1
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Marini F, Giusti F, Palmini G, Aurilia C, Donati S, Brandi ML. Parathyroid carcinoma: molecular therapeutic targets. Endocrine 2023; 81:409-418. [PMID: 37160841 DOI: 10.1007/s12020-023-03376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
Parathyroid carcinoma (PC) is an extremely rare malignant tumor of the parathyroid glands, accounting for less than 1% of primary hyperparathyroidism, commonly characterized by severe and unmanageable hypercalcemia, aggressive behavior, high metastatic potential, and poor prognosis. PC manifests prevalently as a sporadic tumor and only occasionally it is part of congenital syndromic and non-syndromic endocrine diseases. Molecular pathogenesis of this form of parathyroid tumor is not fully elucidated and it appears to be caused by multiple genetic and epigenetic drivers, differing among affected patients and not yet clearly stated in distinguishing PC from the benign parathyroid adenoma (PA). Congenital forms of PC have been prevalently associated with germline heterozygous loss-of-function mutations of the CDC73 tumor suppressor gene, both in the context of the hyperparathyroidism jaw-tumor syndrome (HPT-JT) and of the isolated familial hyperparathyroidism (FIPH). Currently, surgical en bloc resection of affected gland(s) and other involved structures is the elective therapy for both primary and recurrent PC. However, it usually results ineffective for advance and metastatic disease, and a high percentage of post-operative recurrence is reported. Targeted medical therapies for surgically untreatable PC, based on the molecular profile of PC samples, are, therefore, needed. The characterization of genetic and epigenetic alterations and deregulated pathways in PC samples will be of fundamental importance to tailor treatment for each patient. Here, we reviewed main findings on molecular pathogenetic aspects of PC, and the current state of the art of therapies.
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Affiliation(s)
- Francesca Marini
- Fondazione FIRMO Onlus (Fondazione Italiana per la Ricerca sulle Malattie dell'Osso), Florence, Italy
| | - Francesca Giusti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
- Donatello Bone Clinic, Villa Donatello Hospital, Sesto Fiorentino, FI, Italy
| | - Gaia Palmini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Cinzia Aurilia
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Simone Donati
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- Fondazione FIRMO Onlus (Fondazione Italiana per la Ricerca sulle Malattie dell'Osso), Florence, Italy.
- Donatello Bone Clinic, Villa Donatello Hospital, Sesto Fiorentino, FI, Italy.
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2
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Gowrishankar SV, Bidaye R, Das T, Majcher V, Fish B, Casey R, Masterson L. Intrathyroidal parathyroid adenomas: Scoping review on clinical presentation, preoperative localization, and surgical treatment. Head Neck 2023; 45:706-720. [PMID: 36563301 PMCID: PMC10108101 DOI: 10.1002/hed.27287] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/26/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Intrathyroidal parathyroid adenomas (IPAs) are a rare cause of primary hyperparathyroidism. They are often difficult to localize preoperatively and intraoperatively, making diagnosis and treatment challenging. Current data on IPAs are sparse and fragmented in the literature. This makes it difficult to compare the effectiveness of different imaging and surgical techniques. To address this issue, this scoping review maps the literature on IPAs, focusing on four domains: clinical presentation, current localization methods, different surgical techniques, and histopathological features. A search of MEDLINE, Embase, and the Cochrane Library was conducted, with 19 studies meeting the inclusion criteria. The characteristics of IPAs on ultrasound, fine-needle aspiration, CT, MRI, sestamibi-based techniques, and selective venous sampling are summarized. Emerging imaging modalities, including autofluorescence, are introduced. Surgical methods and intraoperative factors that correlate with high success rates for removal are highlighted. This review also identifies gaps in knowledge to guide further research into this area.
