduction ratio (VRR) for all patients at the last follow-up was 93.76%, and clinical symptoms significantly improved. At 12 months, all PHPT patients achieved successful treatment of intact PTH (iPTH). In SHPT patients, the mean iPTH value significantly decreased 1-day post-RFA, subsequently exhibiting a transient rebound which proceeded to decrease, with 57.1% reaching successful treatment standards. SHPT patients with PTX showed a lower complication score, shorter ablation time, higher iPTH baseline and outcomes, and lower VRR, compared to patients without PTX. The serum calcium level significantly decreased to normal range in 85.7% of all patients at 12 months. Severe hypocalcemia occurred in 23.8% at 1 week, and all were corrected with calcium supplements. CONCLUSIONS RFA demonstrates a therapeutic efficacy similar to PTX. It can thus be considered an effective alternative treatment for PHPT, SHPT, or post-PTX patients who are unsuitable for another PTX.
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Affiliation(s)
- Chi-Cheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Ohkuwa K, Sugino K, Katoh R, Nagahama M, Kitagawa W, Matsuzu K, Suzuki A, Tomoda C, Hames K, Akaishi J, Masaki C, Yoshioka K, Ito K. Preoperative inflammatory markers for predicting parathyroid carcinoma. Endocr Connect 2022; 11:EC-22-0062. [PMID: 35700222 PMCID: PMC9346317 DOI: 10.1530/ec-22-0062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Parathyroid carcinoma is a rare tumor among parathyroid tumors. Aspiration cytology and needle biopsy are generally not recommended for diagnostic purposes because they cause dissemination. Therefore, it is commonly diagnosed by postoperative histopathological examination. In this study, we investigated whether preoperative inflammatory markers can be used as predictors of cancer in patients with primary hyperparathyroidism. DESIGN This was a retrospective study. METHODS Thirty-six cases of parathyroid carcinoma and 50 cases of parathyroid adenoma (PA) operated with the diagnosis of primary hyperparathyroidism and confirmed histopathologically at Ito Hospital were included in this study. Preoperative clinical characteristics and inflammatory markers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio (LMR)) were compared and their values in preoperative prediction were evaluated and analyzed. RESULTS Preoperative intact-parathyroid hormone (P = 0.0003), serum calcium (P = 0.0048), and tumor diameter (P = 0.0002) were significantly higher in parathyroid carcinoma than in PA. LMR showed a significant decrease in parathyroid carcinoma (P = 0.0062). In multivariate analysis, LMR and tumor length diameter were independent predictors. In the receiver operating characteristics analysis, the cut-off values for LMR and tumor length diameter were 4.85 and 28.0 mm, respectively, for parathyroid cancer prediction. When the two extracted factors were stratified by the number of factors held, the predictive ability improved as the number of factors increased. CONCLUSION In the preoperative evaluation, a combination of tumor length diameter of more than 28 mm and LMR of less than 4.85 was considered to have a high probability of cancer.
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Affiliation(s)
- Keiko Ohkuwa
- Department of Surgery, Ito Hospital, Tokyo, Japan
- Correspondence should be addressed to K Ohkuwa:
| | | | - Ryohei Katoh
- Department of Pathology, Ito Hospital, Tokyo, Japan
| | | | | | | | | | | | - Kiyomi Hames
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | | | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | | | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo, Japan
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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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Wang Q, Wang J, Xin Y, He Z, Zhou X, Liu X, Zhao T, He L, Shen H, Jin M, Wei B. Hsa_circ_0005729 enhances accuracy in diagnosing parathyroid carcinoma. Endocr Connect 2022; 11:EC-21-0605.R1. [PMID: 35029546 PMCID: PMC8859958 DOI: 10.1530/ec-21-0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/14/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Parathyroid carcinoma (PC), often misdiagnosed as a parathyroid adenoma (PA), is prone to local relapse due to the initial surgery being restricted to parathyroid lesions instead of en bloc resection of parathyroid lesions with negative incision margins. However, it is very challenging to distinguish PC from PA preoperatively; hence, this study investigated an effective biomarker for increasing accuracy in PC diagnosis. METHOD First, the differentially expressed circular RNAs between three PC tissues and three PA tissues were screened by high-throughput circular RNA sequencing, and the expression of hsa_circ_0005729 was verified by qRT-PCR in 14 patients with PC and 40 patients with PA. Secondly, the receiver operating characteristic curve and the area under the curve (AUC) were used to analyze the diagnostic efficiency of hsa_circ_0005729 in PC by combining with laboratory data. Thirdly, RNF138mRNA, the corresponding linear transcript of hsa_circ_0005729, was measured, and the relationship between hsa_circ_0005729 and RNF138 mRNA was analyzed in patients with PA and patients with PC. RESULTS Hsa_circ_0005729 expression was significantly higher in patients with PC than in patients with PA. Serum calcium (P = 0.045), alkaline phosphatase (ALP) (P = 0.048), and creatinine levels (P = 0.036) were significantly higher in patients with PC than in patients with PA. The AUC increased to 0.86 when hsa_circ_0005729 combined with serum calcium, creatinine, and ALP. In addition, hsa_circ_0005729 was positively correlated with RNF138 mRNA in patients with PA but not in patients with PC. CONCLUSION The novel circular RNA hsa_circ_0005729 was found to have a higher expression in patients with PC, indicating its usefulness for distinguishing PC from PA.
