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Procopio PF, Pennestrì F, Martullo A, Raffaelli M. Persistent and recurrent hyperparathyroidism - Attitude. Am J Surg 2024:115826. [PMID: 39068062 DOI: 10.1016/j.amjsurg.2024.115826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Despite parathyroidectomy represents the curative treatment for primary hyperparathyroidism (pHPT) in up to 98% of patients, persistent hyperparathyroidism (perHPT) and recurrent hyperparathyroidism (rHPT) rates are reported in 22% and 10%, respectively. Indications for reoperation must be balanced with the higher risk of postoperative complications. The aim of this review is summarizing the current evidence in terms of preoperative assessment and surgical approach in patients with perHPT and rHPT. METHODS Operations for pHPT between 1997 and 2023 in our center were analyzed and patients with perHPT and rPTH at time of referral were included. RESULTS Among 1730 parathyroidectomies for pHPT, 85 patients underwent revisional surgery. Eleven and 74 out of these 85 cases were due to perHPT and rHPT, respectively. CONCLUSIONS Prior to reoperation, biochemical assessment and localization methods should always be performed to properly plan surgical strategy. Surgical experience represents the primary determinant in achieving effective disease control.
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Affiliation(s)
- Priscilla Francesca Procopio
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pennestrì
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annamaria Martullo
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
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2
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Sapuppo G, Giusti MA, Aricò D, Masucci R, Tavarelli M, Russo M, Pellegriti G. Recurrent parathyromatosis in a patient with concomitant MEN1 and CASR gene alterations: Clinical management of a case report and literature review. Front Endocrinol (Lausanne) 2023; 14:1108278. [PMID: 36998475 PMCID: PMC10044612 DOI: 10.3389/fendo.2023.1108278] [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: 11/25/2022] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction Parathyromatosis is a rare cause of primitive hyperparathyroidism characterized by the presence of numerous parathyroid tissue foci in the neck/mediastinum, due to hyperplasia of parathyroid embryologic residues (primary-form) or to local parathyroid tissue implantation (secondary-form). 63 cases have been described in the literature. In our patient parathyromatosis was due to a combination of two mutations. Case report A 36-years-old woman was diagnosed with osteoporosis secondary to primary hyperparathyroidism. Subsequent right parathyroidectomy showed a parathyroid adenoma. The follow-up was negative but after 10 years she had a relapse. The genetic screening showed a rare intronic mutation of the MEN1 gene and a heterozygous mutation never described in exon 8 of the CASR gene, coding for the calcium receptor. Calcemia and PTH increased over the years with the onset of nephrocalcinosis and the worsening of osteoporosis despite the therapy with Cinacalcet, bisphosphonates and Vitamin D. She had therefore two additional surgical procedures (parathyroid tissue without malignancy). At follow-up she showed elevated levels of PTH (>1000 pg/ml) and calcium (11.2 mg/dl) and CT scans multiple subcentimetric nodules in the neck/upper mediastinum. Since the 68Ga-DOTATATE showed an increased uptake in the neck/mediastinum, lanreotide was added. After two months there was a significant biochemical response but, unfortunately, after six months, the patient showed a new worsening. Conclusions a rare case of parathyromatosis due to a combination of two genetic alterations never described. The main issues concern the diagnosis and the radical treatment. Somatostatin analogues may have a useful role in both diagnosis and therapy.
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Affiliation(s)
- Giulia Sapuppo
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Maria Ausilia Giusti
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Demetrio Aricò
- Department of Nuclear Medicine, Humanitas Oncological Centre of Catania, Catania, Italy
| | - Romilda Masucci
- Clinical and Diagnostic Center, Giovan Battista (G.B.) Morgagni, Catania, Italy
| | - Martina Tavarelli
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Marco Russo
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Gabriella Pellegriti
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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3
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Ilyicheva EA, Bersenev GA. Parathyromatosis as a cause of recurrence primary hyperparathyroidism: A case report. Int J Surg Case Rep 2021; 80:105689. [PMID: 33752295 PMCID: PMC7940790 DOI: 10.1016/j.ijscr.2021.105689] [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: 02/02/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 11/28/2022] Open
Abstract
Parathyromatosis in primary hyperparathyroidism are a difficult diagnostic and therapeutic task. The main method of treatment is the surgical removal of all foci of parathyromatosis. In the postoperative period, observation of such patients is required with laboratory and visual screening to exclude recurrence hyperparathyroidism.
