Case Of Parathyroid Carcinoma Research Articles

FDG-Anorectic Parathyroid Carcinoma With FDG-Avid Bone Metastasis on PET/CT Images

A 53-year-old man complained of aggravated left hip pain of more than 2 months. Whole-body (18)F-FDG PET/CT revealed only 1 hypermetabolic lesion in the left ilium. Histopathologic examination of the lesion suggested metastatic disease. Blood tests documented mildly elevated blood calcium and parathyroid hormone. Subsequent neck ultrasonography, contrast-enhanced CT, and dual-phase scintigraphy with (99m)Tc-MIBI showed a right parathyroid tumor, which was confirmed to be a parathyroid carcinoma postoperatively. We report a case of parathyroid carcinoma rarely encountered with a FDG-negative primary but a FDG-positive metastasis on PET/CT images.

Diagnosis and surgical treatment of parathyroid neoplasms

To explore the clinical features, diagnosis and surgical treatment of parathyroid neoplasms. From January 2003 to December 2011, a total of 51 patients were recruited. Their clinical data, presentations, examinations and surgical approaches were analyzed retrospectively. Among them, there were parathyroid adenoma (n = 32), parathyroid cysts (n = 18) and parathyroid carcinoma (n = 1). The sensitivity and positive rate of neck ultrasonography and (99)Tc(m)-methoxyisobutylisonitrile (MIBI) were 84.3% and 93.5%, 91.7% and 100.0% respectively. The high levels of serum calcium and parathyroid hormone (PTH) in 32 cases of parathyroid adenoma and 1 case of parathyroid carcinoma returned to normal after operation. The levels of serum calcium and PTH remained normal in 18 cases of parathyroid cysts. The clinical manifestations of parathyroid adenoma were complex. The serum levels of calcium and PTH and neck ultrasonography are preferred screening tools for parathyroid neoplasms.(99)Tc(m)-MIBI is suitable for tumor localization.Surgery is effective and safe for parathyroid neoplasm.Real time intraoperative monitoring of PTH is of great importance.

The case of observation and treatment of severe advanced primary hyperparathyroidism with analysis of pitfalls of inadequately delayed management course

Common reasons of delayed diagnosis and treatment faults in patients with primary hyperparathyroidism (PHPT) are discussed in the article on the example of advanced case of parathyroid carcinoma. Among them authors called insufficient awareness of non-endocrinologist about PHPT, polymorphism of PHPT clinical signs, lack of experience of parathyroid surgery in general hospitals, absence of screening of serum calcium. Even in case of advanced bone destructions and renal stones symptoms laboratory confirmation of severe PHPT diagnosis was extremely delayed.

Parathyroid carcinoma survival: improvements in the era of intact parathyroid hormone monitoring?

The intact parathyroid hormone (iPTH) assay is a critical test in the diagnosis and management of PTH-mediated hypercalcemia, including parathyroid carcinoma (PCa). We hypothesized that the survival of patients diagnosed with PCa has improved since adoption of the iPTH assay into clinical practice. We identified all confirmed cases of PCa within the Surveillance, Epidemiology and End Results database from 1973 to 2006. Patients were categorized into two eras based upon introduction of the iPTH assay: 1973 to 1997 (era I) and 1997 to 2006 (era II, when the iPTH assay was in standard use). We estimated overall survival (OS) and disease-specific survival (DSS) using the Kaplan-Meier method, with differences among survival curves assessed via log rank. Multivariate Cox proportional hazards models compared the survival rates between treatment eras while controlling for patient age, sex, race/ethnicity, tumor size, nodal status, extent of disease, and type of surgery. Multivariate models included patients undergoing potentially curative surgery and excluded those with distant metastases. Risks of overall and disease-specific mortality were reported as hazard ratios with 95% confidence intervals. Study criteria were met by 370 patients. Median survival was 15.6 years. Five-year rates of OS and DSS were 78% and 88% for era I and 82% and 96% for era II. On multivariate analysis, age, black race, and unknown extent of disease predicted an increased risk of death from any cause. Treatment era did not predict OS. No factor predicted PCa-specific mortality. In multivariate analysis, neither OS nor DSS have improved in the current era that utilizes iPTH for the detection and management of PCa.

