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Metovic J, Cabutti F, Osella-Abate S, Orlando G, Tampieri C, Napoli F, Maletta F, Daniele L, Volante M, Papotti M. Clinical and Pathological Features and Gene Expression Profiles of Clinically Aggressive Papillary Thyroid Carcinomas. Endocr Pathol 2023; 34:298-310. [PMID: 37208504 PMCID: PMC10511602 DOI: 10.1007/s12022-023-09769-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/21/2023]
Abstract
Papillary thyroid carcinoma (PTC) is considered an indolent neoplasm but it may demonstrate aggressive behavior. We aimed to identify clinical and pathological characteristics and molecular signatures associated with aggressive forms of PTCs. We selected 43 aggressive PTC cases based on the presence of metastases at the time of diagnosis, the development of distant metastasis during follow-up, and/or biochemical recurrence, and 43 PTC patients that were disease-free upon follow-up, matching them according to age, sex, pT, and pN parameters. Twenty-four pairs (a total of 48 cases) and 6 normal thyroid tissues were studied using targeted mRNA screening of cancer-associated genes employing NanoString nCounter® technology. In general, aggressive PTCs showed distinctive clinical and morphological features. Among adverse prognostic parameters, the presence of necrosis and an increased mitotic index were associated with shorter disease-free and overall survivals. Other parameters associated with shorter disease-free or overall survivals include a lack of tumor capsule, the presence of vascular invasion, tumor-infiltrating lymphocytes, fibrosclerotic changes, age > 55 years, and a high pTN stage. Various pathways were differentially regulated in non-aggressive as compared to aggressive PTC, including the DNA damage repair, the MAPK, and the RAS pathways. In particular, the hedgehog pathway was differentially de-regulated in aggressive PTC as compared to non-aggressive PTC cases, being WNT10A and GLI3 genes significantly up- and down-regulated in aggressive PTC and GSK3B up-regulated in non-aggressive PTC cases. In conclusion, our study revealed specific molecular signatures and morphological features in aggressive PTC that may be useful to predict more aggressive behavior in a subset of PTC patients. These findings may be useful when developing novel, tailored treatment options for these patients.
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Affiliation(s)
- Jasna Metovic
- Department of Oncology, University of Turin, Città Della Salute E Della Scienza Hospital, Pathology Unit, Turin, Italy
| | - Francesco Cabutti
- Department of Medical Sciences, University of Turin, Città Della Salute E Della Scienza Hospital, Pathology Unit, Turin, Italy
| | | | - Giulia Orlando
- Department of Oncology, University of Turin, Città Della Salute E Della Scienza Hospital, Pathology Unit, Turin, Italy
| | - Cristian Tampieri
- Department of Medical Sciences, University of Turin, Città Della Salute E Della Scienza Hospital, Pathology Unit, Turin, Italy
| | - Francesca Napoli
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Francesca Maletta
- Pathology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | | | - Marco Volante
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
| | - Mauro Papotti
- Department of Oncology, University of Turin, Città Della Salute E Della Scienza Hospital, Pathology Unit, Turin, Italy
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2
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Ryang S, Yi W, Kim M, Song SH, Lee BJ, Kim BH. Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.22.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Parathyroid carcinoma (PC) in cases of secondary or tertiary hyperparathyroidism is relatively uncommon, and only a few case reports have described this entity. Although some papers have reported patients with one or two parathyroid malignancies, multiple PC–especially three or more–have been even more rarely reported. Herein, we report a case of secondary hyperparathyroidism due to multiple PCs in a chronic hemodialysis patient. A 54-year-old man with end-stage kidney disease was referred for hyperparathyroidism. He had been diagnosed with chronic kidney disease in 2001 and had begun hemodialysis in 2009. In laboratory tests, intact parathyroid hormone (iPTH) was markedly elevated to 1,144.1 pg/mL (normal range: 15.0–68.3 pg/mL) and serum calcium was mildly elevated to 10.56 mg/dL (normal range: 8.5–10.3 mg/dL). Ultrasonography showed hypoechoic nodules in the posterior part of both thyroid glands. All three nodules showed increased uptake on a 99mTc sestamibi scan. The patient underwent total parathyroidectomy with autotransplantation to the right forearm. Histopathology findings showed three PCs with capsular invasion and one parathyroid hyperplasia. In the immediate postoperative period, the iPTH level dropped from 1,446.8 to 82.4 pg/dL and, after 1 month, to 4.0 pg/dL. This patient needed oral calcium carbonate and active vitamin D to maintain appropriate serum calcium levels. Although multiple PCs are rare, they can cause secondary hyperparathyroidism. Therefore, clinicians should suspect multiple PCs when patients’ serum iPTH levels are exceptionally high. Additionally, since PCs could occur in multiple glands, autotransplantation of the parathyroid gland after parathyroidectomy should be done carefully.