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Affiliation(s)
| | - Rohan Bidaye
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tilak Das
- Department of Neuroradiology and Head & Neck Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Veronika Majcher
- Department of Neuroradiology and Head & Neck Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian Fish
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ruth Casey
- Department of Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Liam Masterson
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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3
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Makino H, Notsu M, Asayama I, Otani H, Morita M, Yamamoto M, Yamauchi M, Nakao M, Miyake H, Araki A, Uchino S, Kanasaki K. Successful Control of Hypercalcemia with Sorafenib, Evocalcet, and Denosumab Combination Therapy for Recurrent Parathyroid Carcinoma. Intern Med 2022; 61:3383-3390. [PMID: 35370235 PMCID: PMC9751735 DOI: 10.2169/internalmedicine.9261-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Parathyroid carcinoma (PC) is a rare type of endocrine cancer. Recurrence and metastasis are common after surgery, and refractory hypercalcemia often leads to a poor prognosis. However, there are currently no specific strategies for PC recurrence. We herein report a 61-year-old Japanese man with metastatic PC who was treated with sorafenib, a multikinase inhibitor. In this case, the serum calcium level was under control for 10 months after the initiation of sorafenib. This case suggests that combination therapy with sorafenib, evocalcet, and denosumab may be an alternative, stronger management option for refractory hypercalcemia in recurrent PC.
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Affiliation(s)
- Hirofumi Makino
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | - Masakazu Notsu
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | - Itsuko Asayama
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | - Hazuki Otani
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | - Miwa Morita
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
| | | | - Mika Yamauchi
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
- Research Institute for Metabolic Bone Diseases, Eikokai Ono Hospital, Japan
| | - Mika Nakao
- Cancer Genome Medical Center, Shimane University Faculty of Medicine, Japan
| | - Hitomi Miyake
- Department of Internal Medicine, Unnan City Hospital, Japan
| | - Asuka Araki
- Organ Pathology Unit, Department of Pathology, Shimane University Faculty of Medicine, Japan
| | - Shinya Uchino
- Noguchi Thyroid Clinic and Hospital Foundation, Japan
| | - Keizo Kanasaki
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
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4
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Said A, Abire A, Soukaina L, Hind A, Loubna T, Ilias T, Amal H, Mustapha S, Mohammed Z, Fouad B. Intrathyroidal parathyroid carcinoma presenting as thyroid nodule: Case report of unusual location. Ann Med Surg (Lond) 2022; 79:103994. [PMID: 35860129 PMCID: PMC9289316 DOI: 10.1016/j.amsu.2022.103994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/11/2022] [Accepted: 06/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Parathyroid carcinoma (PC) is considered a rare and uncommon malignancy. Its prevalence is about 0.005% of all cancers. Intrathyroidal location is rare, rendering preoperative diagnosis tedious. Until now, around 700 cases of PC have been documented, reportedly, among them, less than 21 cases of intrathyroidal parathyroid carcinoma have been described in the literature. We report a case of intrathyroidal PC that was taken for a suspicious thyroid nodule, with a literature review. PRESENTATION OF THE CASE: Our case is an asymptomatic intrathyroidal PC imitating a suspicious thyroid nodule, in a 54-year-old woman. A literature review was performed about clinical, radiological features, histopathological findings, and therapeutic options. Discussion The diagnosis of asymptomatic intrathyroidal parathyroid carcinoma, similar to our case report, is even more difficult, our patient had no symptoms of hypercalcemia. Surgery is the cornerstone of the treatment. A better chance to cure this disease is conditioned by complete surgical resection with negative margins microscopically, that was the case of our patient with a very good clinical course after 12 months of follow-up. Parathyroid Carcinoma Is an Uncommon Endocrine Malignancy, Making Approximately 0.005% of All Cancers and 0,5%–2% of Patient With Primary Hyperparathyroidism. Intrathyroidal Location Is Rare and Make Preoperative Suspicion and Diagnosis Challenging. Approximately 700 Cases of Parathyroid Carcinoma Have Been Reported to Date and, to The Best of Our Knowledge, Less Than 24 Cases of Intrathyroidal Parathyroid Carcinoma Has Been Previously Documented.