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Affiliation(s)
- 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
| | - Yunhui Xin
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ziyang He
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiang Zhou
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xing Liu
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Teng Zhao
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lihan He
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong Shen
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bojun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to B Wei:
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Chai HH, Zhao Y, Zeng Z, Ye RZ, Hu QH, He HF, Baek JH, Peng CZ. Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation for Primary Hyperparathyroidism: A Prospective Study. Korean J Radiol 2022; 23:555-565. [PMID: 35506529 PMCID: PMC9081691 DOI: 10.3348/kjr.2021.0716] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To assess the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT). Materials and Methods This prospective study enrolled 39 participants (14 male, 25 female; mean age, 59.5 ± 15.3 [range, 18–87] years) between September 1, 2018, and January 31, 2021. All participants had parathyroid lesions causing PHPT, proven biochemically and through imaging. The imaging features of the PHPT nodules, including the shape, margin, size, composition, and location, were evaluated before treatment. Serum intact parathyroid hormone, calcium, and phosphorus levels; parathyroid nodule volume; and PHPT-related symptoms were recorded before and after treatment. We calculated the technical success, biochemical cure, and clinical cure rates for these patients. Complications were evaluated during and after the ablation. Results Complete ablation was achieved in 38 of the 39 nodules in the 39 enrolled participants. All the patients were treated in one session. The technical success rate was 97.4% (38/39). The mean follow-up duration was 13.2 ± 4.6 (range, 6.0–24.9) months. At 6 and 12 months post-RFA, the biochemical cure rates were 82.1% (32/39) and 84.4% (27/32), respectively, and the clinical cure rates were 100% (39/39) and 96.9% (31/32), respectively. Only 2.6% (1/39) of the patients had recurrent PHPT. At 1, 3, 6, and 12 months after technically successful RFA, 44.7% (17/38), 34.3% (12/35), 15.8% (6/38), and 12.5% (4/32) of participants, respectively, had elevated eucalcemic parathyroid hormone levels. Recurrent laryngeal nerve paralysis occurred in 5.1% (2/39) of the patients, who recovered spontaneously within 1–3 months. Conclusion US-guided RFA was effective and safe for PHPT patients. RFA may be an alternative treatment tool for patients who cannot tolerate or refuse to undergo surgery.
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Affiliation(s)
- Hui-hui Chai
- Department of Graduate, Bengbu Medical College, Bengbu, China
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yu Zhao
- Health Management Center, Department of Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, China
| | - Zeng Zeng
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Rui-zhong Ye
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Qiao-hong Hu
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Hong-feng He
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheng-zhong Peng
- Department of Graduate, Bengbu Medical College, Bengbu, China
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
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10
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Bollen H, Decallonne B, Nuyts S. Radiation Treatment for Inoperable Local Relapse of Parathyroid Carcinoma With Symptomatic Hypercalcemia: A Case Report. Front Oncol 2021; 11:733772. [PMID: 34900684 PMCID: PMC8656308 DOI: 10.3389/fonc.2021.733772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/10/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is an extremely rare malignancy, characterized by slow progression, frequent recurrences and difficult-to-control hypercalcemia which is typically the main contributor to the morbidity and mortality of these patients. Patients often undergo repeated surgical resections, whether or not in combination with adjuvant radiation treatment. The role of radiation therapy within the symptomatic treatment of PC currently remains unclear. CASE DESCRIPTION We describe a 30-year-old male patient with an inoperable local relapse of PC and secondary symptomatic hypercalcemia, maximally pharmacologically treated. After a local radiation treatment to a total dose of 70 Gray in 35 fractions serum calcium and parathyroid hormone (PTH) levels decreased, accompanied by improvement of the severe gastro-intestinal disturbances. CONCLUSION For patients with inoperable symptomatic PC despite maximal medical treatment who are in a good overall condition, radiation treatment can be considered in well-defined cases to decrease symptoms and improve quality of life.
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Affiliation(s)
- Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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11
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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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Shah R, Gosavi V, Mahajan A, Sonawane S, Hira P, Kurki V, Bal M, Sathe P, Pai P, D'Cruz A, Uchino S, Garale MN, Patil V, Lila A, Shah N, Bandgar T. Preoperative prediction of parathyroid carcinoma in an Asian Indian cohort. Head Neck 2021; 43:2069-2080. [PMID: 33751728 DOI: 10.1002/hed.26677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/08/2021] [Accepted: 02/26/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) requires preoperative prediction for appropriate surgical management. Differentiation from symptomatic primary hyperparathyroidism (sPHPT) cohort is difficult. METHODS Patients with sPHPT from a tertiary-care center, Western India, including Cohort-A (n = 19 [10/M; 9/F]) with PC and Cohort-B (n = 93 [33/M; 60/F] with benign parathyroid lesions) were compared to derive predictors for differential diagnosis. RESULTS There were no differences in clinical or biochemical parameters between the two cohorts. Comparison of CECT parameters showed that irregular shape, tumor heterogeneity, infiltration, short/long-axis ratio >0.76, and long-diameter >30 mm had high negative-predictive value and intratumoral calcification had 100% positive-predictive value to diagnose PC; whereas there were no differences in contrast-enhancement patterns. Long diameter, short/long-axis ratio, and heterogeneity were significant predictors on multivariate analysis. CONCLUSION It is difficult to predict diagnosis of PC in an Indian sPHPT cohort based on clinical and biochemical parameters, whereas CECT parathyroid-based parameters can aid in diagnosis.
