Ethanol injection under ultrasound guidance to palliate unresectable parathyroid carcinoma

Abstract

Severe hypercalcemia is the leading cause of death in patients with parathyroid carcinoma. Non-curative resection and pharmacological measures may be useful for palliation in cases with recurrent and metastatic disease. Palliative treatment with intra-neoplastic ethanol injection has not been reported yet. Ultrasound-guided percutaneous alcohol injection in one patient with unresectable parathyroid carcinoma is reported. One male patient with extensive recurrent parathyroid carcinoma suffering from severe hypercalcemia, refractory to all available medical measures has undergone two percutaneous ethanol injections. No major complications ensued and parathormone levels decreased from 2.990 pg/mL to 2.230 pg/ml after the first injection, and to 1.104 pg/mL after the second one. Calcium levels decreased from 19.8 mg/dL to 16.1 mg/dL and to 14.5 mg/dL, respectively. The patient died of metabolic hypercalcemia complications about two months later, probably due to mediastinal disease progression. Ultrasound-guided percutaneous ethanol injection may be employed to palliate parathyroid carcinoma in selected cases, with a transitory decrease in PTH and calcium levels.