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3
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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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4
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Hypercalcemia of Malignancy Revealing a Parathyroid Carcinoma with Hepatic Metastasis: A Case Report and Literature Review. Case Rep Surg 2020; 2020:8883413. [PMID: 33274104 PMCID: PMC7683139 DOI: 10.1155/2020/8883413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/08/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
Parathyroid carcinoma is a very rare malignant tumor of the parathyroid gland. This cancer poses a great diagnostic and therapeutic difficulty due to its rarity and the absence of a characteristic clinical and paraclinical picture. The diagnosis is histological but is not always easy. Surgery remains the only curative treatment, and cervical radiotherapy can be discussed. Good prognostic factors are complete monobloc tumor resection, and bad prognostic factors are the presence of lymph node metastases at diagnosis, distant metastases, and nonsecreting carcinomas.
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5
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Kowa XY, Richards P, Waterhouse M, Parvanta L, Adams A. Atypical presentations of parathyroid gland pathology: A pictorial review. Eur J Radiol Open 2019; 6:320-329. [PMID: 31737749 PMCID: PMC6849138 DOI: 10.1016/j.ejro.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 12/30/2022] Open
Abstract
Adenoma, carcinoma and hyperplasia cause parathyroid gland enlargement. Mimics include thyroid nodules and cystic structures in the head and neck. Enlarged parathyroid glands can enhance variably following contrast administration. Hyperparathyroidism can present acutely with respiratory compromise. Syndromic associations.
Primary hyperparathyroidism is associated with significant morbidity and mortality. It is in this day and age, an eminently treatable condition which relies heavily on preoperative imaging to localise enlarged parathyroid glands. The imaging appearances of parathyroid gland enlargement are varied; this paper seeks to address some of its more unusual manifestations with an emphasis on its atypical enhancement patterns, mimics and associations. An enlarged glands may also present as an ‘incidentaloma’ in head and neck imaging performed for entirely different indications, or as part of sporadic or familial syndrome. Radiologists are in a good position to expedite the relevant investigations and curative treatment, and knowledge of the spectrum of imaging appearances is crucial.
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Affiliation(s)
- Xin-Ying Kowa
- Department of Radiology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Polly Richards
- Department of Radiology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Mona Waterhouse
- Department of Endocrine and Metabolic Medicine, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Laila Parvanta
- Department of Endocrine Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Ashok Adams
- Department of Radiology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
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6
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Storvall S, Ryhänen E, Heiskanen I, Vesterinen T, Bensch FV, Schildt J, Kytölä S, Karhu A, Arola J, Schalin-Jäntti C. MGMT Promoter Methylation and Parathyroid Carcinoma. J Endocr Soc 2019; 3:2114-2122. [PMID: 31687638 PMCID: PMC6821197 DOI: 10.1210/js.2019-00175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022] Open
Abstract
Context Parathyroid carcinoma (PC) is extremely rare. Prognosis is poor, with no known evidence-based systemic therapies. We previously reported complete remission in a patient with metastasized parathyroid carcinoma and high tumor MGMT promoter methylation status who was treated with temozolomide. Objective To study MGMT promoter methylation status in an additional set of aggressive parathyroid tumors. Design/Setting The study included 12 patients: 7 with sporadic and 5 with familial primary hyperparathyroidism (two of the latter carried a CDC73 gross deletion). Patient 9 is the previously described patient with PC and high MGMT methylation status. Her daughter (patient 12) had surgery for severe primary hyperparathyroidism due to atypical parathyroid adenoma during pregnancy. Eleven patients thus had PC and one had atypical parathyroid adenoma. MGMT promoter methylation status was determined from DNA extracted from primary (n = 10) or metastatic (n = 2) tumors. A mean methylation level >20% was considered high. Patient 11 had metastatic PC and received temozolomide cycles. Results Only the previously published patient (patient 9) had high tumor MGMT promoter methylation status. This was not a characteristic of the atypical parathyroid adenoma of the daughter (patient 12). Patient 11 (CDC73 intragenic deletion) has disseminated PC, low MGMT promoter methylation, and stable disease on follow-up after temozolomide treatment. Conclusion High MGMT promoter methylation status seems rare in PC. However, as demonstrated in other neuroendocrine tumors, some patients with disseminated PC might benefit from temozolomide. Demonstration of high methylation status could be a predictor of positive response to temozolomide treatment.