Parathyroid carcinoma in tertiary hyperparathyroidism

Parathyroid carcinoma is a rare disease of unknown etiology. This study presents a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Despite a successful kidney transplantation, the intact parathyroid hormone (iPTH) level of the patient was elevated consistently and could not be controlled by medical therapy. Due to the development of tertiary hyperparathyroidism with bone pain and osteoporosis, subtotal parathyroidectomy was performed 4 months after the kidney transplantation. Histological evaluation revealed that one of four parathyroid lesions was a parathyroid carcinoma, while the others were diffuse hyperplasia. Postoperative laboratory studies indicated a decreased level of iPTH. A positron emission tomography-computed tomography performed 6 months after the operation revealed no evidence of local recurrence or distant metastasis.

Parathyroid carcinoma masquerading as morning sickness in pregnancy

Incidence of primary hyperparathyroidism (PHP) in pregnancy is 8/100,000 population/year with less than 200 cases reported. Physiological changes associated with pregnancy make a diagnosis of PHP difficult and 80% are asymptomatic. High index of suspicion is required as physiological hypocalcemia related to hemodilution, increased glomerular filtration rate resulting in maternal hypercalciuria and gestational hypoalbuminemia can mask hypercalcemia of PHP. Maternal and fetal complication rates are high. Early recognition followed by appropriate management and treatment significantly reduces complications. Here, we present a rare case of parathyroid carcinoma in pregnancy and highlight the difficulties in diagnosis given the non-specific symptoms related to hypercalcemia. We have also discussed the management of PHP during the pregnancy. PHP is a preventable cause of fetal and maternal morbidity and mortality.

Parathyroid carcinoma: review of a problematic case

Parathyroid carcinoma (PTCA) is a rare neoplasm that accounts for less than 1% of primary hyperparathyroidism cases. Several clinical and biochemical features can directing to PTCA, but accurate pre and intraoperative diagnosis are still difficult. This study presents a case of PTCA that diagnosed postoperatively with a discussion of microscopic feature. The surgical exploration revealed an enlarged parathyroid mass which invade recurrent laryngeal nerve and right thyroid gland. Histologic features showed tumor nodules separated by thick fibrous band with capsular invasion and local infiltration to adjacent tissues. The final diagnosis of PTCA was made based on clinical feature and specimens examination. (Med J Indones. 2012;21:170-4)

An Unusual Ectopic Location of a Parathyroid Carcinoma Arising within the Thyroid Gland

Parathyroid carcinomas are very rare tumors and may arise in the normally located or ectopic gland. The latter present certain diagnostic difficulties, and there are no specific guidelines on their management. We present a case of parathyroid carcinoma arising within an ectopically located intrathyroid gland and discuss the diagnosis, management, and difficulties encountered. Furthermore, we review all six previously reported cases of this rare event and demonstrate the patterns in presentation, as well as the differences in management. A 39-yr-old male presented with a right neck mass with biochemical derangement suggestive of a parathyroid lesion. However, radiological investigations were inconclusive as to the true nature of this lesion because they demonstrated a mass within the right thyroid lobe. A sestamibi (99m)technetium subtraction study was performed, which suggested an intrathyroid parathyroid carcinoma. The patient underwent successful surgical intervention. Although rare, ectopically located parathyroid glands can harbor malignant disease. Those located within the thyroid gland can be difficult to diagnose, and thus a combination of radiological modalities, including sestamibi (99m)technetium studies, need to be utilized. Although surgical resection is the most effective treatment, there are no specific guidelines as to the radicality of such treatment.

A case of parathyroid carcinoma

A case of parathyroid carcinoma

A Case of Parathyroid Carcinoma in a Patient with Stage 3 Chronic Kidney Disease

Parathyroid carcinoma is a rare disease in patients with primary hyperparathyroidism. We experienced a case of parathyroid carcinoma presenting with hyperparathyroidism. A 62-year-old male patient had hypercalcemia, chronic kidney disease, and an elevated parathyroid hormone level for at least 3 months. An ultrasonogram and parathyroid scan did not show parathyroid neoplasm. He underwent left hemithyroidectomy and parathyroidectomy. Biopsy revealed a parathyroid carcinoma. His azotemia and hypercalcemia improved after surgery. (Korean J Med 2012;83:796-801)