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Affiliation(s)
- Ravikumar Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Vikrant Gosavi
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Center, Mumbai, India
| | - Sushil Sonawane
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Priya Hira
- Department of Radiology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Vineeth Kurki
- Department of Radiodiagnosis and Imaging, Tata Memorial Center, Mumbai, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Center, Mumbai, India
| | - Pragati Sathe
- Department of Pathology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Prathamesh Pai
- Department of Head & Neck Surgical Oncology, Tata Memorial Center, Mumbai, India
| | - Anil D'Cruz
- Department of Head & Neck Surgical Oncology, Apollo Hospital, Navi Mumbai, India
| | - Shinya Uchino
- Noguchi Thyroid Clinic and Hospital Foundation, Beppu, Oita, Japan
| | - Mahadeo Namdeo Garale
- Department of General Surgery, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Virendra Patil
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Anurag Lila
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Nalini Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
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Davies MP, John Evans TW, Tahir F, Balasubramanian SP. Parathyroid cancer: A systematic review of diagnostic biomarkers. Surgeon 2021; 19:e536-e548. [PMID: 33642204 DOI: 10.1016/j.surge.2021.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Parathyroid cancers are rare and difficult to distinguish from benign parathyroid tumours. Prediction of malignancy often relies on intraoperative assessment of invasion. Standard histology is also inadequate; especially in the absence of local invasion, lymph nodal disease and metastasis. The aim of this project was to systematically review published literature on potential bio-markers used for the diagnosis of parathyroid cancer. METHODS Pubmed, Web of Science and Medline databases were searched. Inclusion criteria included English language papers published after 1985 and reporting on biomarkers in human studies of parathyroid cancer and benign disease. RESULTS 118 relevant papers were appraised; all were observational studies. At least 2 papers studied 8 serum, 4 urine and 27 tissue biomarkers on the diagnosis of parathyroid cancer. Of these, 5 serum and 13 tissue markers have been demonstrated in at least one study to be statistically different in benign and malignant disease. We present a synthesis of data for each biomarker and measures of diagnostic accuracy where possible. CONCLUSIONS Consideration should be given to the use of a panel of biomarkers to review patients with suspected parathyroid cancer. A profile including serum calcium and PTH levels and tissue expression of APC, Parafibromin, PGP9.5, Galectin 3 and Ki67 is proposed. Systematic Review Registration Number - CRD42019127833.
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Affiliation(s)
- Matthew Philip Davies
- Faculty of Medicine, Dentistry and Health, The University of Sheffield, United Kingdom.
| | | | - Fawzia Tahir
- Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Saba P Balasubramanian
- Faculty of Medicine, Dentistry and Health, The University of Sheffield, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
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Apaydın T, Yavuz DG. Seven cases of parathyroid carcinoma and review of the literature. Hormones (Athens) 2021; 20:189-195. [PMID: 32578053 DOI: 10.1007/s42000-020-00220-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
Parathyroid cancer is a rare malignancy and an uncommon cause of hyperparathyroidism. In the present study, we present seven cases of parathyroid carcinoma. The female ratio was 5/7 (71.4%). Median age at diagnosis was 47 years, and median follow-up duration was 60 months (IQR 29-75). Mean calcium level at diagnosis was 12.7 mg/dL (range, 11.3-13.9), and mean parathormone level was 1115 ng/L (IQR 287-1470). Two patients (28.5%) had a palpable neck mass. Coexisting brown tumor was present in three patients (42.8%), and nephrolithiasis was found in one patient (14.2). Average tumor size was 29 mm (IQR 28-40). Capsular and vascular invasion were detected in six patients (85.7%), intrathyroidal spread was observed in two patients (28.5%), and soft tissue invasion was seen in three patients (42.8%). Parathyroid adenoma was present in one patient and parathyroid gland hyperplasia in another patient. Adjuvant radiotherapy was given to four patients (57.1%). There was no metastatic disease or death. At the last visit, two patients had increased parathormone levels and no additional focus could be detected in either. Patients with markedly elevated parathormone and calcium levels and a palpable larger mass on the neck should be evaluated for parathyroid cancer. En bloc resection is the mainstay treatment. Despite contradictory results, adjuvant radiotherapy to the neck may help to reduce the risk of local recurrence in patients with microscopic residual parathyroid carcinoma.
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Affiliation(s)
- Tugce Apaydın
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey.
| | - Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
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15
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Lin X, Fan Y, Zhang Z, Yue H. Clinical Characteristics of Primary Hyperparathyroidism: 15-Year Experience of 457 Patients in a Single Center in China. Front Endocrinol (Lausanne) 2021; 12:602221. [PMID: 33716964 PMCID: PMC7947808 DOI: 10.3389/fendo.2021.602221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022] Open
Abstract
Objective Primary hyperparathyroidism (PHPT) is a common endocrine disorder of calcium metabolism. However, data concerning a large cohort of PHPT patients in the Chinese population are scarce. Thus, the objective of this study was to determine the general clinical signatures of 457 Chinese PHPT patients and explore the clinical characteristic differences between benign and malignant PHPT. Methods A single-center retrospective study was designed. Medical records between preoperation and postoperative follow-up, were assessed and statistical analysis of the clinical data was performed. Results Patients with PHPT aged 12-87 years, with a mean onset age of 56.16 ± 14.60 years, were included. Most patients (68.7%) in our center had symptomatic patterns described as bone pain (74.8%), urolithiasis (25.5%), fatigue (17.5%), and pathological fracture (13.1%), but an increasing tendency has been established in the proportion of patients with asymptomatic forms. Correlation analysis revealed that patients with higher serum levels of parathyroid hormone (PTH) and calcium presented higher serum levels of bone turnover markers (BTMs) and lower 25-hydroxy-vitamin D (25OHD) values (P<0.001). Gains in bone mineral density (BMD) at L1-4, the femoral neck and the total hip were observed 1-2 years after parathyroidectomy (9.6, 5.9, and 6.8%). Parathyroid carcinoma patients presented prominently higher serum PTH and calcium levels and BTMs and lower BMD at femoral neck and total hip than benign PHPT patients (P<0.05), while no significant differences in age, sex, and serum 25OHD concentration were observed between benign and malignant PHPT patients. Conclusions PHPT should be paid attention to in the patients with bone pain. While, BMD and BTMs can differentiate parathyroid carcinoma from parathyroid adenoma and hyperplasia to some extent. In addition, anti-osteoporosis drugs could be used when necessary to avoid hip fractures in patients with parathyroid carcinoma.