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Affiliation(s)
- Anajar Said
- ENT Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
- Corresponding author. ENT Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Street ait baha, Bd Bordeaux N 5, Casablanca, Morocco.
| | - Allaoui Abire
- internal Medecin Department, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Laidi Soukaina
- Endocrinology Department, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Alatawna Hind
- Pathologist-Anatomical, IBN Zohr Center, Casablanca, Morocco
| | - Taali Loubna
- ENT Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Tahiri Ilias
- ENT Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Hajjij Amal
- ENT Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Saadi Mustapha
- ENT Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Zalakh Mohammed
- ENT Department, Face and Neck Surgery, Military Hospital Mohammed V, Rabat, Morocco
| | - Benariba Fouad
- ENT Department, Face and Neck Surgery, Military Hospital Mohammed V, Rabat, Morocco
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5
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Daniel H, Pillutla P, Schwartz C, Nguyen T. Intrathyroidal Parathyroid Carcinoma: Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2022:1455613221093729. [PMID: 35403461 DOI: 10.1177/01455613221093729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Intrathyroidal parathyroid carcinoma (PC) is a rare malignancy that is usually difficult to diagnose. We present a case of a 31-year-old male with a history of hyperparathyroidism who was found to have intrathyroidal PC upon review of immunostains along with a review of the current literature. A systematic review of the literature utilizing the PubMed database identified 24 relevant, full-text articles. 25 cases were analyzed, including our own report. The case of a 31-year-old man with a history of hyperparathyroidism managed with subtotal thyroidectomy and subtotal parathyroidectomy who had persistent hypercalcemia and elevated parathyroid hormone. Abnormal radiotracer uptake was noted in the left thyroid gland. Neck exploration with left parathyroidectomy and revision thyroidectomy was performed. A candidate left inferior parathyroid was found within the left thyroid lobe remnant and identified as parathyroid carcinoma. Immunostains determined an intrathyroidal parathyroid carcinoma. The literature review shows the average presenting age was 50.9 years. 54.17% (CI, 43-82%) of affected patients are female. Right-sided thyroid involvement is seen in 54.17% (CI, 34-74%) of cases. The inferior aspect of the thyroid is involved in 66.67% of cases (CI, 53-89%). Intrathyroidal parathyroid carcinoma is a rare and challenging diagnosis due to similarities with other more common endocrine abnormalities. This review found that the inferior parathyroid is more likely to be located within the thyroid gland. Surgeons may consider aberrant anatomical locations, including intrathyroidal locations, for the inferior parathyroid glands.
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Affiliation(s)
- Hannah Daniel
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - Pranati Pillutla
- Department of Head and Neck Surgery, 8783UCLA, Los Angeles, CA, USA
| | - Cynthia Schwartz
- Department of Otolaryngology-Head and Neck Surgery, 12343Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Tam Nguyen
- Department of Otolaryngology-Head and Neck Surgery, 12343Texas Tech University Health Sciences Center, Lubbock, TX, USA
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6
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Tao M, Luo S, Wang X, Jia M, Lu X. A Nomogram Predicting the Overall Survival and Cancer-Specific Survival in Patients with Parathyroid Cancer: A Retrospective Study. Front Endocrinol (Lausanne) 2022; 13:850457. [PMID: 35663321 PMCID: PMC9160525 DOI: 10.3389/fendo.2022.850457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to explore a visual model for predicting the prognosis of patients with parathyroid carcinoma (PC) and analyze related biochemistries in different groups of stage. METHODS The training dataset of 342 patients with PC was obtained from the Surveillance, Epidemiology, and End Results (SEER) database, and the validation dataset included 59 patients from The First Affiliated Hospital of Zhengzhou University. Univariate and multivariate Cox regression analyses were performed to evaluate significant independent prognostic factors. Based on those factors, nomograms and Web-based probability calculators were constructed to evaluate the overall survival (OS) and the cancer-specific survival (CSS) at 3, 5, and 8 years. The concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram in the training set and validation set. Moreover, biochemistries from the validation set were retrospectively analyzed in different groups of stage by Kruskal-Wallis test. RESULTS Age, marital status, tumor size, stage, lymph node status, and radiation were identified as prognostic factors of OS. In contrast, only tumor size and stage were predictive for CSS. The nomogram was developed based on these independent factors. The C-index, ROC curve, calibration curve, and DCA of the nomogram in both training and validation sets showed that the nomogram had good predictive value, stability, and clinical benefit in predicting 3-, 5-, and 8-year OS and CSS in PC patients. Among the 59 PC patients from our hospital, lower albumin (ALB) levels and higher postoperative parathyroid hormone (PTH) levels were found in patients with distant metastasis (Distant vs. Regional ALB levels: p = 0.037; Distant vs. Local ALB levels: p = 0.046; Distant vs. Regional postoperative PTH levels: p = 0.002; Distant vs. Local postoperative PTH: p = 0.002). CONCLUSION The established nomogram application can provide accurate prognostics for patients with PC in the Chinese population, but it must be validated on prospectively collected real-world data.