Introduction and importance Parathyromatosis is a rare cause of recurrent hyperparathyroidism. The main cause of this pathology is secondary implantation into the surrounding tissues of the damaged parathyroid gland (rough manipulation of the gland tissue) during the primary operation. Nowadays, parathyromatosis remain a difficult diagnostic and therapeutic task. Case presentation A 57-year-old woman 12 years ago underwent right inferior parathyroid adenomectomy. For the last 2 years, the patient began to worry about pain in large tubular bones, thoracic spine. In the biochemical analysis of the patient's blood, the serum ionized calcium level was increased - 1.56 mmol/l, parathyroid hormone - 144 pg/ml. Ultrasound scan of the neck showed the presence of two hypoechoic formations with dimensions of 24 × 12 × 6 mm and 14 × 9 × 8 mm behind the right lobe of the thyroid gland (the site of a previously operation).The patient underwent cervicotomy, removal of 3 fragments of the parathyromatosis tissue. According to a histological study, there fragments are presented by diffuse-nodular hyperplasia from dark main cells. Remission of primary hyperparathyroidism was achieved. Clinical discussion This clinical case shows the need for differential diagnosis in recurrence primary hyperparathyroidism with parathyroid cancer, secondary hyperparathyroidism, parathyromatosis. Conclusion The main method of treatment is the surgical removal of all foci of parathyromatosis. In the postoperative period, observation of such patients is required with laboratory and visual screening to exclude recurrence hyperparathyroidism.
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Affiliation(s)
- Elena A Ilyicheva
- Federal State Budgetary Scientific Institution "Irkutsk Scientific Center of Surgery and Traumatology", ul. Bortsov Revolyutsii 1, Irkutsk, Irkutsk Region, 664003, Russian Federation.
| | - Gleb A Bersenev
- Federal State Budgetary Scientific Institution "Irkutsk Scientific Center of Surgery and Traumatology", ul. Bortsov Revolyutsii 1, Irkutsk, Irkutsk Region, 664003, Russian Federation.
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4
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Yang J, Zhang J, Liu NH, Liu H, Dong MJ. Persistent secondary hyperparathyroidism caused by parathyromatosis and supernumerary parathyroid glands in a patient on haemodialysis. BMC Nephrol 2020; 21:257. [PMID: 32631272 PMCID: PMC7339528 DOI: 10.1186/s12882-020-01917-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) is a common high-risk factor for mortality in end-stage renal disease, and parathyromatosis and supernumerary parathyroid glands are very rare causes of persistent SHPT. Preoperative diagnosis and removal of all hyperplastic parathyroid glands are challenging. We report a rare case of persistent SHPT due to parathyromatosis and supernumerary parathyroid glands and successful management by multiple imaging modalities. Case presentation A 53-year-old Chinese woman on haemodialysis experienced discomfort due to itching and bone pain due to persistent SHPT after parathyroidectomy. The supernumerary parathyroid glands and parathyromatosis were detected by multiple imaging modalities, including 99mTc-sestamibi (99mTc-MIBI) scans, ultrasonography and four-dimensional computed tomography (4D-CT) and then excised; pathological confirmation was performed. During follow-up, her serum calcium and parathyroid hormone levels were stable in the appropriate ranges, and no complications arose. Conclusions Because of persistent SHPH after parathyroidectomy in patients with haemodialysis, multiple imaging modalities, including 99mTc-MIBI scans, 4D-CT and ultrasonography, are helpful for detecting supernumerary parathyroid glands and parathyromatoses. Accurate preoperative localization of this rare lesion is important for management, enabling the removal of all affected parathyroid tissues.
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Affiliation(s)
- Jun Yang
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China
| | - Jun Zhang
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China
| | - Ning-Hu Liu
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China
| | - Hao Liu
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China
| | - Meng-Jie Dong
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China.
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Haciyanli M, Karaisli S, Gucek Haciyanli S, Atasever A, Arikan Etit D, Gur EO, Acar T. Parathyromatosis: a very rare cause of recurrent primary hyperparathyroidism - case report and review of the literature. Ann R Coll Surg Engl 2019; 101:e178-e183. [PMID: 31509000 DOI: 10.1308/rcsann.2019.0105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parathyromatosis is a rare entity and usually appears as a consequence of the seeding on previous parathyroid surgery which was applied for the secondary hyperparathyroidism. A 63-year-old woman presented with a history of subtotal thyroidectomy 20 years ago and parathyroidectomy due to primary hyperparathyroidism (PHPT) four years ago. Imaging methods revealed multiple parathyromatosis foci on subcutaneous tissue of the neck. En-bloc resection was performed and pathological examination confirmed the diagnosis of parathyromatosis. After an uneventful 10 months, biochemical and radiological tests revealed recurrence on bilateral thyroid lodges. En-bloc resection was performed. The patient has remained well for 24 months after the second operation and has been followed-up with normal parathormone and serum calcium values. To the best of our knowledge, this report describes the twenty-first case of parathyromatosis in PHPT setting in the literature. It should be kept in mind that parathyromatosis may recur at different sites in the neck even in patients with PHPT.