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Affiliation(s)
- Xiaoyun Lin
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Youben Fan
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhenlin Zhang
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Hua Yue
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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16
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Yu Y, Wang Y, Wu Q, Zhao X, Liu D, Zhao Y, Li Y, Wang G, Xu J, Chen J, Zhang N, Tian X. Case Report and Systematic Review: Sarcomatoid Parathyroid Carcinoma-A Rare, Highly Malignant Subtype. Front Endocrinol (Lausanne) 2021; 12:793718. [PMID: 34975762 PMCID: PMC8719313 DOI: 10.3389/fendo.2021.793718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is a rare malignancy, the incidence of which is less than 1/1 million per year. Sarcomatoid parathyroid carcinoma (SaPC) is an extremely peculiar subtype; only three cases have been reported internationally. It consists of both malignant epithelial components and sarcomatoid components (mesenchymal origin) simultaneously. This "confusing" cancer exhibits higher invasiveness, and traditional surgery does not appear to achieve the expectation, which differs significantly from that of general PC. OBJECTIVE To characterize the clinicopathologic features of SaPC and explore similarities and differences between SaPC and general PC. MATERIALS AND METHODS We collected clinical data of SaPC cases from our center and literature. The SaPC case in our center was presented. To better understand the characteristics of SaPC, we also reviewed clinical information in general PC cases from our center and literature within the last 5 years, and a systematic review was performed for further comparison. RESULTS A 60-year-old woman was admitted for a neck mass and hoarseness. After the surgery, she was confirmed as SaPC and ultimately developed local recurrence at 3 months. Together with the reported cases from literature, four cases of SaPC (three cases from literature) and 203 cases of general PC (200 cases from literature) were reviewed. Both tumors showed obvious abnormalities in parathormone (PTH) level and gland size. Compared to general PC, SaPC has a later age of onset (60.50 ± 7.42 vs. 51.50 ± 8.29), relatively low levels of PTH (110.28 ± 59.32 vs. 1,156.07 ± 858.18), and a larger tumor size (6.00 ± 1.63 vs. 3.14 ± 0.70). For SaPC, all four cases were initially misdiagnosed as thyroid tumors (4/4). Spindle cell areas or transitional zones were common pathological features in SaPC cases (3/4). CONCLUSION SaPC is a very rare pathologic subtype of PC and appears to be much more easily misdiagnosed as a thyroid tumor. Spindle cell areas or transitional zones are highly possible to be pathological features in its sarcomatoid components. Despite many similarities, there are some differences between SaPC and general PC-SaPC does not show the obvious endocrine feature but stronger aggressiveness. Surgical treatment of SaPC does relieve life-threatening symptoms and improve quality of life even with recurrence in the short term.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ning Zhang
- *Correspondence: Xiaofeng Tian, ; Ning Zhang,
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Hu L, Xie X. Parathyroid carcinoma with sarcomatoid differentiation: a case report and literature review. Diagn Pathol 2020; 15:142. [PMID: 33317559 PMCID: PMC7737283 DOI: 10.1186/s13000-020-01060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Parathyroid carcinoma (PC) is a rare thyroid tumor. PC with sarcomatoid differentiation(PCSD) is even rarer and its exact etiology remains unclear. We here report a case of PCSD, and present the clinicopathological features and pathological diagnosis and review the literature. Case presentation A 71-year-old man presented with a mass of 4.5 cm × 3.5 cm in the right neck. The tumor was composed of nest-like transparent cells, and the septum had heterotypic rhabdoid cells with sarcomatoid differentiation. Immunophenotype was as follows: myogenic differentiation 1(MyoD1), myogenin and desmin were positive; clear cells were positive for chromogranin A(CGA), synaptophysin(Syn) and GATA-3; and Ki-67 proliferation index was 40%. Hematoxylin and eosin staining and immunohistochemistry were performed. The patient was diagnosed with PCSD, and died 6 months after surgery. Conclusions PCSD is a rare type of primary parathyroid tumor with high malignancy and poor prognosis. Definitive diagnosis should be based on histopathological morphology and immunophenotype, and surgical treatment should be performed as soon as possible.
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Affiliation(s)
- Liang Hu
- Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, PR China
| | - Xiaojun Xie
- Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, PR China.
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Rodrigo JP, Hernandez-Prera JC, Randolph GW, Zafereo ME, Hartl DM, Silver CE, Suárez C, Owen RP, Bradford CR, Mäkitie AA, Shaha AR, Bishop JA, Rinaldo A, Ferlito A. Parathyroid cancer: An update. Cancer Treat Rev 2020; 86:102012. [PMID: 32247225 DOI: 10.1016/j.ctrv.2020.102012] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Parathyroid cancer (PC) is a rare malignant tumor which comprises 0.5-5% of patients with primary hyperparathyroidism (PHPT). Most of these cancers are sporadic, although it may also occur as a feature of various genetic syndromes including hyperparathyroidism-jaw tumor syndrome (HPT-JT) and multiple endocrine neoplasia (MEN) types 1 and 2A. Although PC is characterized by high levels of serum ionized calcium (Ca) and parathyroid hormone (PTH), the challenge to the clinician is to distinguish PC from the far more common entities of parathyroid adenoma (PA) or hyperplasia, as there are no specific clinical, biochemical, or radiological characteristic of PC. Complete surgical resection is the only known curative treatment for PC with the surgical approach during initial surgery strongly influencing the outcome. In order to avoid local recurrence, the lesion must be removed en-bloc with clear margins. PC has high recurrence rates of up to 50% but with favorable long-term survival rates (10-year overall survival of 60-70%) due to its slow-growing nature. Most patients die not from tumor burden directly but from uncontrolled severe hypercalcemia. In this article we have updated the information on PC by reviewing the literature over the past 10 years and summarizing the findings of the largest series published in this period.
