Parathyroid Carcinoma: Analysis of Patient Characteristics and Outcomes in a Retrospective Review of Eight Cases seen in a Single Center
DOI:
https://doi.org/10.15605/jafes.034.02.17Keywords:
parathyroid neoplasms, carcinoma, hypercalcemiaAbstract
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.
Downloads
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.1991;15(6):738-44. https://www.ncbi.nlm.nih.gov/pubmed/1767540. https://doi.org/10.1007/bf01665308.
Shane E. Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab. 2001;86(2):485-93.
https://www.ncbi.nlm.nih.gov/pubmed/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.2001;2(4):347–54.
https://www.ncbi.nlm.nih.gov/pubmed/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.
https://www.ncbi.nlm.nih.gov/pubmed/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. .https://www.ncbi.nlm.nih.gov/pubmed/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. https://www.ncbi.nlm.nih.gov/pubmed/1518393
Levin KE, Galante M, Clark OH. Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery. 1987;101(6):649-60. https://www.ncbi.nlm.nih.gov/pubmed/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. https://www.ncbi.nlm.nih.gov/pubmed/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. https://www.ncbi.nlm.nih.gov/pubmed/2684326. 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.
https://www.ncbi.nlm.nih.gov/pubmed/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;19(4):221-5. https://www.ncbi.nlm.nih.gov/pubmed/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.
https://www.ncbi.nlm.nih.gov/pubmed/11113666
Pandya C, Uzilov AV, Bellizzi J, et al. Genomic profiling reveals mutational landscape in parathyroid carcinomas. JCI Insight. 2017;2(6):e92061. https://www.ncbi.nlm.nih.gov/pubmed/28352668. https://www.ncbi.nlm.nih.gov/pmc/articles/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. https://www.ncbi.nlm.nih.gov/pmc/articles/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. https://www.ncbi.nlm.nih.gov/pmc/articles/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. https://www.ncbi.nlm.nih.gov/pmc/articles/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. https://www.ncbi.nlm.nih.gov/pmc/articles/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.
https://www.ncbi.nlm.nih.gov/pmc/articles/24423366. https://doi.org/10.1210/jc.2013-397.
Dudney WC, Bodenner D, Stack Jr BC. Parathyroid carcinoma. Otolaryngol Clin North Am. 2010;43(2):441-53. https://www.ncbi.nlm.nih.gov/pmc/articles/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. https://www.ncbi.nlm.nih.gov/pubmed/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. https://www.ncbi.nlm.nih.gov/pubmed/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. https://www.ncbi.nlm.nih.gov/pubmed/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. https://www.ncbi.nlm.nih.gov/pubmed/15287039. https://doi.org/10.1002/hed.20049.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.