Parathyroid Carcinoma Presenting Research Articles

MON-LB060 Atypical Presentation of Parathyroid Carcinoma: Case Report

Background: Parathyroid carcinoma is a rare cause of primary hyperparathyroidism (0.74%), with an incidence of 0.36 (2000-2012), age presentation between 44-54 y/o, and symptoms associated with neck mass, bone and renal disease, as a consequence of marked hypercalcemia and elevated Parathyroid Hormone (PTH)1. Clinical Case: 85 y/o male, with 12-month history of weight loss (20Kg) along with unstable gait, laboratory with incidental findings of hypercalcemia (serum Calcium: 15.5mg/dL) and elevated PTH (PTH: 1141pg/mL). SESTAMIBI SPECT showed increased uptake in the inferior left thyroid lobe. Patient is admitted for elective parathyroidectomy with diagnosis of parathyroid adenoma. Patient had well-controlled hypertension and denied bone fractures, kidney stones, neck nodules or tumors. On physical exam, no visible or palpable neck mass was evident. Repeat admission lab results confirm malignant hypercalcemia: calcium: 14.14mg/dL, PTH: 1262pg/mL, creatinine: 2.34mg/dL. Surgery Findings: calcified enlarged left thyroid mass with no clear parathyroid definition. Mass is removed along with lymph nodes. Hypercalcemia and elevated PTH persists postoperatively (Serum calcium: 15.2mg/dL, PTH: 1552pg/mL) and patient is started on zoledronic acid with good response. Final pathology report: neoplastic ovoid and round cells, fibrous bands circumscribing lobes, acinar and trabecular structures with plexiform vasculature, areas of necrosis and calcifications with venous angioinvasion: parathyroid carcinoma. Oncology discharges patient with palliative care upon family request. Being a sporadic parathyroid carcinoma, genetic testing for germline HRPT2 (CDC73) mutations is requested. No mutations were detected. Conclusion: Parathyroid carcinoma is a rare endocrine tumor, with a 5-year survival rate of 64,8% upon complete tumor resection. Our patient represents one of the few case reports on silent parathyroid carcinoma in an elderly patient with residual disease currently on pharmacological management for persistent hypercalcemia, and negative genetic testing. Key words: parathyroid carcinoma, hyperparathyroidism, hypercalcemia, HRPT2 (CDC73) gen

Parathyroid carcinoma presenting with type 1 renal tubular acidosis

Primary hyperparathyroidism usually caused by parathyroid adenoma, parathyroid hyperplasia or rarely parathyroid carcinoma (PTC). PTC accounts for 0.4% to 5.2% of all reported cases of hyperparathyroidism, which is approximately 0.2% to 0.5% of malignant endocrine tumors overall. Renal tubular acidosis has been reported to be associated with primary hyperparathyroidism. We report a case of parathyroid carcinoma diagnosed with only using the minor criteria who had concurrent renal tubular acidosis. This case highlights the importance of keeping the suspicion of PTC in mind when clinically hypercalcemic patients presented with abnormally high serum calcium levels.

Parathyroid Carcinoma Presenting as an Acute Pancreatitis

Parathyroid carcinoma is the cause of only of hyperparathyroidism cases The incidence of acute pancreatitis inpatients with hyperparathyroidism was reported to be only The occurrence of pancreatitis in patients with parathyroid carcinoma is unusual ranging from to Here we report a very rare case of parathyroid carcinoma presenting as an acute pancreatitis in a years old woman who was suspected for hypercalcemia and higher levels of intact parathyroid hormone The parathyroid carcinoma was verified with ultrasound CT Scan and single photon emission computed tomography The pathological anatomy report showed a minimally invasive parathyroid carcinoma Following surgery the patient was free after almost a years follow up

Parathyroid carcinoma.

This article highlights recent advances in our understanding of the incidence, epidemiology, clinical presentation, evaluation, diagnosis, treatment, and prognosis of parathyroid carcinoma. The prevalence of parathyroid carcinoma is approximately 0.005% of all cancers. Therefore, parathyroid carcinoma is one of the rarest malignancies known. Patients with parathyroid carcinoma present with clinical symptoms of hypercalcaemia as these cancers are usually hormonally functional. It is not uncommon that patients present with complications of profound hypercalcaemia because of an elevated parathyroid hormone. Parathyroid carcinoma is difficult to diagnose preoperatively unless patients present with metastatic disease. Serum calcium often exceeds 14 mg/dl and serum parathyroid hormone is significantly elevated commonly between three and 10 times of the upper limit. Fine needle aspiration is not recommended because of the risk of parathyromatosis. Treatment includes surgery as a primary form of therapy and this usually follows with postoperative radiotherapy, although its use remains controversial. Patients with parathyroid carcinoma should undergo adequate surgical excision with an attempt of preserving vital structures such as the recurrent laryngeal nerve. Often en bloc resection of the ipsilateral thyroid lobe with comprehensive level VI dissection is required. Postoperative radiotherapy should be considered in most cases.