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Affiliation(s)
- Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain.
| | | | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear, Harvard Medical School Boston, MA, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Dana M Hartl
- Division of Surgical Oncology, Gustave Roussy Cancer Center and Paris-Sud University, Villejuif Cedex, Paris, France
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, CIBERONC, Oviedo, Spain
| | - Randall P Owen
- Division of Surgical Oncology, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok R Shaha
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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19
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Liu J, Zhan W, Zhou J, Zhou W. Role of ultrasound in the differentiation of parathyroid carcinoma and benign parathyroid lesions. Clin Radiol 2020; 75:179-184. [DOI: 10.1016/j.crad.2019.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/01/2019] [Indexed: 12/31/2022]
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Liu R, Xia Y, Chen C, Ye T, Huang X, Ma L, Hu Y, Jiang Y. Ultrasound combined with biochemical parameters can predict parathyroid carcinoma in patients with primary hyperparathyroidism. Endocrine 2019; 66:673-681. [PMID: 31489590 DOI: 10.1007/s12020-019-02069-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/21/2019] [Indexed: 01/03/2023]
Abstract
PURPOSES Parathyroid cancer (PC) is rare, but fatal condition. Preoperative prediction of PC remains challenging but meaningful. The aim of this study was to determine an effective model to predict PC in patients with parathyroid lesions >1.5 cm. METHODS In this retrospective case-control study, we enrolled 30 patients with PC matched to 60 patients with parathyroid adenoma or hyperplasia by admission year. All patients were diagnosed with primary hyperparathyroidism (pHPT) and had parathyroid lesions >1.5 cm. Ultrasonic features of the two patient groups, as well as demographic, clinical, and biochemical characteristics were retrospectively compared. Best subset selection and multivariate logistic regression analysis were conducted to identify the independent risk factors of PC. ROC curve and decision curve analysis were developed to evaluate the applicability of the new model. RESULTS The best subset selection method and multiple logistic regression analysis showed that ultrasonic features of DR (two diameters' ratio of the lesion) and tumor infiltration in conjunction with intact parathyroid hormone (iPTH) level (collective model) were independent predictors of malignancy. Meanwhile, DR, shape, and tumor infiltration (ultrasound model) were found to be risk factors when only ultrasonic features were included in the multivariate analysis. The decision curve analysis showed that collective model outperforms ultrasound model with a better net benefit and a wider range of threshold probabilities. CONCLUSIONS Ultrasonic features in combination with iPTH level may be an applicable model for predicting PC and has a better potential to facilitate decision-making preoperatively.
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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, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Cheng Chen
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Tiantian Ye
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Xuepei Huang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Li Ma
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Ya Hu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China.
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China.
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Buisset C, Demarquet L, Raynal M, Busby H, Nominé-Criqui C, Brunaud L. When a Pathological Forearm Fracture Led to Explore the Neck: About a Case. Head Neck Pathol 2019; 14:828-832. [PMID: 31606867 PMCID: PMC7413925 DOI: 10.1007/s12105-019-01085-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022]
Abstract
The majority of patients with parathyroid carcinoma (PC) have significant clinical signs and simultaneous symptoms related to the unregulated hypersecretion of parathyroid hormone (PTH) by the tumor. The aim of this case was to report a patient presenting an isolated bone fracture leading to the diagnosis of PC. A 20-years-old female patient presenting a fracture of both bones of the forearm following a fall from her own height. Imageries showed diffuse bone demineralization. Biology revealed malignant hypercalcemia at 4.1 mmol/L and PTH at 1331 pg/mL. Bone densitometry showed severe osteoporosis with a femoral and lumbar T-score < - 3DS. Imageries showed a right parathyroid mass of 32 mm. An one-piece excision of the pathological gland, right thyroid lobectomy and ipsilateral central lymph node dissection were performed. Postoperatively, the patient presented a hungry bone syndrome with severe hypocalcemia and required substitutive treatment. PTH on day 1 was normal. Pathology analysis found a PC with Ki67 at 3%, lymph node removal was negative. Complete one-piece surgical excision is the only potentially curative treatment for PC. Preoperative suspicion and intraoperative recognition of malignant features is important in order to propose an appropriate compartmental surgery, which can provide the lowest possible recurrence rate.
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Affiliation(s)
- Cyrille Buisset
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital Nancy Brabois, Rue du Morvan, 54511 Vandoeuvre-Les-Nancy, Grand Est France
| | - Léa Demarquet
- Department of Endocrinology, University Hospital Nancy Brabois, Rue du Morvan, 54511 Vandoeuvre-Les-Nancy, Grand Est France
| | - Marie Raynal
- Department of Rhumatology, University Hospital Nancy Brabois, Rue du Morvan, 54511 Vandoeuvre-Les-Nancy, Grand Est France
| | - Hélène Busby
- Department of Pathology, University Hospital Nancy Brabois, Rue du Morvan, 54511 Vandoeuvre-Les-Nancy, Grand Est France
| | - Claire Nominé-Criqui
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital Nancy Brabois, Rue du Morvan, 54511 Vandoeuvre-Les-Nancy, Grand Est France
| | - Laurent Brunaud
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital Nancy Brabois, Rue du Morvan, 54511 Vandoeuvre-Les-Nancy, Grand Est France
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22
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Ferraro V, Sgaramella LI, Di Meo G, Prete FP, Logoluso F, Minerva F, Noviello M, Renzulli G, Gurrado A, Testini M. Current concepts in parathyroid carcinoma: a single Centre experience. BMC Endocr Disord 2019; 19:46. [PMID: 31142320 PMCID: PMC6541564 DOI: 10.1186/s12902-019-0368-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parathyroid carcinoma is a rare neoplasm that may present sporadically or in the context of a genetic syndrome. Diagnosis and management are challenging due to the lack of clinical and pathological features that may reliably distinguish malignant from benign disease. METHODS From January 2013 to December 2017, from 358 consecutive patients affected by parathyroid diseases, 3 patients with parathyroid carcinoma were treated at our academic Department of General Surgery. We present our experience as illustrative of the different features of clinical presentation of parathyroid carcinoma and review its management considering the recent relevant literature. RESULTS Case 1: A 62-year-old man was hospitalized for left-sided palpable neck mass, hypercalcemia and elevated PTH. US-guided FNA was suspect for parathyroid carcinoma. A large cystic mass was excised in bloc with total thyroidectomy and central neck dissection. Genetic studies framed a pathologically confirmed parathyroid carcinoma within MEN1 syndrome. Case 2: A 48-year-old woman with hypothyroidism had total thyroidectomy performed for a suspect for right follicular thyroid lesion. Pathology revealed parathyroid carcinoma. Case 3: A 47 year-old man was admitted for hypercalcaemic crisis and renal failure in the context of PHPT. A lesion suggestive on US and MIBI scan for parathyroid adenoma in the right lower position was removed by mini-invasive approach. Pathology revealed parathyroid cancer and patient had completion hemythyroidectomy and central neck dissection. CONCLUSION Parathyroid cancer is a particularly rare endocrine malignancy, however it should be suspected in patients with primary hyperparathyroidism when severe hypercalcemia is associated to cervical mass, renal and skeletal disease. Parathyroid surgery remains the mainstay of treatment. Radical tumour resection and expedited treatment in a dedicated endocrine Center represent crucial prognostic factors.