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Affiliation(s)
- Mei Tao
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuyan Luo
- Department of Neurology Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoming Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Jia
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xiubo Lu, ; Meng Jia,
| | - Xiubo Lu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xiubo Lu, ; Meng Jia,
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7
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Yu JY, Zhang Y, Wang Z. Fine-needle aspiration cytology of an intrathyroidal nodule diagnosed as squamous cell carcinoma: A case report. World J Clin Cases 2021; 9:9982-9989. [PMID: 34877340 PMCID: PMC8610907 DOI: 10.12998/wjcc.v9.i32.9982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/31/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both squamous cell carcinoma (SCC) and papillary thyroid carcinoma (PTC) are common malignant tumors in the neck. However, seldom has SCC of the thyroid been diagnosed. Further, cytological features of SCC and PTC have rarely been reported. The significance of fine-needle aspiration cytology (FNAC) in the diagnosis of neck masses has been established. Herein, we present an exceedingly rare case of an intrathyroidal SCC diagnosed using FNAC, along with its cytological features.
CASE SUMMARY A 66-year-old man presented with a left-sided neck mass. Ultrasound examination showed an ill-defined nodule. The appearance was hypoechoic with a few hyperechoic spots. FNAC of the left thyroid nodule was performed. A cellular smear was obtained, and it showed a large number of neoplastic cells with rich cytoplasm and poor cell adhesion. Tumor cell nuclei showed coarse nuclear chromatin and a few enlarged prominent nucleoli. An increased nuclear/cytoplasm ratio was observed. Thus, malignancy was diagnosed without a confirmed tumor type. Percutaneous tumor biopsy was performed to make a definite diagnosis. The tumor cells showed typical squamous cell characteristics.
CONCLUSION Head and neck SCC and PTC have different cytologies. Measures are needed to ensure accurate diagnosis using FNAC.
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Affiliation(s)
- Jin-Yang Yu
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Ying Zhang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhe Wang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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8
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Мокрышева НГ, Еремкина АК, Мирная СС, Крупинова ЮА, Воронкова ИА, Ким ИВ, Бельцевич ДГ, Кузнецов НС, Пигарова ЕА, Рожинская ЛЯ, Дегтярев МВ, Егшатян ЛВ, Румянцев ПО, Андреева ЕН, Анциферов МБ, Маркина НВ, Крюкова ИВ, Каронова ТЛ, Лукьянов СВ, Слепцов ИВ, Чагай НБ, Мельниченко ГА, Дедов ИИ. [The clinical practice guidelines for primary hyperparathyroidism, short version]. PROBLEMY ENDOKRINOLOGII 2021; 67:94-124. [PMID: 34533017 PMCID: PMC9753843 DOI: 10.14341/probl12801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022]
Abstract
Primary hyperparathyroidism (PHPT) is an endocrine disorder of parathyroid glands characterized by excessive secretion of parathyroid hormone (PTH) with an upper normal or elevated blood calcium level. Classical PHPT refers to a symptomatic, multi-system disorder, wich can lead to a significant decrease in the quality of life, disability of patients, and even an increased risk of premature death. Hypercalcemia and the catabolic effect of PTH on various cells are considered as the main pathogenetic mechanisms of the PHPT associated complications. In the last two decades, there has been an increase in the incidence of PHPT, mainly due to the mild forms of the disease, primarily due to the routine calcium screening in North America, Western Europe and, Asia. High prevalence of the disease, as well as the variety of clinical manifestations, cause the attention of different specialists - physicians, rheumatologists, urologists, nephrologists, cardiologists and other doctors. This review cover the main issues of Russian guidelines for the management of PHPT, approved in 2020, including laboratory and instrumental methods, differential diagnosis, surgical and conservative approach, short-term and long-term follow-up. This guidelines also include the recommendations for special groups of patients with hereditary forms of PHPT, parathyroid carcinoma, PHPT during pregnancy.