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Affiliation(s)
- M Haciyanli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - S Karaisli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - S Gucek Haciyanli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - A Atasever
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - D Arikan Etit
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - E O Gur
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - T Acar
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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6
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Wei AE, Garrett MR, Gupta A. PARATHYROMATOSIS: A RARE CASE OF RECURRENT HYPERPARATHYROIDISM LOCALIZED BY FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY. AACE Clin Case Rep 2019; 5:e384-e387. [PMID: 31967077 DOI: 10.4158/accr-2019-0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/08/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To present a rare case of parathyromatosis. Methods We present the clinical, laboratory, and imaging findings, along with a review of the literature. Results A 33-year-old man with a history of right upper parathyroid adenoma removal 5 years prior due to hyperparathyroidism was admitted for severe hypercalcemia (15.6 mg/dL; normal, 8.5 to 10.5 mg/dL) with elevated plasma parathyroid hormone (PTH) (882 pg/mL; normal, 15 to 65 pg/mL). Ultrasound, computed tomography (CT), sestamibi, and positron emission tomography scans were unremarkable; however, a four-dimensional CT (4DCT) of the neck showed an area of increased signal enhancement and hypervascularity without discrete nodule in the posterior right thyroid region. The patient underwent parathyroid surgical exploration with right hemithyroidectomy and compartment neck dissection to remove the affected tissue. PTH levels dropped to 208 pg/mL postoperatively; calcium decreased but remained elevated at 12.7 mg/dL. Pathology revealed the presence of several small nodular foci of atypical hyperplastic parathyroid tissue in the right thyroid and soft tissue in the left central neck compartment consistent with parathyromatosis. Conclusion This case report represents the first-time use of 4DCT to localize parathyromatosis. Parathyromatosis is a rare but problematic cause of recurrent hyperparathyroidism. Ultrasound and 4DCT may represent the best imaging modalities for identification and perioperative management to remove all affected tissue without reseeding.
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7
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Li X, Wei Y, Shao H, Peng L, An C, Yu MA. Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study. Int J Hyperthermia 2019; 36:647-653. [PMID: 31305184 DOI: 10.1080/02656736.2019.1627429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ying Wei
- Interventional Ultrasound Center, China-Japan Friendship Hospital, Beijing, China
| | - Hongzeng Shao
- Department of Ultrasound, The Fourth People's Hospital of Zibo, Zibo, China
| | - Lili Peng
- Interventional Ultrasound Center, China-Japan Friendship Hospital, Beijing, China
| | - Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ming-An Yu
- Interventional Ultrasound Center, China-Japan Friendship Hospital, Beijing, China
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8
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Miller MJ, Agrawal N, Katz G, Ogilvie J, Melamed J. Parathyromatosis with a papillary architecture. Histopathology 2019; 75:598-602. [PMID: 31152597 DOI: 10.1111/his.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Nidhi Agrawal
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
| | - Gillian Katz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
| | - Jennifer Ogilvie
- Department of Surgery, Division of Endocrine Surgery, NYU Langone Health, New York, NY, USA
| | - Jonathan Melamed
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
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9
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Aggarwal A, Wadhwa R, Aggarwal V. Parathyromatosis Following Endoscopic Parathyroid Surgery: A Rare Occurrence. Indian J Endocrinol Metab 2017; 21:641-642. [PMID: 28670557 PMCID: PMC5477461 DOI: 10.4103/ijem.ijem_61_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ajay Aggarwal
- Department of Endocrinology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Roopak Wadhwa
- Department of Endocrinology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Vivek Aggarwal
- Department of Endocrine Surgery, Fortis Hospital, Shalimar Bagh, New Delhi, India
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10
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Jain M, Krasne DL, Singer FR, Giuliano AE. Recurrent primary hyperparathyroidism due to Type 1 parathyromatosis. Endocrine 2017; 55:643-650. [PMID: 27743301 DOI: 10.1007/s12020-016-1139-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Parathyromatosis is a rare condition consisting of multiple nodules of benign hyperfunctioning parathyroid tissue scattered throughout the neck and superior mediastinum. As a potential cause of recurrent or persistent hyperparathyroidism, parathyromatosis is a challenging condition to diagnose and treat. The optimal evaluation and management of patients with parathyromatosis is not well established. The reported case involves a patient who was initially diagnosed with primary hyperparathyroidism. The diagnosis of Type 1 parathyromatosis was made after the patient developed recurrent hyperparathyroidism with hypercalcemia and osteoporosis 17 years after the initial operation and underwent two additional operations. The majority of parathyromatosis cases are diagnosed in the setting of secondary hyperparathyroidism. Consensus regarding the preoperative diagnosis and evaluation is lacking due to the paucity of cases of this rare clinical entity. Management involves complete surgical extirpation of all identifiable rests of parathyroid tissue. Intra-operative parathyroid hormone level monitoring and frozen section examination are excellent tools that could increase the rates of initial operative success. Despite this, long-term disease remission is rare, and medical therapy, including calcimimetics and bisphosphonates, may be required for postoperative or non-operative management.