Hyperfunctional Parathyroid Carcinoma With Mediastinal Extension

Parathyroid carcinoma (PC) is an extremely rare malignancy, of which 0.005% are of all tumours and between 0.5% and 5% of all parathyroid neoplasms. Preoperative diagnosis is often difficult and is almost always obtained only after post-surgical histopathology. The prognosis is related to the local extent of disease and to complete surgical resection of the tumour.We report an uncommon case of hyperfunctional PC with mediastinal extension, emphasising the diagnostic difficulties, histopathological features and treatment strategies. The most recent data in the literature are analysed as well.

Hypercalcaemia due to parathyroid carcinoma presenting in the third trimester of pregnancy

Primary hyperparathyroidism (pHPT) in pregnancy may be associated with significant maternal and fetal morbidity and mortality. Medical management of pHPT in pregnancy is limited, and surgery is the only definitive therapeutic option. The ideal timing for surgery is mid-second trimester, but surgery may also be safely performed in the third trimester. Delayed parathyroid surgery may result in a hypercalcaemic crisis postpartum owing to loss of active placental calcium transfer. We present a case of parathyroid carcinoma in pregnancy presenting with pre-eclampsia at 32 weeks' gestation.

A 32-Year-Old Man With Recurrent Kidney Stones and an Abnormal Chest Radiograph

A 32-Year-Old Man With Recurrent Kidney Stones and an Abnormal Chest Radiograph

Parathyroid carcinoma in multiple endocrine neoplasia type 1. Case report and review of the literature

Parathyroid carcinoma is an infrequent cause of primary hyperparathyroidism. Although hyperparathyroidism in multiple endocrine neoplasia 1 (MEN1) syndrome is the most common manifestation, parathyroid carcinoma is rare. We report a male patient who was diagnosed at 44 years of age with parathyroid carcinoma in the context of MEN1 syndrome coincident with a malignant gastrinoma and non-functioning adrenal adenomas. A genetic analysis revealed the mutation W183C in exon 3 of the MEN1 gene. The diagnosis of carcinoma was made after parathyroid surgery; there had been no clinical suspicion prior to surgery, as the patient had presented only moderate hypercalcemia. Our review of the few published cases of parathyroid carcinoma in MEN1 syndrome reported in the literature indicates that MEN1 gene mutations do not confer a greater risk for parathyroid carcinoma and do not appear to differ from sporadic parathyroid carcinoma.