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Affiliation(s)
- Sara Storvall
- Department of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eeva Ryhänen
- Department of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Heiskanen
- Department of Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Vesterinen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Frank V Bensch
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka Schildt
- HUS Medical Imaging Center, Department of Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Soili Kytölä
- Laboratory of Genetics, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Auli Karhu
- Laboratory of Genetics, HUSLAB, Helsinki University Hospital, Helsinki, Finland.,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.,Department of Applied Tumor Genomics, Research Programs Unit, University of Helsinki, Helsinki Finland
| | - Johanna Arola
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- Department of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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7
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Prihantono P, Palinggi E, Haryasena H, Hamdani W, Binekada IMC. Surgical Treatment for Parathyroid Adenoma: A Case Report. Open Access Maced J Med Sci 2019; 7:2497-2501. [PMID: 31666854 PMCID: PMC6814464 DOI: 10.3889/oamjms.2019.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Parathyroid adenoma is a rare disease. This article aimed to present the classic symptoms, diagnosis, and management of parathyroid adenoma. CASE REPORT: We report the case of a 24-year-old Asian woman with a several-month-long history of prolonged fatigue, bone, and joint pain. The patient was admitted to our hospital with multiple fractures without significant trauma. Physical examination revealed no palpable masses in the neck. The bone survey showed multiple fractures and osteoporosis of the humerus, clavicle, femur, and lumbar vertebrae. The laboratory workup showed a significantly elevated parathyroid hormone (PTH) level of 1,276 pg/ml (reference range: 10-55 pg/ml) and hypercalcemia, at 11.3 mg/dl (reference range: 8.5-10.5 mg/dl). MRI revealed enlargement of the left inferior parathyroid gland. The patient was diagnosed with a parathyroid gland tumour. Surgical resection was performed, and histopathology revealed parathyroid adenoma. The clinical manifestations and PTH and calcium levels gradually decreased to normal after the surgery. At the two-year follow-up, there was no recurrence of the disease. The patient has resumed her daily life as a farmer. CONCLUSIONS: Parathyroid adenoma has an excellent prognosis with surgical treatment.
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Affiliation(s)
- Prihantono Prihantono
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Emmy Palinggi
- Department of Surgery, Faculty of Medicine, Haluoleo University, Kendari, Indonesia
| | - Haryasena Haryasena
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - William Hamdani
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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8
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Storvall S, Ryhänen E, Bensch FV, Heiskanen I, Kytölä S, Ebeling T, Mäkelä S, Schalin‐Jäntti C. Recurrent Metastasized Parathyroid Carcinoma-Long-Term Remission After Combined Treatments With Surgery, Radiotherapy, Cinacalcet, Zoledronic Acid, and Temozolomide. JBMR Plus 2019; 3:e10114. [PMID: 31044184 PMCID: PMC6478586 DOI: 10.1002/jbm4.10114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/20/2023] Open
Abstract
Parathyroid carcinoma is a rare cause of primary hyperparathyroidism with rather poor prognosis. Apart from surgery, no evidence-based treatments exist. A 48-year-old woman presented with weight loss, nausea, constipation, hypercalcemic crisis, and a recurrent neck tumor 5 years after primary surgery of a parathyroid tumor that primarily was classified as an adenoma. Histopathological reevaluation of the original tumor revealed the correct diagnosis to be parathyroid carcinoma (PC). The patient underwent surgery of the recurrent tumor, which was locally invasive with metastatic spread to the mediastinum and neck lymph nodes. Computed tomography demonstrated large lytic bone lesions in both iliac bones including, on the right, a soft tissue mass compatible with bone metastasis. The patient was treated with cinacalcet, repeated zoledronic acid infusions, and temozolomide cycles for 1 year. She underwent two additional neck surgeries for PC and sternotomy for resection of mediastinal metastases. Massive osteolytic lesions in both femoral necks caused imminent fracture risk and therefore both femurs were prophylactically stabilized by intramedullary nail. Serum calcium normalized after the third neck surgery, cinacalcet was discontinued, and parathyroid hormone gradually normalized during continued treatments with temozolomide, adjuvant radiotherapy, and zoledronic acid, with no signs of active disease on imaging and normal biochemistry. The patient remains in remission 17 years after successful combined treatments for recurrent, metastasized PC. The parathyroid tumor tissue demonstrated high O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status, a known predictor of positive temozolomide treatment response in other tumors. In addition, synergistic effects of multiple treatments may have accounted for the favorable response. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Sara Storvall