Primary Hyperparathyroidism from Parathyroid Carcinoma Presenting with Multiple Skeletal Fractures and Brown Cell Tumors

We report the case of a 19-year old Filipino woman who presented with hard masses on the left upper arm and leg with multiple fractures on all extremities. Her serum calcium and intact parathyroid hormone (iPTH) levels were elevated, while serum phosphorus was low. Ultrasonography of the neck revealed a left inferior parathyroid mass. Ultrasound-guided fine needle aspiration of the mass revealed findings consistent with parathyroid carcinoma. After hydration and administration of diuretic and bisphosphonate to control the severe hypercalcemia, she subsequently underwent 3½ gland parathyroidectomy with en-bloc left thyroid lobectomy. There was immediate normalization of biochemical indices after surgery. Three months later, the fractures on all extremities were fully resolved.

Parathyroid Carcinoma: A Case Report and Review of the Literature.

Primary hyperparathyroidism is the most frequent cause of asymptomatic hypercalcaemia in ambulatory patients (1). Parathyroid carcinoma (PCA) accounts for 5% of all the cases of primary and it has a variable prognosis (2). There is no published literature in the West Indies regarding the management of parathyroid carcinoma and this is the fourth case seen in our department of surgery for over 40 years. This report highlights an interesting presentation of parathyroid carcinoma and aims to review the current diagnosis and treatment of this disease entity.

Abstract #507: Unusual Presentation of Parathyroid Carcinoma in a Young Patient

Abstract #507: Unusual Presentation of Parathyroid Carcinoma in a Young Patient

A Case of Parathyroid Carcinoma Presenting as Brown Tumors

Carcinoma of the parathyroid gland has been reported as a rare disease occurring in 0.5 to 4% of patients with the primary hyperparathyroidism. Brown tumor is characterized as the terminal stage of remodeling processes during the primary or secondary hyperparathyroidism. Brown tumor induced by the primary hyperparathyroidism can commonly occur in the ribs, clavicle, and pelvic bone. We experienced a case of a 29-year old female patient, who had parathyroid carcinoma leading to primary hyperparathyroidism, followed by multiple Brown tumor. We present this case of parathyroid carcinoma with Brown tumors with a brief review of literature.

Hypercalcemia Due to Parathyroid Carcinoma Presenting in the Third Trimester of Pregnancy

Hypercalcemia Due to Parathyroid Carcinoma Presenting in the Third Trimester of Pregnancy

Parathyroid carcinoma in a 30-year-old man: a diagnostic and management challenge

Parathyroid carcinoma is a rare endocrine malignancy, accounting for less than 1% of cases of primary hyperparathyroidism. Patient-related factors such as age and sex, as well as the biological features and management of the cancer, influence mid-term and long-term survival. We report a case of a young man with an unusual presentation of parathyroid carcinoma. The patient presented with left thigh swelling, which had been present for 6 months without other symptoms of hypercalcemia. On computed tomography scan a hypodense lesion, 30 × 20 × 20 mm in size, was seen in the posterior thyroid. There was no evidence of cervical lymphadenopathy or local infiltration. On a Sestamibi scan, a hot spot was seen in the lower pole of left thyroid lobe. Cervical neck exploration was performed. The patient subsequently underwent surgery and a parathyroid tumor was excised. The tumor was adherent to the thyroid capsule, but there was no evidence of invasion. After surgery, the patient’s calcium and parathyroid hormone levels normalized, but histology confirmed parathyroid carcinoma with capsular and vascular invasion. The patient was offered reoperation, but declined, and developed recurrent parathyroid carcinoma 2 years later. In this report, we aim to present the challenges in managing parathyroid carcinoma and discuss factors that might contribute to future locoregional recurrences. This case also highlighted several issues, including the challenge of ascertaining the diagnosis before surgery and the dilemma of reoperation after simple excision.

Parathyroid carcinoma and hungry bone syndrome

We hereby report two patients with parathyroid carcinoma presenting extremely high calcium and PTH levels, severe bone disease, and palpable neck mass at diagnosis. They both underwent parathyroidectomy, and one of them evolved to lung metastasis. Important hypocalcemia was observed after surgery in both: after parathyroidectomy in one patient, and only after surgical removal of the metastasis in the other. Both required intravenous calcium replacement, thus revealing hungry bone syndrome (HBS). HBS usually reflects rapid mineralization after correction of hyperparathyroidism. The more severe the bone disease before surgery, the more prone the patient is to HBS after surgery. Despite being an unfavorable outcome, HBS state suggests that surgical removal of hypersecretory parathyroid tissue was accomplished. In this study, HBS was observed in both patients, who presented severe bone disease prior to surgery. HBS would be expected post-operatively in successful parathyroid carcinoma removal.