Head and Neck Pathology

Most malignant tumors in the head and neck are conventional keratinizing squamous cell carcinomas, and their microscopic diagnosis usually pose little challenge for pathologists. However, other conditions including rare malignancies can be encountered so infrequently that diagnosis or grading may be challenging. This issue of Pathology Case Reviews attempts to answer some of the more common questions that pathologists ask of their colleagues with an expertise in oral and/or head and neck pathology. These include the diagnosis and grading of oral epithelial dysplasia, the differential diagnosis of basaloid squamous carcinoma, and the relevance of HPV infection in squamous cancer of the oropharynx. Complementary articles discuss the diagnosis and grading of mucoepidermoid carcinoma, the clinical and pathologic features of salivary duct carcinoma, the diagnostic criteria of parathyroid carcinoma, and the microscopic and immunophenotypic features of marginal zone (MALT) lymphoma of the parotid gland. The diagnosis and terminology of precursor lesions to carcinomas of the upper aerodigestive tract is a challenging area for many pathologists because of the subtle microscopic features that form the basis of grading. This area is important because grading often guides clinical management for patients with premalignant disease. In their article, Drs Speight and Torres-Rendon present a case of squamous dysplasia of the oral tongue that progressed to squamous cell carcinoma. They clarify the clinical presentation of oral epithelial dysplasia and provide terminology and the histologic criteria for grading. The practical differential diagnosis and clinical management of oral epithelial dysplasia is also covered. Mucoepidermoid carcinoma is the most common primary malignancy of the salivary glands. Microscopic grading seems to play an important role in treatment selection and patient prognosis, and yet no common grading system has been agreed on. Drs Griffith and Seethala present a case of mucoepidermoid carcinoma arising in a minor salivary gland of the buccal mucosa. They present the differential diagnosis for mucoepidermoid carcinoma and then compare competing microscopic grading systems, problems in their application, and the clinical significance of grading. Salivary duct carcinoma is a rare, high-grade adenocarcinoma of the major salivary glands with a poor prognosis. Despite the distinctive cytologic and histologic features of this tumor and its resemblance to apocrine-type ductal carcinoma of the breast, salivary duct carcinoma can be mistaken for several other high-grade malignancies including mucoepidermoid carcinoma. We present a case of salivary duct carcinoma of the parotid gland and discuss the diagnostic features in fine needle aspirate and histologic samples, including the important role immunohistochemical assessment plays in establishing the diagnosis. Given the prevalence of primary hyperparathyroidism and the routine nature of parathyroid specimens in surgical pathology, a clear understanding of the diagnostic criteria for parathyroid carcinoma is required. Drs Khanafshar and van Zante discuss a case of parathyroid carcinoma, present the diagnostic criteria for a diagnosis of carcinoma and the diagnostic category of atypical adenoma. The applicability of a limited panel of immunostains is additionally reviewed. Another challenging area of head and neck pathology is the diagnosis of marginal zone (MALT) lymphoma, especially given the overlapping findings between long-standing autoimmune sialadenitis and MALT lymphoma. Drs McAlhany, Etzell, and Treseler present a case of MALT lymphoma of the parotid and discuss the histologic features, immunophenotype, and differential diagnosis. Recent advances in the understanding of the etiology of squamous cell cancer of the head and neck has shown that this group of tumors is made up of distinct subtypes with unique biological and histologic features. It has now been established that most squamous cell carcinomas arising in the oropharynx (base of tongue and lingual tonsils) are etiologically associated with oncogenic strains of human papillomavirus (HPV) rather than tobacco and alcohol, the traditional risk factors for head and neck cancer. Many HPV-associated squamous cell carcinomas are nonkeratinizing with a basaloid appearance. In their article, Drs Mills, Stelow, and Mills discuss the diagnosis of basaloid squamous cell carcinoma and highlight the broad differential that must be considered when a basaloid or small cell malignancy is encountered in the head and neck region. Finally, given that treatment paradigms may soon rely on pathologists to differentiate HPV-driven tumors and HPV-negative tumors, pathologists should make an effort now to understand the typical clinical presentation and histology of HPV-associated squamous cell carcinoma. A basic understanding of the indications for and limitations of immunohistochemistry for p16 and in situ hybridization for the identification of high-risk HPV is also required. The final article in this journal is an orientation to HPV-associated squamous cell carcinoma of the oropharynx and provides practical advice on how to evaluate and report squamous cancers of the oropharynx and the clinical implications of the diagnosis.FIGUREFIGURE

Erythema nodosum revealing parathyroid carcinoma

Parathyroid carcinoma (PTC) is a rare parathyroid tumor. We report a case of PTC revealed by erythema nodosum (EN). A 53-year-old woman was admitted for EN exploration. Biology found hypercalcemia (3 mmol/L) and 184.89 ng/L parathormonemia. Histology following cervicotomy diagnosed PTC. Postoperative course was free of complications. At eight months' follow-up, there was no recurrence of EN. PCT is rare and life threatening. Paraneoplastic EN is rare, and has not previously been reported in association with PCT. Solid neoplasia and hemopathy should be systematically explored for in case of recurrent EN or resistance to conventional treatment.

Carcinoma hiperfuncionante paratiroideo con extensión mediastínica

Parathyroid carcinoma (PC) is an extremely rare malignancy, 0.005% of all tumours and between 0.5% and 5% of all parathyroid neoplasms. Preoperative diagnosis is often difficult and is almost always obtained only after post-surgical histopathology. The prognosis is related to the local extent of disease and to complete surgical resection of the tumour. We report an uncommon case of hyperfunctional PC with mediastinal extension, emphasising the diagnostic difficulties, histopathological features and treatment strategies. The most recent data in the literature is analysed as well.