- Endocrinology, Abdominal CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Eeva Ryhänen
- Endocrinology, Abdominal CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Frank V Bensch
- RadiologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Ilkka Heiskanen
- Endocrine SurgeryAbdominal CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Soili Kytölä
- Laboratory of Genetics, HUSLABHelsinki University HospitalHelsinkiFinland
| | - Tapani Ebeling
- EndocrinologyUniversity of Oulu and Oulu University HospitalOuluFinland
| | - Siru Mäkelä
- Department of OncologyComprehensive Cancer CentreUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Camilla Schalin‐Jäntti
- Endocrinology, Abdominal CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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9
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Tsoli M, Angelousi A, Rontogianni D, Stratakis C, Kaltsas G. Atypical manifestation of parathyroid carcinoma with late-onset distant metastases. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170106. [PMID: 29118988 PMCID: PMC5670324 DOI: 10.1530/edm-17-0106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/10/2017] [Indexed: 12/13/2022] Open
Abstract
Parathyroid carcinoma is an extremely rare endocrine malignancy that accounts for less than 1% of cases of primary hyperparathyroidism. We report a 44-year-old woman who presented with fatigue and diffuse bone pain. Laboratory findings revealed highly elevated serum calcium and parathyroid hormone (PTH) levels and a 4.5 × 3 × 2.5 cm cystic lesion in the lower pole of the right thyroid lobe that was shown histologically to be a parathyroid carcinoma. Ten years later, the patient developed brain and pulmonary metastases and recurrence of PTH-related hypercalcemia. Treatment of hypercalcemia along with localized radiotherapy and various chemotherapy regimens failed to induce a biochemical or radiological response. In conclusion, parathyroid carcinoma is a rare neoplasia that may develop metastases even after prolonged follow-up, for which there is no evidence-based treatment besides surgery. Different chemotherapeutic schemes did not prove to be of any benefit in our case highlighting the need for registering such patients to better understand tumor biology and develop specific treatment.
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Affiliation(s)
- Marina Tsoli
- Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Angelousi
- Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Constantine Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Gregory Kaltsas
- Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
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10
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Takada D, Tsukamoto T, Fuse M, Kada S, Yanagita M. The use of cinacalcet hinders the diagnosis of parathyroid carcinoma in a chronic dialysis patient: a case report. BMC Nephrol 2017; 18:315. [PMID: 29047366 PMCID: PMC5648519 DOI: 10.1186/s12882-017-0733-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 09/28/2017] [Indexed: 12/15/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) is a common complication in patients receiving chronic dialysis therapy. Although cinacalcet can control parathyroid function and bone turnover, preventing ectopic calcification remains challenging. Cinacalcet can also suppress PTH secretion due to parathyroid carcinoma in the same way as it does for parathyroid hyperplasia in the uremic condition. We present a case of parathyroid carcinoma partially controlled by cinacalcet, in which tumorous calcinosis was successfully resolved by total parathyroidectomy. Case presentation A female patient in her forties who had received dialysis for 12 years was referred to our hospital for painful ectopic calcifications on her right hip joint and both knees. Although she had been treated with alfacalcidol and cinacalcet for 2 years, this therapy had been discontinued 6 months earlier as a result of hypercalcemia. The patient exhibited normocalcemia (2.37 mmol/L) and hyperphosphatemia (2.42 mmol/L) with elevated intact parathyroid hormone (707,000 μg/L). Ultrasonography revealed an enlarged parathyroid gland on the left lower side of the thyroid gland. The otolaryngologist surgeons had to perform an en bloc excision to remove this parathyroid gland because of tight adhesions. Histological examination revealed that parathyroid cells had invaded the surrounding skeletal muscle through fibrous capsules, consistent with parathyroid carcinoma. Her joint pain disappeared 2 weeks after parathyroidectomy, and the tumorous calcinosis had largely resolved after 1 year. Conclusions Parathyroid carcinoma is a rare cause of hyperparathyroidism in end-stage kidney disease. Our case indicates that the use of cinacalcet hinders the diagnosis of parathyroid carcinoma in a chronic dialysis patient. When uncontrolled hypercalcemia and/or hyperphosphathemia develop during cinacalcet administration, parathyroidectomy should be considered to prevent a vicious exacerbation of ectopic calcification.