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Affiliation(s)
- Monica Jain
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - David L Krasne
- Department of Pathology, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Frederick R Singer
- Endocrine/Bone Disease Program, John Wayne Cancer Institute at Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Armando E Giuliano
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
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11
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Nakamura M, Tanaka K, Fujii T. Hyperparathyroidism caused by distant pulmonary lesions and parathyromatosis after ethanol injection/parathyroidectomy for secondary hyperparathyroidism. Hemodial Int 2017; 21:E45-E49. [PMID: 28078796 DOI: 10.1111/hdi.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Secondary hyperparathyroidism (SHPT) treatment includes parathyroidectomy and percutaneous ethanol injection therapy (PEIT), which are invasive procedures. The condition in which benign hyperfunctioning parathyroid tissue is distributed throughout the neck and mediastinum is termed parathyromatosis. Here, we present the case of a 51-year-old woman who began hemodialysis in 1986 due to chronic kidney disease of unknown etiology and developed SHPT in 1999. She underwent 6 rounds of PEIT followed by total a parathyroidectomy with partial forearm autotransplantation. Between 2011 and 2013, surgeons removed several nodules from her pulmonary and cervical regions and the transplanted masses from her forearm; all showed hyperplasia but exhibited no histological evidence of malignancy. Damage to the parathyroid capsule after repeated PEITs may cause local cervical recurrence and pulmonary lesions, although distant lesions are extremely rare in SHPT. This case is of interest due to the possible association between PEIT and parathyromatosis and distal lesions.
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Affiliation(s)
- Michio Nakamura
- Department of Transplant Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | | | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Minatoku, Tokyo, Japan
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12
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Achour I, Charfi S, Chaabouni MA, Chakroun A, Guermazi F, Hammami B, Ghorbel A. [Parathyromatosis: An uncommon cause of recurrent hyperparathyroidism]. Rev Med Interne 2016; 38:61-64. [PMID: 27083335 DOI: 10.1016/j.revmed.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 03/15/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Parathyromatosis is a rare cause of recurrent hyperparathyroidism. It results from hyperfunctioning parathyroid tissue scattered throughout the thyroid bed region. CASE REPORT A 51-year-old man with a history of parathyroidectomy, presented 18 years later with recurrent primary hyperparathyroidism. Surgical exploration identified a single parathyroid gland. The act was completed by a central compartment dissection and ipsilateral lobectomy. The patient was free of recurrence after a one-year follow-up. CONCLUSION Parathyromatosis a rare cause of recurrent hyperparathyroidism. Its management is challenging. Extensive surgery is required with clearance of the central neck compartment and homolateral lobectomy. Medical therapy could be used to decrease parathormone level in recurrent parathyromatosis.
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Affiliation(s)
- I Achour
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie.
| | - S Charfi
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - M A Chaabouni
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - A Chakroun
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - F Guermazi
- Service de médecine nucléaire, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - B Hammami
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - A Ghorbel
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
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Abstract
This review focuses on the pathologic entities associated with hyperparathyroidism in humans. A discussion of the lesions, their embryology, and pathologic features is included. Immunohistology, cytopathology, and a brief overview of molecular aspects of the lesion are included.