Diagnosis and treatment of parathyroid carcinoma: 9 cases report and literature review

To investigate the diagnosis and surgical treatment of parathyroid carcinoma. The clinical data of 9 cases of parathyroid carcinoma treated from January 1967 to December 2009 was analyzed retrospectively with the review of related Chinese literatures. Parathyroid carcinoma accounted for 8.9% (8/90) of all patients with primary hyperparathyroidism in our hospital, and the other one case was transferred from another hospital. Of the patients, 8 cases were found with primary hyperparathyroidism. Primary surgery was carried out with small incision: 5 patients underwent en bloc resection, among which, 3 cases received central lymph node dissection; 2 patients received simple parathyroidectomy; one case underwent palliative tumor resection. The case from another hospital received subtotal thyroidectomy. Considering preoperative, intraoperative data and frozen sections pathology, all patients were diagnosed as parathyroid carcinoma. Nine patients were followed-up for 1 - 14 years, no recurrence occurred, and the patient received palliative resection died from carcinoma two years after the operation. In previous Chinese literatures and this group, there were total 146 patients reported as parathyroid carcinoma. Those patients were diagnosed through routine histopathology, accounted for 1.8% - 11.5% of patients with primary hyperparathyroidism. The diagnosis of parathyroid carcinoma is established according to severe hypercalcemia, clinical features, subset B-ultrasound and Tc(99m)-sestamibi scanning, intraoperative finding of adherence to close structures and histopathology. The initial surgical procedure of choice is en bloc resection of the tumor by minimally invasive small incision, including adjacent structures and ipsilateral thyroidectomy. The prognosis is favorable after the operation.

Parathyroid carcinoma: a 16-year experience in a single institution

This study aims to describe our experiences of parathyroid carcinoma. The data of clinicopathological features, surgical treatment and outcomes of seven cases of parathyroid carcinoma among 171 patients who underwent surgery for primary hyperparathyroidism over a 16-year period were analyzed. The major symptoms at the diagnosis included a neck mass in three cases and multiple bone pain in five. Two patients were asymptomatic. No remarkable increases of serum calcium levels were noted in the patients, but serum parathyroid hormone (PTH) concentrations were high in most of the patients (4 of 5 in available). A variety of imaging studies including ultrasonography, sestamibi scan, and computed tomography scan were helpful in identifying the abnormal parathyroid glands, but not specific for the diagnosis of parathyroid carcinoma. In most patients, the parathyroid carcinomas were suspected at the time of neck exploration, and confirmed by final histopathologic examinations. All patients underwent complete surgical excision with curative intent. During the follow-up period, one patient developed lung metastases 6 years later and the other one died of unrelated cause. Preoperative diagnosis of parathyroid carcinoma is difficult, but operative findings are helpful in the diagnosis. The optimal surgical treatment is en block radical resection including adjacent structures when parathyroid carcinoma is suspected. Unusually, although our patients presented with high serum PTH concentrations, they had normal or mild elevated serum calcium concentrations. The reason of why should be investigated in future studies.

Parathyroid Carcinoma: Current Understanding and New Insights into Gene Expression and Intraoperative Parathyroid Hormone Kinetics

Parathyroid carcinoma is an indolent but ultimately life-threatening malignancy. Due to the lack of definitive diagnostic markers and overlapping clinical features of benign primary hyperparathyroidism (PHPT), this disease is often misdiagnosed as parathyroid adenoma. Therefore, a high index of suspicion preoperatively and early intraoperative recognition with en bloc surgical resection are crucial for favorable outcome. Owing to the rarity of the disease, little is known about the molecular pathogenesis of parathyroid carcinoma. Here, we review the literature to present current understanding of the disease and provide new information on gene expression and use of intraoperative parathyroid hormone (PTH) monitoring in the surgical management of this rare malignancy. Specifically, using microarray transcriptome analysis of an unequivocal case of parathyroid carcinoma and a biopsy from the same patient's normal parathyroid gland, we identify APP, CDH1, KCNJ16, and UCHL1 as differentially expressed genes in parathyroid carcinoma. Further, using case records from four cases of unequivocal parathyroid carcinoma, we compared intraoperative PTH kinetics of these patients to 475 patients with benign PHPT, and show that intraoperative PTH monitoring is accurate in predicting postoperative normocalcemia in initial en bloc operations for parathyroid carcinoma.