Parathyroid Carcinoma: Analysis of Patient Characteristics and Outcomes in a Retrospective Review of Eight Cases seen in a Single Center

Keywords: parathyroid neoplasms, carcinoma, hypercalcemia

Abstract

Eight cases of parathyroid carcinoma were identified (8 females; median age 45 years, range 28-72). Half of whom were diagnosed preoperatively. Hypercalcemic symptoms were seen in 87.5% of the patients and the main complication was nephrolithiasis. At presentation, the median calcium was 3.675 mmol/L, median phosphate of 0.68 mmol/L, median intact parathyroid hormone (iPTH) was 211 pmol/L. Five patients had regional nodes metastasis and 1 had distant metastasis to the lungs. Parathyroid gland invasion to adjacent structures was seen in 62.5% of cases while another 62.5% showed capsular or vascular infiltration on histology with median tumour size of 3.2 cm. Recurrent hypercalcemia occurred in 50% of the patients with median time of recurrence of 21 months. In this case series, we found that patients with severe hypercalcemia and high iPTH also exhibited a high index suspicion of PC.

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Author Biographies

Shamira Shahar, Hospital Putrajaya
Diabetes and Endocrine Unit, Department of Medicine
Kim Piow Lim, Hospital Putrajaya

Diabetes and Endocrine Unit, Department of Medicine

 

Masni Mohamad, Hospital Putrajaya

Diabetes and Endocrine Unit, Department of Medicine

 

References

De Quervain F. Parastruma maligna aberrata. Deutsche Zeitschr Chir. 1904;100:334-52.

Obara T, Fujimoto Y. Diagnosis and treatment of patients with

parathyroid carcinoma: An update and review. World J Surg.

;15(6):738-44. PMID: 1767540. https://doi.org/10.1007/bf01665308.

Shane E. Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab. 2001;86(2):485-93. PMID: 11157996. https://doi.org/10.1210/jcem.86.2.7207.

Favia G, et al. La patologia chirurgica della tiroide e delle

paratiroidi. Club delle UEC; Il carcinoma delle paratiroidi; 2000.

Kebebew E. Parathyroid carcinoma. Curr Treat Options Oncol.

;2(4):347–54. PMID: 12057115.

Heath H 3rd, Hodgson SF, Kennedy MA. Primary hyperparathyroidism:Incidence, morbidity, and potential economic impact in a community. N Engl J Med. 1980;302(4):189-93. PMID: 7350459. https://doi.org/10.1056/NEJM198001243020402.

Silverberg SJ, Shane E, Jacobs TP, et al. Nephrolithiasis and bone involvement in primary hyperparathyroidism. Am J Med. 1990;89(3):327-34. PMID: 2393037. https://doi.org/10.1016/0002-9343 (90)90346-f.

Wynne AG, van Heerden J, Carney JA, Fitzpatrick LA. Parathyroid carcinoma: Clinical and pathological features in 43 patients. Medicine.1992;71(4):197-205. PMID: 1518393.

Levin KE, Galante M, Clark OH. Parathyroid carcinoma versus

parathyroid adenoma in patients with profound hypercalcemia.

Surgery. 1987;101(6):649-60. PMID: 3589961.

Sidhu PS, Talat N, Patel P, Mulholland NJ, Schulte KM. Ultrasound features of malignancy in the preoperative diagnosis of parathyroid cancer: A retrospective analysis of parathyroid cancer. Eur Radiol. 2011;21(9):1865-73. PMID: 21556910. https://doi.org/10.1007/s00330-011-2141-3.

Daly BD, Coffey SL, Behan M. Ultrasonography appearances of

parathyroid carcinoma. Br J Radiol. 1989; 62(743):1017-9. PMID:

https://doi.org/10.1259/0007-1285-62-743-1017.

Schantz A, Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer. 1973;31(3):600-5. PMID: 4693587. https://doi.org/10.1002/1097-0142(197303)31:3<600::aid-cncr2820310316>3.0.co;2-0.

Delellis RA. Challenging lesions in the differential diagnosis of

endocrine tumors: Parathyroid carcinoma. Endocr Pathol. 2008;

(4):221-5. PMID: 19058032. https://doi.org/10.1007/s12022-008-9050-2.

Koea JB, Shaw JH. Parathyroid cancer: Biology and management. Surg Oncol. 1999;8(3):155-65. PMID: 11113666.

Pandya C, Uzilov AV, Bellizzi J, et al. Genomic profiling reveals

mutational landscape in parathyroid carcinomas. JCI Insight.

;2(6):e92061. PMID: 28352668. PMCID: PMC5358487. https://doi.org/10.1172/jci.insight.92061.

Sandelin K, Auer G, Bondeson L, Grimelius L, Farnebo LO. Prognostic factors in parathyroid cancer: A review of 95 cases. World J. Surg.1999;16(4):724-31. PMID: 1413841. https://doi.org/10.1007/bf02067369.

Schulte KM, Talat N, Galata G, et al. Oncologic resection achieving r0 margins improves disease-free survival in parathyroid cancer. Ann Surg Oncol. 2014;21(6):1891-7. PMID: 24522991. https://doi.org/10.1245/s10434-014-3530-z.

Kebebew E, Arici C, Duh QY, Clark OH. Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg. 2001;136(8):878-85. PMID: 11485522. https://doi.org/10.1001/archsurg.136.8.878.

Wei CH, Harari A. Parathyroid carcinoma: Update and guidelines for management. Curr Treat Options Oncol. 2012;13(1):11-23. PMID:22327883. https://doi.org/10.1007/s11864-011-0171-3.

Rolighed, L, Rejnmark L, Sikjaer T, et al. Vitamin D treatment in

primary hyperparathyroidism: A randomized placebo controlled trial.

J Clin Endocrinol Metab. 2014;99(3):1072-80. PMID: 24423366. https://doi.org/10.1210/jc.2013-3978.

Dudney WC, Bodenner D, Stack Jr BC. Parathyroid carcinoma.

Otolaryngol Clin North Am. 2010;43(2):441-53. PMID: 20510726.

https://doi.org/10.1016/j.otc.2010.01.011.

Tong CV, Hussein Z, Noor NM, Mohamad M, Ng WF. Use of denosumab in parathyroid carcinoma with refractory hypercalcemia, QJM. 2015;108(1):49–50. PMID: 25099611. https://doi.org/10.1093/qjmed/hcu166.

Silverberg SJ, Rubin MR, Faiman C, et al. Cinacalcet hydrochloride reduces the serum calcium concentration in inoperable parathyroid carcinoma. J Clin Endocrinol Metab. 2007;92(10):3803-8. PMID:17666472. https://doi.org/10.1210/jc.2007-0585.

Harari A, Waring A, Fernandez-Ranvier G, et al. Parathyroid

carcinoma: A 43-year outcome and survival analysis. J Clin Endocrinol Metab. 2011;96(12):3679-86. PMID: 21937626. https://doi.org/10.1210/jc.2011-1571.

Busaidy NL, Jimenez C, Habra MA, et al. Parathyroid carcinoma: A 22-year experience. Head Neck. 2004;26(8):716-26. PMID: 15287039. https://doi.org/10.1002/hed.20049.

Published
2019-11-26
How to Cite
Shahar, S., Lim, K. P., & Mohamad, M. (2019). Parathyroid Carcinoma: Analysis of Patient Characteristics and Outcomes in a Retrospective Review of Eight Cases seen in a Single Center. Journal of the ASEAN Federation of Endocrine Societies, 34(2), 229-232. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/675
Section
Case Reports