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Affiliation(s)
- Valentina Ferraro
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Lucia Ilaria Sgaramella
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Giovanna Di Meo
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Francesco Paolo Prete
- Department of Emergency and Organ Transplant, University Medical School of Bari, Bari, Italy
| | - Francesco Logoluso
- Department of Emergency and Organ Transplant, University Medical School of Bari, Bari, Italy
| | - Francesco Minerva
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Marica Noviello
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Giuseppina Renzulli
- Interdisciplinary Department of Medicine, University Medical School of Bari, Bari, Italy
| | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
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Relationship Between the Neutrophil to Lymphocyte Ratio and Parathyroid Adenoma Size in Patients With Primary Hyperparathyroidism. Int Surg 2019; 100:1185-9. [PMID: 26595491 DOI: 10.9738/intsurg-d-15-00044.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of our study was to evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and adenoma size in parathyroidectomized patients who underwent a parathyroidectomy. The neutrophil to lymphocyte ratio has recently become popular as a biomarker for malignant diseases or for estimating tumor size preoperatively. This study aimed to estimate the relationship between adenoma size and NLR. Furthermore, we assessed whether a higher level of NLR is correlated with the presence of parathyroid carcinoma. A retrospective chart review was performed for patients with parathyroid adenoma who underwent parathyroidectomy between January 2012 and August 2014. Data related to age, sex, NLR, parathyroid hormone level (PTH), preoperative calcium, phosphorus, adenoma size, and pathology reports were collected. The neutrophil to lymphocyte ratio was significantly correlated with calcium levels, PTH levels, parathyroid adenoma size, and the presence of cancer. However, there was no correlation between NLR and age, sex, and phosphorus levels. This study is the first to document a positive correlation between NLR and parathyroid adenoma size, as well as the presence of cancer, in patients who underwent surgery as a result of primary hyperparathyroidism.
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24
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Korkusuz H, Wolf T, Grünwald F. Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation. Int J Hyperthermia 2018; 34:639-643. [DOI: 10.1080/02656736.2018.1453552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- H. Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - T. Wolf
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - F. Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
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25
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Kim JK, Chai YJ, Chung JK, Hwang KT, Heo SC, Kim SJ, Choi JY, Yi KH, Kim SW, Cho SY, Lee KE. The prevalence of primary hyperparathyroidism in Korea: a population-based analysis from patient medical records. Ann Surg Treat Res 2018; 94:235-239. [PMID: 29732354 PMCID: PMC5931933 DOI: 10.4174/astr.2018.94.5.235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/04/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Because primary hyperparathyroidism (PHPT) is difficult to recognize, it has a high likelihood of being underdiagnosed. In this study, we estimated the incidence of PHPT and evaluated PHPT diagnosis in Korea. Methods To calculate the prevalence of PHPT, we examined the medical records of patients that were hospitalized for urolithiasis between 2013 and 2016 at a single institute, and then identified those who were diagnosed with PHPT from the same group. A Korea-wide insurance claim database was used to ascertain the number of urolithiasis patients and the number of parathyroidectomies performed in Korea. The incidence of PHPT in the Korean population was estimated using the ratio of patients who presented with urolithiasis as the initial symptom of PHPT. Results During the 4-year study period, 4 patients from the 925 urolithiasis patients enrolled in this study (0.4%) were diagnosed with PHPT. During this same period, there were 85,267 patients with urolithiasis in Korea, and the estimated number of PHPT patients was 341, which was 0.4% of 85,267. Considering that 12% to 23% of patients with PHPT are initially diagnosed with urolithiasis, the total number of PHPT patients was estimated to range from 1,483 to 2,842. The number of patients who underwent parathyroidectomy due to PHPT was 1,935 during the study period. Conclusion The number of patients we estimated to have PHPT corresponded closely with the number of patients undergoing parathyroidectomy during the study period. Considering the number of nonsymptomatic PHPT patients, PHPT may be properly diagnosed in Korea.
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Affiliation(s)
- Jong-Kyu Kim
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Kee Chung
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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26
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González-Clavijo AM, Fierro-Maya LF, Neira F, Guevara O. Hepatic metastasis of a parathyroid carcinoma treated with intra-arterial embolization. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n3.55522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Se reporta el caso de una paciente con carcinoma de paratiroides metastásico al hígado con hipercalcemia de muy difícil control pese a manejo con ácido Zoledrónico y Cinacalcet. La paciente fue llevada a embolización intraarterial con microesferas de alcohol polivinílico de la arteria hepática derecha, con lo que se obtuvo un excelente control bioquímico después de la intervención.
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27
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Pappa A, Hackman T. Simultaneous Incidental Parathyroid Carcinoma and Intrathyroid Parathyroid Gland in Suspected Renal Failure Induced Hyperparathyroidism. Surg J (N Y) 2017; 3:e23-e24. [PMID: 28825015 PMCID: PMC5553488 DOI: 10.1055/s-0037-1599072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/09/2017] [Indexed: 11/08/2022] Open
Abstract
Hyperparathyroidism is a common disorder affecting more than hundreds of thousands of people annually. While most commonly secondary to an adenoma, it may also arise from four-gland hyperplasia or malignancy. In the case of primary hyperparathyroidism, the number of glands involved may be unknown prior to surgery. In contrast, the metabolic disorder associated with renal failure induced hyperparathyroidism ensures a hyperplasia picture. Despite the uniform hyperplasia seen in tertiary disease and the preoperative expectation for four-gland exploration, our case demonstrates the continued need for a surgeon's vigilance during dissection to identify all glands and appropriately use intraoperative parathyroid hormone (PTH) testing. In addition, while intraoperative PTH assessment is an effective method for confirming adequacy of treatment for hyperparathyroidism, only surgical pathology can confirm malignancy, which should be considered with PTH levels > 1,000. The case also underscores the importance of comprehensive surgery management and mindful interpretation of intraoperative PTH levels in the management of hyperparathyroidism. Standard surgical technique includes complete exploration of the central compartment, and thyroid lobectomy when the aforementioned exploration fails to reveal the necessary parathyroid tissue, especially with a persistently elevated PTH. Without a standardized progressive compartment exploration and judicious use of intraoperative hormone testing, intrathyroidal parathyroid glands can be missed.