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Affiliation(s)
- Daisuke Takada
- Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, Japan. .,Department of Nephrology & Dialysis, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan.
| | - Tatsuo Tsukamoto
- Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, Japan.,Department of Nephrology & Dialysis, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Miho Fuse
- Department of Otorhinolaryngology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinpei Kada
- Department of Otorhinolaryngology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, Japan
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11
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Wang P, Xue S, Wang S, Lv Z, Meng X, Wang G, Meng W, Liu J, Chen G. Clinical characteristics and treatment outcomes of parathyroid carcinoma: A retrospective review of 234 cases. Oncol Lett 2017; 14:7276-7282. [PMID: 29344163 PMCID: PMC5754841 DOI: 10.3892/ol.2017.7076] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/27/2017] [Indexed: 12/20/2022] Open
Abstract
Parathyroid carcinoma (PC) is one of the rarest known types of cancer and has a moderate prognosis, with estimated 5- and 10-year overall survival rates between 78–85% and between 49–70%, respectively. To raise awareness of this disease, and to optimize its diagnosis, clinical management and prognosis, the present study retrospectively reviewed 234 cases of PC. A total of 226 cases of PC, which were archived between 1984 and 2015 in the three major databases of the Chinese population, were retrieved and pooled with the 8 cases diagnosed and treated at the Department of Thyroid Surgery of The First Hospital of Jilin University (Changchun, China) between June 2008 and December 2015. The clinicopathological features, diagnosis, surgical procedures and outcomes of these cases of PC were investigated. The review revealed that misdiagnosis has been a considerable issue, with >80% of the patients misdiagnosed prior to surgery, and the accuracy of intraoperative diagnosis based on frozen sections was only 15.04%. The use of radical resection as first-line therapy significantly improved the disease-free survival by ~8 years (log-rank, 20.956; P<0.001); and, at relapse, reoperation prolonged patient survival by ~7 years (log-rank, 35.322; P<0.001). Consistently, a Cox proportional hazards analysis indicated that radical resection as a first-line therapy reduced the risk of postoperative recurrence (P=0.030), and that reoperation following recurrence significantly improved patient survival (P=0.030). The 5- and 10-year cumulative disease-specific survival rates of the cases of PC were 83 and 67%, respectively. Notably, an increased mortality rate was observed among males with PC compared with female patients with PC. In summary, in the past 32 years (1984–2015), the majority of patients with PC have been misdiagnosed. Performing radical resection as the first-line therapy significantly reduces recurrence and improves patient survival time; and, following relapse, subsequent surgery has also been demonstrated to be an effective approach.
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Affiliation(s)
- Peisong Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shuo Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi Lv
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xianying Meng
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Guimin Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wei Meng
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jia Liu
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Guang Chen
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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12
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Marchiori E, Pelizzo MR, Herten M, Townsend DM, Rubello D, Boschin IM. Specifying the molecular pattern of sporadic parathyroid tumorigenesis-The Y282D variant of the GCM2 gene. Biomed Pharmacother 2017; 92:843-848. [PMID: 28609842 DOI: 10.1016/j.biopha.2017.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Sporadic carcinoma of the parathyroid glands is a rare malignant neoplasia. The GCM2 gene encodes a transcription factor that is crucial to embryonic parathyroid development. The Y282D variant of GCM2 exhibits increased transcriptional activity, and the presence of this variant is significantly associated with a higher prevalence of primitive hyperparathyroidism. The present study investigated the prevalence of the Y282D variant of the GCM2 gene and its association with clinical parameters in patients with a definitive histological diagnosis of sporadic parathyroid carcinoma (SPC) or atypical adenoma (AA).
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Affiliation(s)
- Elena Marchiori
- Department of Oncological Surgical and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy; Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany.
| | - Maria Rosa Pelizzo
- Department of Oncological Surgical and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Monika Herten
- Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany
| | - Danyelle M Townsend
- Department of Drug Discovery and Pharmaceutical Sciences, Medical University of South Carolina, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology and Clinical Pathology, Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Isabella Merante Boschin
- Department of Oncological Surgical and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
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13
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Razzak R, McMullen T, Bédard ELR. Excision of middle mediastinal parathyroid adenoma by videoscopic assisted mediastinoscopy (VAM). J Thorac Dis 2016; 8:2651-2653. [PMID: 27747020 DOI: 10.21037/jtd.2016.08.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a case involving a female patient with primary hyperparathyroidism arising from a middle mediastinal parathyroid adenoma. Initial diagnosis was made based on a history of polyuria and recurrent renal colic. At the age of 77 she underwent videoscopic assisted mediastinoscopy (VAM) for resection of the adenoma which was localized using single-photon emission computed tomography (SPECT/CT). This case illustrates the importance for accurate pre-operative localization and intra-operative monitoring to ensure complete surgical removal in order to improve postoperative normocalcemia success rates.
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Affiliation(s)
- Rene Razzak
- Division of Thoracic Surgery, Department of Surgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Todd McMullen
- Division of General Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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