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Affiliation(s)
- Н. Г. Мокрышева
- Национальный медицинский исследовательский центр эндокринологии
| | - А. К. Еремкина
- Национальный медицинский исследовательский центр эндокринологии
| | | | - Ю. А. Крупинова
- Национальный медицинский исследовательский центр эндокринологии
| | - И. А. Воронкова
- Национальный медицинский исследовательский центр эндокринологии
| | - И. В. Ким
- Национальный медицинский исследовательский центр эндокринологии
| | - Д. Г. Бельцевич
- Национальный медицинский исследовательский центр эндокринологии
| | - Н. С. Кузнецов
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. А. Пигарова
- Национальный медицинский исследовательский центр эндокринологии
| | - Л. Я. Рожинская
- Национальный медицинский исследовательский центр эндокринологии
| | - М. В. Дегтярев
- Национальный медицинский исследовательский центр эндокринологии
| | - Л. В. Егшатян
- Национальный медицинский исследовательский центр эндокринологии
| | | | - Е. Н. Андреева
- Национальный медицинский исследовательский центр эндокринологии
| | - М. Б. Анциферов
- Эндокринологический диспансер Департамента здравоохранения города Москвы
| | - Н. В. Маркина
- Эндокринологический диспансер Департамента здравоохранения города Москвы
| | - И. В. Крюкова
- Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского
| | - Т. Л. Каронова
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | | | | | - Н. Б. Чагай
- Ставропольский государственный медицинский университет
| | | | - И. И. Дедов
- Национальный медицинский исследовательский центр эндокринологии
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9
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Benali K, Aarab J, Benmessaoud H, Nourreddine A, Majjaoui SE, Kacemi HE, Kebdani T, Benjaafar N. Intrathyroidal parathyroid carcinoma: a case report and literature review. Radiat Oncol J 2021; 39:145-151. [PMID: 33857367 PMCID: PMC8497858 DOI: 10.3857/roj.2020.01060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/05/2021] [Indexed: 11/22/2022] Open
Abstract
Parathyroid carcinoma is an uncommon endocrine malignancy comprising 0.5%–2% of patients with primary hyperparathyroidism. The probability of an intrathyroidal location is low (0.2%) and make preoperative suspicion and diagnosis challenging. Less than 20 cases of intrathyroidal parathyroid carcinoma have been reported. We introduce a case of intrathyroidal parathyroid carcinoma mimicking a suspicious thyroid nodule, and review the literature, with a focus on the role of adjuvant radiotherapy.
