Diagnosis and Treatment of Parathyroid Carcinoma: A Report of 7 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HULin , CUIAi-min , BAINan , ZHAOJing-ming , ZHANGZi-qin

Department of General Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100096, China;

Corresponding author：

HULin, Email: foxfoxhl@hotmail.com

Keywords：

Parathyroid carcinoma; Diagnosis; Treatment

DOI：

10.7507/1007-9424.20150018

Video：

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Objective To explore the diagnosis and treatment features of parathyroid carcinoma (PTC). Methods The clinical data of 7 cases of parathyroid carcinoma treated from January 1993 to April 2014 were analyzed retrospectively. Results All of the 7 patients had symptoms of hyperparathyroidism. Four patients had palpable neck mass. The average serum calcium level of preoperation was 3.07 mmol/L (2.35-4.98 mmol/L). The average parathyroid hormone (PTH) level was 1 181.5 pg/mL (78.4-2 061.7 pg/mL), which elevated 17 times the upper limit of normal. One case had operation in other hospital and six cases in Jishuitan hospital. The tumors located in the left inferior parathyroid gland in 3 cases, 2 cases of right lower parathyroid, and right superior parathyroid gland in 1 cases. One case underwent parathyroidectomy, parathyroidectomy including ipsilateral thyroid lobe or part of it was performed in 5 cases. Of 5 cases, 1 case was added central compartment lymphadenectomy. Three cases of postoperative tumor recurrence underwent reoperation, of which 1 case recurred 3 times. Two cases died. The remining 5 had survived until now, had survived for 5 years in 3 cases. Conclusions A comprehensive approach with clinical presentation, serum calcium and PTH levels, B-ultrasonography, ⁹⁹Tc^m-MIBI, intraoperation aberrant findings, and histopathology offers help to accurate diagnosis of parathyroid carcinoma. Surgery is en bloc resection of the primary lesion. Recurrence needs reoperation, and long-term follow-up is advised.

Citation： HULin, CUIAi-min, BAINan, ZHAOJing-ming, ZHANGZi-qin. Diagnosis and Treatment of Parathyroid Carcinoma: A Report of 7 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(1): 76-80. doi: 10.7507/1007-9424.20150018 Copy

1.	Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995:a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer, 1999, 86(3):538-544.
2.	徐少明.应重视甲状旁腺癌的诊治.中华外科杂志, 2010, 48(17):1281-1284.
3.	Shane E. Clinical review 122:Parathyroid carcinoma. Clin Endocrinol Metab, 2001, 86(2):485-493.
4.	Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med, 2000, 343(25):1863-1875.
5.	Christmas TJ, Chapple CR, Noble JG, et al. Hyperparathyroidism after neck irradiation. Br J Surg, 1988, 75(9):873-874.
6.	Vasef MA, Brynes RK, Sturm M, et al. Expression of cyclin D1 in parathyroid carcinomas, adenomas, and hyperplasias:a paraffin immunohistochemical study. Mod Pathol, 1999, 12(4):412-416.
7.	Cryns VL, Thor A, Xu HJ, et al. Loss of the retinoblastoma tumor-suppressor gene in parathyroid carcinoma. N Engl J Med, 1994, 330(11):757-761.
8.	Cryns VL, Rubio MP, Thor AD, et al. p53 abnormalities in human parathyroid carcinoma. J Clin Endocrinol Metab, 1994, 78(6):1320-1324.
9.	Rodgers SE, Perrier ND. Parathyroid carcinoma. Curr Opin Oncol, 2006, 18(1):16-22.
10.	Wilkins BJ, Lewis JS Jr. Non-functional parathyroid carcinoma:a review of the literature and report of a case requiring extensive surgery. Head Neck Pathol, 2009, 3(2):140-149.
11.	Wynne AG, van Heerden J, Carney JA, et al. Parathyroid carcinoma:clinical and pathological features in 43 patients. Medicine, 1992, 71(4):197-205.
12.	Levin K, Galante M, Clark OH. Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery, 1987, 101(6):649-660.
13.	Silverberg SJ, Shane E, Jacobs TP, et al. Nephrolithiasis and bone involvement in primary hyperparathyroidism. Am J Med, 1990, 89(3):327-334.
14.	刘赫, 姜玉新, 张缙熙.甲状旁腺癌的声像图表现.中国医学影像技术, 2004, 20(12):1860-1861.
15.	Sidhu PS, Talat N, Patel P, et al. Ultrasound features of malignancy in the preoperative diagnosis of parathyroid cancer:a retrospective analysis of parathyroid tumours larger than 15 mm. Eur Radiol, 2011, 21(9):1865-1873.
16.	Elliott DD, Monroe DP, Perrier ND. Parathyroid histopathology:is it of any value today? J Am Coll Surg, 2006, 203(5):758-765.
17.	Schantz A, Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer, 1973, 31(3):600-605.
18.	Smith JF, Coombs RR. Histological diagnosis of carcinoma of the parathyroid gland. J Clin Pathol, 1984, 37(12):1370-1378.
19.	ObaraT, FujimotoY, Hirayama A, et al. Flowcytometric DNA analysis of parathyroid tumors with special reference to its diagnostic and prognostic value in parathyroid carcinoma. Cancer, 1990, 65(8):1789-1793.
20.	Obara T, Fujimoto Y. Diagnosis and treatment of patients with parathyroid carcinoma:an update and review. World J Surg, 1991, 15(6):738-744.
21.	Wiseman SM, Rigual NR, Hicks WL Jr, et al. Parathyroid carcinoma:a multicenter review of clinicopathologic features and treatment outcomes. Ear Nose Throat J, 2004, 83(7):491-494.
22.	Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer:a review of 95 cases. World J Surg, 1992, 16(4):724-731.
23.	Wei CH, Harari A. Parathyroid carcinoma:update and guidelines for management. Curr Treat Options Oncol, 2012, 13 (1):11-23.
24.	Lumachi F, Basso SM, Basso U. Parathyroidcancer:etiology, clinical presentation and treatment. Anticancer Res, 2006, 26(6C):4803-4807.
25.	Betea D, Bradwell AR, Harvey TC, et al. Hormonal and biochemical normalization and tumor shrinkage induced by anti-parathyroid hormone immunotherapy in a patient with metastatic parathyroid carcinoma. J Clin Endocrinol Metab, 2004, 89(7):3413-3420.
26.	Montenegro FL, Chammas MC, Juliano AG, et al. Ethanol injection under ultrasound guidance to palliate unresectable parathyroid carcinoma. Arq Bras Endocrinol Metabol, 2008, 52(4):707-711.
27.	Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer:a review of 95 cases. World J Surg, 1992, 16(4):724-731.
28.	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):3679-3686.

1. Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995:a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer, 1999, 86(3):538-544.
2. 徐少明.应重视甲状旁腺癌的诊治.中华外科杂志, 2010, 48(17):1281-1284.
3. Shane E. Clinical review 122:Parathyroid carcinoma. Clin Endocrinol Metab, 2001, 86(2):485-493.
4. Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med, 2000, 343(25):1863-1875.
5. Christmas TJ, Chapple CR, Noble JG, et al. Hyperparathyroidism after neck irradiation. Br J Surg, 1988, 75(9):873-874.
6. Vasef MA, Brynes RK, Sturm M, et al. Expression of cyclin D1 in parathyroid carcinomas, adenomas, and hyperplasias:a paraffin immunohistochemical study. Mod Pathol, 1999, 12(4):412-416.
7. Cryns VL, Thor A, Xu HJ, et al. Loss of the retinoblastoma tumor-suppressor gene in parathyroid carcinoma. N Engl J Med, 1994, 330(11):757-761.
8. Cryns VL, Rubio MP, Thor AD, et al. p53 abnormalities in human parathyroid carcinoma. J Clin Endocrinol Metab, 1994, 78(6):1320-1324.
9. Rodgers SE, Perrier ND. Parathyroid carcinoma. Curr Opin Oncol, 2006, 18(1):16-22.
10. Wilkins BJ, Lewis JS Jr. Non-functional parathyroid carcinoma:a review of the literature and report of a case requiring extensive surgery. Head Neck Pathol, 2009, 3(2):140-149.
11. Wynne AG, van Heerden J, Carney JA, et al. Parathyroid carcinoma:clinical and pathological features in 43 patients. Medicine, 1992, 71(4):197-205.
12. Levin K, Galante M, Clark OH. Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery, 1987, 101(6):649-660.
13. Silverberg SJ, Shane E, Jacobs TP, et al. Nephrolithiasis and bone involvement in primary hyperparathyroidism. Am J Med, 1990, 89(3):327-334.
14. 刘赫, 姜玉新, 张缙熙.甲状旁腺癌的声像图表现.中国医学影像技术, 2004, 20(12):1860-1861.
15. Sidhu PS, Talat N, Patel P, et al. Ultrasound features of malignancy in the preoperative diagnosis of parathyroid cancer:a retrospective analysis of parathyroid tumours larger than 15 mm. Eur Radiol, 2011, 21(9):1865-1873.
16. Elliott DD, Monroe DP, Perrier ND. Parathyroid histopathology:is it of any value today? J Am Coll Surg, 2006, 203(5):758-765.
17. Schantz A, Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer, 1973, 31(3):600-605.
18. Smith JF, Coombs RR. Histological diagnosis of carcinoma of the parathyroid gland. J Clin Pathol, 1984, 37(12):1370-1378.
19. ObaraT, FujimotoY, Hirayama A, et al. Flowcytometric DNA analysis of parathyroid tumors with special reference to its diagnostic and prognostic value in parathyroid carcinoma. Cancer, 1990, 65(8):1789-1793.
20. Obara T, Fujimoto Y. Diagnosis and treatment of patients with parathyroid carcinoma:an update and review. World J Surg, 1991, 15(6):738-744.
21. Wiseman SM, Rigual NR, Hicks WL Jr, et al. Parathyroid carcinoma:a multicenter review of clinicopathologic features and treatment outcomes. Ear Nose Throat J, 2004, 83(7):491-494.
22. Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer:a review of 95 cases. World J Surg, 1992, 16(4):724-731.
23. Wei CH, Harari A. Parathyroid carcinoma:update and guidelines for management. Curr Treat Options Oncol, 2012, 13 (1):11-23.
24. Lumachi F, Basso SM, Basso U. Parathyroidcancer:etiology, clinical presentation and treatment. Anticancer Res, 2006, 26(6C):4803-4807.
25. Betea D, Bradwell AR, Harvey TC, et al. Hormonal and biochemical normalization and tumor shrinkage induced by anti-parathyroid hormone immunotherapy in a patient with metastatic parathyroid carcinoma. J Clin Endocrinol Metab, 2004, 89(7):3413-3420.
26. Montenegro FL, Chammas MC, Juliano AG, et al. Ethanol injection under ultrasound guidance to palliate unresectable parathyroid carcinoma. Arq Bras Endocrinol Metabol, 2008, 52(4):707-711.
27. Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer:a review of 95 cases. World J Surg, 1992, 16(4):724-731.
28. 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):3679-3686.

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Diagnosis and Treatment of Parathyroid Carcinoma: A Report of 7 Cases

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