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Affiliation(s)
- Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Kathleen T Montone
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Zubair N Baloch
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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14
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Callender GG, Udelsman R. Surgery for primary hyperparathyroidism. Cancer 2014; 120:3602-16. [DOI: 10.1002/cncr.28891] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/24/2014] [Accepted: 03/31/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Glenda G. Callender
- Department of Surgery; Section of Endocrine Surgery, Yale University School of Medicine; New Haven Connecticut
| | - Robert Udelsman
- Department of Surgery; Section of Endocrine Surgery, Yale University School of Medicine; New Haven Connecticut
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15
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Scorza ABT, Moore AG, Terry M, Bricker LA. Secondary parathyromatosis in a patient with normal kidney function: review of diagnostic modalities and approaches to management. Endocr Pract 2013; 20:e4-7. [PMID: 24013979 DOI: 10.4158/ep13053.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a patient with secondary parathyromatosis, a rare complication of parathyroidectomy, and to discuss issues currently pertinent to its diagnosis and management. METHODS Data were derived from clinical and pathologic observations obtained during patient care. RESULTS The index patient developed intractable hyperparathyroidism and hypercalcemia that has persisted after 4 surgical procedures and has remained largely resistant to medication, albeit with partial amelioration with combined bisphosphonate and cinacalcet. CONCLUSION Despite the rarity of this difficult complication of parathyroidectomy, its iatrogenic basis emphasizes a need for heightened awareness and caution among surgeons and endocrinologists. Herein we report an instance of intractable secondary parathyromatosis in a patient with normal kidney function, and we review current approaches to diagnosis and management.
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Affiliation(s)
- Anda B Tuncay Scorza
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan
| | - Andreea G Moore
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan
| | - Marisa Terry
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan
| | - Lee A Bricker
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan
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(99m)Tc MIBI SPECT findings in parathyromatosis--a rare entity causing recurrent hyperparathyroidism. Clin Nucl Med 2013; 38:e443-5. [PMID: 23603581 DOI: 10.1097/rlu.0b013e318279bc2c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parathyromatosis is a rare clinical condition resulting in recurrent hyperparathyroidism that often poses challenges in its diagnosis and complete surgical cure. We report the (99m)Tc MIBI SPECT findings in a patient with recurrent hyperparathyroidism requiring multiple parathyroid explorations. MIBI SPECT helped localize the areas of these "recurrent parathyroid lesions" that were often found outside of the expected locations within the neck.
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Parathyromatosis after parathyroidectomy because of primary hyperparathyroidism: A case report. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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Hage MP, Salti I, El-Hajj Fuleihan G. Parathyromatosis: a rare yet problematic etiology of recurrent and persistent hyperparathyroidism. Metabolism 2012; 61:762-75. [PMID: 22221828 DOI: 10.1016/j.metabol.2011.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 11/29/2022]
Abstract
Recurrent or persistent hyperparathyroidism is an uncommon yet challenging clinical problem, and parathyromatosis is one of its very rare causes. In this minireview, we review causes of recurrent hyperparathyroidism and all cases of parathyromatosis available in the literature. The clinical course of a case of parathyromatosis with the longest follow-up (1977-2011) is described. Similar cases reported between 1975 and the present are reviewed and analyzed to characterize the clinical presentation, course, and management of this rare condition. Parathyromatosis, which is benign parathyroid tissue seeding, has been detailed in 35 patients in the English literature. The majority were female subjects, with end-stage renal disease, in their fifth to sixth decade of life. In most cases, the diagnosis was made intraoperatively; and the condition was often refractory to surgery. A calcimimetic agent was used in 5 cases with end-stage renal disease; serum calcium and/or parathyroid hormone levels decreased in 4 subjects, but only one was reported to experience increments in bone density. Medical management combining a calcimimetic with a bisphosphonate may therefore be a preferred alternative.
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Affiliation(s)
- Mirella P Hage
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut-Medical Center, Riad El Solh 1107 2020, Beirut, Lebanon
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Recurrent hyperparathyroidism and forearm parathyromatosis after total parathyroidectomy. Surgery 2010; 148:867-73; discussion 873-5. [DOI: 10.1016/j.surg.2010.07.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Accepted: 07/15/2010] [Indexed: 11/23/2022]
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Affiliation(s)
- Wen T Shen
- Department of Surgery, Section of Endocrine Surgery, Mt. Zion Medical Center, University Of California San Francisco, Hellman Bldg. Room C-349, Campus Box 1674, San Francisco, CA 94115, USA.
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