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Affiliation(s)
- Kenza Benali
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Jihan Aarab
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Houda Benmessaoud
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Abdelati Nourreddine
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Équipe de Science de la Matière et du Rayonnement, Department of Physics, Mohammed V University, Faculty of Science, Rabat, Morocco
| | - Sanaa El Majjaoui
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Hanan El Kacemi
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Tayeb Kebdani
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Noureddine Benjaafar
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
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10
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De Falco N, Santangelo G, Chirico F, Cangiano A, Sommella MG, Cosenza A, Ronchi A, Accardo M, Pellino G, Parmeggiani D, Canonico S, De Falco M. Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature. BMC Endocr Disord 2021; 21:60. [PMID: 33827539 PMCID: PMC8028146 DOI: 10.1186/s12902-021-00724-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Parathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. The intrathyroidal localization of a parathyroid gland is not frequent with a reported prevalence of 0.2%. Carcinoma of parathyroids with intrathyroidal localization represents an even rarer finding, reported in only 16 cases described in literature. The rare constellation of synchronous parathyroid and thyroid carcinomas has prompted us to report our experience and perform literature review. CASE PRESENTATION We herein report a case of a 63-years-old man with multinodular goiter and biochemical diagnosis of hyperparathyroidism. Total thyroidectomy with radio-guide technique using gamma probe after intraoperative sesta-MIBI administration and intraoperative PTH level was performed. The high radiation levels in the posterior thyroid lobe discovered an intrathyroidal parathyroid. Microscopic examination revealed a parathyroid main cell carcinoma at the posterior thyroidal left basal lobe, a classic papillary carcinoma at the same lobe and follicular variant of papillary carcinoma at the thyroidal right lobe. To the best of our knowledge, this is the first case documenting a synchronous multicentric non medullary thyroid carcinomas and intrathyroidal parathyroid carcinoma. CONCLUSIONS Our experience was reported and literature review underlining challenging difficulties in diagnostic workup and surgical management was carried out.
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Affiliation(s)
- Nadia De Falco
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Giuseppe Santangelo
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Fabrizio Chirico
- Maxillofacial Surgery Unit, Federico II University, Naples, Italy
| | - Angelo Cangiano
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Maria Giulia Sommella
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Angelo Cosenza
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Andrea Ronchi
- Division of Morphopathology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marina Accardo
- Division of Morphopathology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianluca Pellino
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Domenico Parmeggiani
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Silvestro Canonico
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Massimo De Falco
- General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy.
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11
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Mir F, Rohra P, Aakash N, Furlan K, Ghai R, Reddy V, Cheng L, Gattuso P. Fine needle aspiration of an intrathyroidal parathyroid carcinoma mimicking a primary thyroid anaplastic carcinoma: A case report with review of the literature. Diagn Cytopathol 2020; 49:E14-E19. [PMID: 32749783 DOI: 10.1002/dc.24560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/20/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
Intrathyroidal parathyroid carcinoma is an uncommon malignancy. A 46-year-old male presented with a left neck mass. Computed tomography (CT) scan revealed a hypodense mass in the left thyroid lobe along with evidence of metastatic lymphadenopathy. Aspiration of the left thyroid nodule was performed, and a diagnosis of malignancy was rendered, favoring a primary anaplastic carcinoma. Based on the cytologic diagnosis, the patient underwent a total thyroidectomy. Before the surgery, intact parathyroid hormone (PTH) and calcium level (PTH = 78 pg/mL; Calcium = 10.6 mg/dL) were found to be minimally elevated. On gross examination, a 3.2 cm mass within the left inferior thyroid lobe was seen. Histopathologic examination and ancillary studies supported the diagnosis of a parathyroid carcinoma. We, hereby present, an exceedingly rare presentation of an intrathyroidal parathyroid carcinoma with only minimal elevation of PTH and calcium, mimicking a primary anaplastic thyroid carcinoma on cytologic examination.
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Affiliation(s)
- Fatima Mir
- Rush University Medical Center, Chicago, Illinois, USA
| | - Prih Rohra
- Rush University Medical Center, Chicago, Illinois, USA
| | - Nfn Aakash
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Karina Furlan
- Rush University Medical Center, Chicago, Illinois, USA
| | - Ritu Ghai
- Rush University Medical Center, Chicago, Illinois, USA
| | - Vijaya Reddy
- Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Rush University Medical Center, Chicago, Illinois, USA
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12
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Abstract
Parathyroid cancer is one of the rarest causes of primary hyperparathyroidism and tends to present with more severe symptoms than its more benign counterparts. This article details various aspects of the disease process, including epidemiology, clinical presentation, and a step-wise diagnostic process for parathyroid cancer. This includes laboratory assessments as well as a proposed staging system. The en bloc principle of surgical intervention is detailed, as well as the current role of adjuvant treatments. A general guide to surveillance and the natural history of the disease is also outlined.
