Abstract
Parathyroid carcinoma is a rare type of endocrine cancer, with significant morbidity and mortality associated with parathyroid hormone (PTH)-mediated hypercalcemia. Concerning clinical features for parathyroid cancer include severe hypercalcemia (albumin-corrected calcium > 3 mmol/L), a palpable neck mass ( > 3 cm), 3rd/2nd generation PTH assay ratio ( > 1), and intraoperative suspicion of local invasion or regional metastasis. A definite diagnosis of malignancy is rendered when a parathyroid tumor presents one of the following clinicopathological features: (1) vascular invasion, (2) perineural invasion, (3) gross invasion into adjacent anatomical structures, and/or (4) metastasis. In difficult cases, the use of ancillary biomarkers is critical to establish an accurate diagnosis. Recent advances in molecular pathology have uncovered the important role of CDC73/HRPT2, a tumor suppressor gene deregulated in parathyroid carcinomas. Loss of nuclear and/or nucleolar expression of parafibromin (the gene product of CDC73/HRPT2) is now regarded as a diagnostic, prognostic and predictive biomarker for parathyroid carcinoma. Furthermore, over 15-20% of seemingly sporadic parathyroid carcinomas have underlying germline CDC73/HRPT2 mutations. As a result, many centers have integrated the use of ancillary biomarkers, notably parafibromin staining, in their routine practise. Radical surgery with en bloc resection has emerged as a primary treatment modality in parathyroid cancer, achieving cure in some patients. However, in those with inoperable disease, there remains a dire need for new therapies, as current treatments are largely ineffective. This review provides an update on the current knowledge of parathyroid carcinoma and highlights its exciting changes in endocrine practice.
Highlights
Parathyroid carcinoma is a highly aggressive endocrine tumor, with an annual incidence of less than 1 per million [1,2,3,4,5,6,7,8]
This review provides an update on the current knowledge of parathyroid carcinomas and highlights the clinicopathological correlates of this rare disease
When compared to conventional imaging modalities, the sestamibi scan has the advantage of localizing ectopic hyperfunctioning parathyroid tissue; if present, this finding should prompt the physician to consider the possibility of a metastatic parathyroid carcinoma [1,8,10,15,21,30,33,57,58,59,60,64,65,66,67,68]
Summary
Parathyroid carcinoma is a highly aggressive endocrine tumor, with an annual incidence of less than 1 per million [1,2,3,4,5,6,7,8]. Reported symptoms relate to overt hyperparathyroidism, including renal (nephrolithiasis, nephrocalcinosis), skeletal (bone pain, osteopenia), and neurocognitive involvement (anxiety, depression) [1,4,8,9,10,19,29,33,34,35] In the past, both benign and malignant parathyroid disease would present symptomatically in affected patients [1,4,8,9,10,19,29,30,33,34,35,36,37]. “non-functioning” parathyroid carcinomas have been described in less than 10% of cases [8,11,26,35,56]
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