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Affiliation(s)
- Andrew Pappa
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor Hackman
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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28
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The Results of Ultrasonography-Guided Percutaneous Radiofrequency Ablation in Hyperparathyroid Patients in Whom Surgery Is Not Feasible. Cardiovasc Intervent Radiol 2017; 40:596-602. [DOI: 10.1007/s00270-016-1544-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/09/2016] [Indexed: 01/20/2023]
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29
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Makay Ö, Özçınar B, Şimşek T, Arıcı C, Güngör B, Özbaş S, Akça T, Emre AU, Karadeniz Çakmak G, Akçay M, Ünal B, Girgin M, Girgin S, Görgülü S, Sezer A, Karataş A, Özemir İA, Aksakal N, Erel S, Uğurlu MÜ, Filiz Aİ, Atalay C, Uzunköy A, Deveci U, Kotan Ç, İçöz G, Kurt Y, Kebudi A, Cantürk NZ, Erbil Y, Pandev R, Güllüoğlu BM. Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism. Balkan Med J 2017; 34:28-34. [PMID: 28251020 PMCID: PMC5322512 DOI: 10.4274/balkanmedj.2015.0865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/27/2016] [Indexed: 01/03/2023] Open
Abstract
Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. Study Design: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.
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Affiliation(s)
- Özer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Beyza Özçınar
- Department of General Surgery, Division of Endocrine Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Turgay Şimşek
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Cumhur Arıcı
- Department of General Surgery, Division of Endocrine Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Bülent Güngör
- Department of General Surgery, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Serdar Özbaş
- Department of General Surgery, Güven Hospital, Ankara, Turkey
| | - Tamer Akça
- Department of General Surgery, Division of Endocrine Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Ali Uğur Emre
- Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | | | - Müfide Akçay
- Department of General Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Bülent Ünal
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Mustafa Girgin
- Department of General Surgery, Fırat University School of Medicine, Elazığ, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Semih Görgülü
- Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Atakan Sezer
- Department of General Surgery, Trakya University School of Medicine, Edirne, Turkey
| | - Adem Karataş
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - İbrahim Ali Özemir
- Department of General Surgery, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Nihat Aksakal
- Department of General Surgery, Division of Endocrine Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Serap Erel
- Department of General Surgery, Ankara Training and Research Hospital, Ankara, Turkey
| | - M Ümit Uğurlu
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
| | - Ali İlker Filiz
- Department of General Surgery, Okan University School of Medicine, Istanbul, Turkey
| | - Can Atalay
- Department of General Surgery, Ankara Oncology Training Hospital, Ankara, Turkey
| | - Ali Uzunköy
- Department of General Surgery, Harran University School of Medicine, Şanlıurfa, Turkey
| | - Uğur Deveci
- Department of Gernral Surgery, Sultan Abdülhamid Training and Research Hospital, İstanbul, Turkey
| | - Çetin Kotan
- Department of General Surgery, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Gökhan İçöz
- Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Yavuz Kurt
- Department of Gernral Surgery, Sultan Abdülhamid Training and Research Hospital, İstanbul, Turkey
| | - Abut Kebudi
- Department of General Surgery, Okan University School of Medicine, Istanbul, Turkey
| | - N Zafer Cantürk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Yeşim Erbil
- Department of General Surgery, Division of Endocrine Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Rumen Pandev
- Department of General Surgery, Division of Endocrine Surgery, Tsaritsa Yoanna University School of Medicine, Sofia, Bulgaria
| | - Bahadır M Güllüoğlu
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
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30
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Cakir B, Polat SB, Kilic M, Ozdemir D, Aydin C, Süngü N, Ersoy R. Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:537-544. [PMID: 27901181 PMCID: PMC10522169 DOI: 10.1590/2359-3997000000224] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/19/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical histopathologic features and don't fulfill criteria for carcinoma are classified as atypical adenomas (APA). The purpose of this study was to determine a biochemical or ultrasonographic feature that can predict aggressive disease requiring more extensive surgery and closer follow-up. SUBJECTS AND METHODS Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients) or carcinoma (5 patients) were enrolled in this study. The control group consisted of 102 patients operated between the same dates and diagnosed with classical PA. Classical adenomas, atypical adenomas, and carcinomas were compared according to their biochemical and ultrasonographic parameters. RESULTS Serum Ca levels were significantly higher in the PC group compared with the APA and classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the APA and carcinoma groups compared to the classical PA group. ROC analysis was made to determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05 pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic appearance were independent predictors for aggressive disease. CONCLUSION Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally invasive surgery.