Polymyalgia rheumatica as the first presentation of parathyroid carcinoma

Polymyalgia rheumatica as the first presentation of parathyroid carcinoma

Ectopic mediastinal parathyroid carcinoma presenting as acute pancreatitis

Parathyroid carcinoma is a rare cause of hyperparathyroidism, accounting for fewer than 1% of cases. The incidence of acute pancreatitis in patients with hyperparathyroidism was reported to be only 1.5%. We report a very rare case of ectopic mediastinal parathyroid carcinoma presenting as acute pancreatitis. A 72-year-old man presented with acute pancreatitis and hypercalcemia. During the work-up for hypercalcemia, a mediastinal parathyroid tumor was identified by 99mTc-sestamibi scintigraphy and magnetic resonance imaging. The tumor was completely removed via a lower cervical collar incision. The histopathology revealed parathyroid carcinoma. There was no tumor recurrence or abdominal symptoms at 3-year follow-up.

Parathyroid carcinoma presenting as normocalcemic hyperparathyroidism

Parathyroid carcinoma (PC) is a rare malignancy, with an indolent but progressive course. Long-term survival is largely dependent on the extent of the primary surgical resection. Hence, pre- or intraoperative suspicion of malignancy is of great importance. We describe the case of a 62-year-old woman with a 2-year history of asthenia and mental depression. Her past medical history was significant for osteoporosis. A diagnosis of primary normocalcemic hyperparathyroidism was established and the patient underwent surgery. PC was suspected intraoperatively because of the size and appearance of the parathyroid mass (a grayish, lobulated 3.5 cm mass). Thus, aggressive surgery (en bloc resection) was performed, along with bilateral neck exploration. Pathological examination of the specimens confirmed the suspicion of PC, demonstrating vascular invasion and extracapsular infiltration into adjacent soft tissue. Immunohistochemical staining revealed an elevated Ki-67 score (8.43%; cut-off value 5%). The mean area of silver-stained nucleolar organizer regions (AgNOR) was high (4.972 μm(2)), indicating an elevated proliferation rate. Serum calcium and parathyroid hormone levels normalized postoperatively, and the patient's 5-year outcome was good. The present case provides evidence that parathyroid malignancy cannot be excluded a priori based on normocalcemic hyperparathyroidism, emphasizing the variability in clinical presentation. Moreover, Ki-67 expression and AgNOR analysis confirmed their additional value in complementing the histological evaluation of a parathyroid malignant mass.

Parathyroid Carcinoma Presenting as a Hyperparathyroid Crisis

Parathyroid Carcinoma Presenting as a Hyperparathyroid Crisis

Multiple brown tumors: Unusual presentation of parathyroid carcinoma

Brown tumors represent the terminal stage of the remodeling process during hyperparathyroidism, and it is a rare clinical presentation of primary hyperparathyroidism. Parathyroid carcinoma is even more rare cause of primary hyperparathyroidism. This is a report of a multiple brown tumor caused by primary hyperparathyroidism secondary to parathyroid carcinoma. A 41-year-old woman, who was presented with a generalized bony pain and pathological fracture of left humerus. X-ray demonstrated lytic lesion in bilateral humerus and left ulna. Laboratory investigations showed hypercalcemia and hypophosphatemia with elevated parathyroid hormone level. Ultrasonography did not reveal any parathyroid lesion, whereas radionuclide Sestamibi scan delineated a focus of abnormal tracer uptake in the lower pole region of right lobe of thyroid, left maxilla, bilateral humerus, and left clavicle. She underwent right inferior parathyroidectomy, right hemithyroidectomy and central node dissection. Histological diagnosis confirmed parathyroid carcinoma. The rarity and the interesting clinical presentation of such association are discussed.

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)

A Case of Parathyroid Carcinoma Presenting Hyperparathyroidism that was Clinically Easy to Overlook

Parathyroid carcinoma is very rare in patients with primary hyperparathyroidism, only accounts for 1% to 2% of all cases. It is characterized by higher incidence of renal dysfunction, metabolic bone disease and gastrointestinal symptoms. Although the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma when compared to those with those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma without pathologic confirmation. To our knowledge, there have only been a few cases of hyperparathyroidism due to parathyroid carcinomas reported to date. Here, we report a case of 63-year-old woman developing osteoporosis, hypercalcemia and hypophosphatemia due to a parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively. [Korean Journal of Bone Metabolism, 19(1): 59-65, 2012]

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.

Maxillary brown tumour: unusual presentation of parathyroid carcinoma

AbstractThis is a report of a maxillary brown tumour caused by primary hyperparathyroidism (HPT) secondary to parathyroid carcinoma. A 62-year-old man presented with a large swelling in the right maxilla, which caused right-sided nasal obstruction, intermittent bleeding and diplopia. A computed tomography scan demonstrated an expansible, destructive soft tissue mass centred on the right ethmoid sinus, extending from the maxilla to the orbital floor. Histology showed a central giant cell granuloma of bone, thought to be a brown tumour of HPT and this was supported by serum calcium of 3.0 mmol/l and serum parathyroid hormone of 880 ng/l (normal 7 to 40 ng/l). Parathyroid imaging was consistent with a left lower parathyroid adenoma. The patient underwent removal of the parathyroid gland, left hemithyroidectomy and central node dissection. Histology confirmed parathyroid carcinoma. Surgical removal of the brown tumour was offered but declined. The symptoms improved and the maxillary swelling gradually reduced...