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Affiliation(s)
- Nikita N Machado
- Department of Surgery, University Hospitals Conneaut, Conneaut, OH 44030, USA.
| | - Scott M Wilhelm
- Department of Surgery, Endocrine Surgery, University Hospitals Cleveland, University Hospitals, Cleveland, OH 44106, USA.
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13
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Machado NN, Wilhelm SM. Parathyroid Cancer: A Review. Cancers (Basel) 2019; 11:cancers11111676. [PMID: 31661917 PMCID: PMC6896123 DOI: 10.3390/cancers11111676] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
Parathyroid cancer is one of the rarest causes of primary hyperparathyroidism and tends to present with more severe symptoms than its more benign counterparts. This article details various aspects of the disease process, including epidemiology, clinical presentation, and a step-wise diagnostic process for parathyroid cancer. This includes laboratory assessments as well as a proposed staging system. The en bloc principle of surgical intervention is detailed, as well as the current role of adjuvant treatments. A general guide to surveillance and the natural history of the disease is also outlined.
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Affiliation(s)
- Nikita N Machado
- Department of Surgery, University Hospitals Conneaut, Conneaut, OH 44030, USA.
| | - Scott M Wilhelm
- Department of Surgery, Endocrine Surgery, University Hospitals Cleveland, University Hospitals, Cleveland, OH 44106, USA.
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14
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Zhang R, Meng Z, Zhang Y, Wang P, Tan J. VISUAL VIGNETTE. Endocr Pract 2019; 25:980-981. [PMID: 30865537 DOI: 10.4158/ep-2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ruiguo Zhang
- From the Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- From the Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yujie Zhang
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin, China
| | - Peng Wang
- From the Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Tan
- From the Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
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15
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Akirov A, Asa SL, Larouche V, Mete O, Sawka AM, Jang R, Ezzat S. The Clinicopathological Spectrum of Parathyroid Carcinoma. Front Endocrinol (Lausanne) 2019; 10:731. [PMID: 31708875 PMCID: PMC6819433 DOI: 10.3389/fendo.2019.00731] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/10/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Parathyroid carcinoma is rare, representing <1% of primary hyperparathyroidism cases. Methods: Retrospective data of patients referred for evaluation of parathyroid disease between 2001 and 2018 were reviewed. The goal was to describe the clinical presentation, histopathologic characteristics, and treatment outcomes of parathyroid carcinoma. Results: We identified 8 cases of parathyroid carcinoma from the outpatient practice of a quaternary care Endocrine Oncology practice in Toronto, Canada. The clinical presentation was as follows: 5/8 cases (62.5%) of symptomatic hypercalcemia and 3/8 cases (37.5%) of a suspicious thyroid nodule. Hypercalcemia was evident in all 7 cases with pre-operative calcium measurements. Histopathologic features included: vascular invasion in 7/8 cases (87.5%) and immunohistochemical loss of either parafibromin, retinoblastoma, or p27 in all 8 cases. Additional treatment included: external beam radiotherapy in 5/8 cases (62.5%), chemotherapy for 2/8 patients (25%), and additional surgery for 3/8 patients (37.5%). Only 2 patients (25%) had long-term remission following surgical treatment, and the others had either persistent (3 patients) or recurrent disease (3 patients). Five patients developed metastatic disease, all involving lung. In one of two patients treated with Sorafenib there was evidence of regression of lung metastases. One patient died of disease progression. Conclusion: In this series of patients with parathyroid carcinoma largely presenting with symptomatic hypercalcemia and angioinvasive disease, only a minority achieved a durable remission. Lung was the most common site of distant metastasis. Surgery led to remission in two cases, but none of the six patients with persistent or recurrent disease ultimately achieved disease remission.
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Affiliation(s)
- Amit Akirov
- Department of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Amit Akirov
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vincent Larouche
- Department of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anna M. Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Raymond Jang
- Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Shereen Ezzat
- Department of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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