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Affiliation(s)
- Bekir Cakir
- Yildirim Beyazit UniversityAtaturk Education and Research HospitalAnkaraTurkeyYildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
| | - Sefika Burcak Polat
- Yildirim Beyazit UniversityAtaturk Education and Research HospitalAnkaraTurkeyYildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
| | - Mehmet Kilic
- Yildirim Beyazit UniversityAtaturk Education and Research HospitalAnkaraTurkeyYildirim Beyazit University, Ataturk Education and Research Hospital, General Surgery Department, Ankara, Turkey
| | - Didem Ozdemir
- Yildirim Beyazit UniversityAtaturk Education and Research HospitalAnkaraTurkeyYildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
| | - Cevdet Aydin
- Yildirim Beyazit UniversityAtaturk Education and Research HospitalAnkaraTurkeyYildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
| | - Nuran Süngü
- Yildirim Beyazit UniversityAtaturk Education and Research HospitalAnkaraTurkeyYildirim Beyazit University, Ataturk Education and Research Hospital, Pathology Department, Ankara, Turkey
| | - Reyhan Ersoy
- Yildirim Beyazit UniversityAtaturk Education and Research HospitalAnkaraTurkeyYildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
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Xue S, Chen H, Lv C, Shen X, Ding J, Liu J, Chen X. Preoperative diagnosis and prognosis in 40 Parathyroid Carcinoma Patients. Clin Endocrinol (Oxf) 2016; 85:29-36. [PMID: 26939543 DOI: 10.1111/cen.13055] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/16/2016] [Accepted: 03/02/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Parathyroid carcinoma (PC) is a rare disease which is difficult to diagnose preoperatively and predict prognosis. The goal of this study was to analyse the preoperative predictive factors and prognostic factors in PC patients and to evaluate the possibility of diagnosing PC preoperatively. DESIGN, SETTING AND PATIENTS This is a retrospective study from Jan 2000 to Aug 2015 conducted in Shanghai Ruijin Hospital. MEASUREMENTS Comparisons were made between 40 parathyroid carcinoma patients and 282 patients with benign parathyroid lesions during the same period. All patients underwent parathyroid surgery, and the results were certified by paraffin pathology. Prognostic factors were analysed in the 40 PC patients. RESULTS Patients with higher levels of intact parathyroid hormone (P < 0·001, OR = 1·001, CI: 1·000-1·002), calcium (P = 0·008, OR = 3·395, CI: 1·382-8·341) and a larger parathyroid volume (P = 0·001, OR = 2·023, CI: 1·333-3·071) were more likely to have PC. Local excision (P = 0·008, OR = 4·992, CI: 1·533-16·252), stage III in the Schulte staging system (P = 0·039, OR = 9·600, CI: 1·12-82·322), high risk in the Schulte Risk Classification (P = 0·012, OR = 5·466, CI: 1·448-20·628) and first surgery by other medical teams (P = 0·008, OR = 4·992, CI: 1·496-15·037) were associated with PC recurrence. Calcium (P = 0·01, OR = 7·270, CI: 1·611-32·812), intact parathyroid hormone (P = 0·037, OR = 1·001, CI: 1·000-1·001), local excision (P = 0·009, OR = 6·875, CI: 1·633-28·936) and recurrence (P = 0·014, OR = 7·762, CI: 1·504-40·055) were associated with death. CONCLUSIONS A preoperative diagnostic system may provide a new method to distinguish PC from benign parathyroid lesions before surgery. For PC patients who did not undergo en-bloc resection at first operation, timely further surgery may offer a second chance of cure. Early diagnosis and surgery are pivotal to reduce mortality in PC patients.
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Affiliation(s)
- Song Xue
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haizhen Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chunhui Lv
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohui Shen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiazeng Ding
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianmin Liu
- Shanghai Institute of Endocrinology and Metabolism, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xi Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Abstract
Parathyroid carcinoma is an exceedingly rare endocrine malignancy first described in 1933. It accounts for between 0.5% and 5% of all cases of primary hyperparathyroidism. Parathyroid carcinoma is unusual among endocrine malignancies, being more hormonally active than its benign counterpart. Parathyroid carcinoma poses a diagnostic challenge both clinically and histologically due to the lack of features which can definitively distinguish malignant from benign disease early in its clinical course. Here, we describe the clinical features of the disease, and present the current opinion on optimal management. Further, we analyse the most recent histological advances made to aid in the diagnosis and management of this rare, but potentially devastating, disease.
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Villar-del-Moral J, Jiménez-García A, Salvador-Egea P, Martos-Martínez JM, Nuño-Vázquez-Garza JM, Serradilla-Martín M, Gómez-Palacios A, Moreno-Llorente P, Ortega-Serrano J, de la Quintana-Basarrate A. Prognostic factors and staging systems in parathyroid cancer: A multicenter cohort study. Surgery 2014; 156:1132-44. [DOI: 10.1016/j.surg.2014.05.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 05/07/2014] [Indexed: 12/19/2022]
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Fine-needle aspiration cytology of parathyroid carcinoma mimic hürthle cell thyroid neoplasm. Case Rep Endocrinol 2014; 2014:680876. [PMID: 25177504 PMCID: PMC4142373 DOI: 10.1155/2014/680876] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 07/15/2014] [Accepted: 07/21/2014] [Indexed: 11/26/2022] Open
Abstract
Background. Fine-needle aspiration (FNA) can cause misdiagnosis of cytomorphological findings between parathyroid and thyroid lesions. Case Presentation. A 31-year-old man presented with a palpable neck mass on the right thyroid lobe. FNA cytology was reported as intrathyroidal lymphoid hyperplasia. After 5 years, repeated FNA was done on the enlarged nodule with result of Hürthle cell lesion. Prior to right lobectomy, laboratories revealed elevated serum calcium and parathyroid hormone (PTH). Careful history taking revealed chronic knee pain and ossifying fibroma at the maxilla. Ultrasonography showed a 2.8 cm mass inferior to right thyroid lobe. Pathology from en bloc resection was parathyroid carcinoma and immunohistochemical study revealed positivity for PTH. Genetic analysis found somatic mutation of CDC73 gene in exon1 (c.70delG) which caused premature stop codon in amino acid 26 (p.Glu24Lysfs*2). The final diagnosis was hyperparathyroidism-jaw tumor syndrome. Conclusions. FNA cytology of parathyroid can mimic thyroid lesion. It is important to consider and correlate the entire information from clinical history, laboratory, imaging, and FNA.
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Kim BS, Eom TI, Kang KH, Park SJ. Radiofrequency ablation of parathyroid adenoma in primary hyperparathyroidism. J Med Ultrason (2001) 2013; 41:239-43. [DOI: 10.1007/s10396-013-0501-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
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