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PubMed1980

Parathyroid carcinoma with tracheal invasion and airway obstruction.

The following report presents an unusual case of a patient with a recurrent parathyroid carcinoma that grossly invaded the lumen of the trachea with a polypoid appearance and brought about severe airway obstruction. The three rings of the upper trachea, including the lower part of the cricoid cartilage, were resected with the tumor, and the airway was reconstructed by end-to-end anastomosis. The present case demonstrates that parathyroid carcinoma can become an intratracheal hazard, as can carcinomas of the thyroid gland, esophagus, lung, or larynx.

Adult↗
PubMed2004

Parathyroid carcinoma: a multicenter review of clinicopathologic features and treatment outcomes.

We conducted a retrospective study of 13 patients with parathyroid carcinoma to assess their clinical characteristics and surgical outcomes. Study parameters included patient demographics, survival, treatment response, and recurrence. We found that all patients who had undergone local tumor excision developed a recurrence, compared with only 33% of those available for follow-up after en bloc tumor resection. Based on these findings, we recommend en bloc tumor resection as the initial treatment of choice for patients diagnosed with parathyroid carcinoma.

Adult↗
PubMed2004

Intracranial metastatic parathyroid carcinoma. Case report and review of the literature.

Parathyroid carcinoma (PTC) is a rare pathological entity, with fewer than 400 reported cases. Intracranial metastasis of a PTC is exceptional; only five other cases have been identified in the English literature. The authors present a unique case of a patient with a solitary intracerebral metastasis of a PTC in an individual presumed to have hereditary hyperparathyroidism who had concomitant papillary and follicular carcinomas of the thyroid. The literature relevant to the management of these rare lesions is reviewed and discussed.

Brain Neoplasms↗
PubMed2000

PCNA and Ki-67 as prognostic markers in human parathyroid carcinomas.

BACKGROUND: It is widely accepted that histological diagnosis of parathyroid tumors is established with great difficulty. Carcinomas cannot be reliably separated from adenomas by histology alone. In this study, immunohistochemical staining for proliferating cell nuclear antigen (PCNA) and Ki-67 was determined in 10 cases of parathyroid carcinomas, labeling indices (LIs) were calculated, and the results were correlated with the clinical outcomes. METHODS: Ten cases of formalin-fixed, paraffin-embedded tissue with surgically resected parathyroid carcinoma were used. Immunohistochemical staining for PCNA and Ki-67 was performed and the LIs were calculated. We also examined whether LI could become a useful marker for parathyroid carcinomas. RESULTS: Although nine patients with minimally invasive growth without recurrence of the tumor showed a low LI for both markers, one patient with a widely invasive neoplasm, and who died, had a high LI. CONCLUSIONS: These results suggested that the LI of PCNA and Ki-67, in addition to the histological appearance, may be markers of the biological behavior of parathyroid carcinomas. However, this study was on a small scale, so it may be valuable to repeat these studies in a larger group of patients with better defined histological criteria.

Adult↗
PubMed1991

Intravenous pamidronic acid in hypercalcemia due to parathyroid carcinoma.

Three patients aged between 31 and 59 were treated with pamidronic acid (APD) due to severe hypercalcemia caused by parathyroid carcinoma. APD was given in 250 cm3 intravenous saline over a 2 h period in a dose of 0.45 to 0.50 mg/kg per day. Two patients received 6 and the other 9 infusions. Mean serum calcium diminished from 15.7 +/- 1.3 mg/dl to 11.7 +/- 0.6 mg/dl (p less than 0.05). Mean serum ionized calcium decreased from 8.1 mg/dl to 5.5 mg/dl, urinary calcium excretion from 478 mg/24 h to 229 mg/24 h and hydroxyproline from 204 mg/24 h to 117 mg/24 h. Serum calcium returned to pretreatment levels after 5 and 15 days post intravenous APD in two patients. In the third patient treated with 900 mg/day of oral APD, after the intravenous therapy the relapse occurred during the fourth month. The three patients received a second course of intravenous (iv) APD. The effect upon serum calcium (14.6 +/- 1.1 mg/dl to 11.8 +/- 0.6 mg/dl, p less than 0.05) was similar to the one obtained with the first course. Intravenous APD administration appears to be an effective and safe treatment of the severe hypercalcemia due to parathyroid carcinoma. To sustain levels of serum calcium attained in patients with non resectable tumors, a suitable program of iv APD pulses should be established.

Adult↗
PubMed1991

Parathyroid carcinoma associated with polycythemia vera.

A link between hyperparathyroidism and the growth of hematopoietic stem cells is suggested by this report of a parathyroid carcinoma with polycythemia vera. A 56-year-old white woman presented with splenomegaly, a palpable neck mass and hypercalcemia, recurrent six years after resection of a parathyroid tumor. She had pancytosis with a subnormal serum concentration of erythropoietin. Radiographs showed subperiosteal erosions an dosteopenia. Nephrocalcinosis was absent. Bone biopsy showed a decreased cortical width with many intracortical osteoclasts. The cancellous bone area remained normal, but the osteoid area/bone area, osteoblast perimeter and osteoclast perimeter were increased. At surgery, a parathyroid carcinoma was found in the same location operated on previously. As in two other reported cases, postoperative improvement in the hypercalcemia was associated with remission of the blood dyscrasia. A novel finding in this case is that when the hypercalcemia eventually recurred, it was again accompanied by pancytosis. With bisphosphonate therapy, the serum intact parathyroid hormone level increased in response to a decrease in the ionized calcium level, indicating that the cancer was not autonomous. This case suggests that in the presence of the ionized hypercalcemia, the parathyroid tumor may have produced or induced production of a growth factor that can stimulate pancytosis. The differential diagnosis of polycythemia and hypercalcemia should be expanded to include parathyroid tumors in addition to hepatic, adrenal, renal, and ovarian neoplasms.

Bone and Bones↗
PubMed2005

Galectin-3 expression in parathyroid carcinoma: immunohistochemical study of 26 cases.

The diagnosis of parathyroid carcinoma (PC) is difficult and based on morphological features that are not totally reliable. Several molecular markers proved useful in the evaluation of PC, but their sensitivity, specificity, or both are rather low. With the aim of identifying a marker of malignancy in parathyroid tumors, we tested the expression of galectin-3 (Gal-3), a lectin expressed in several malignant tumors, including follicular carcinomas (but not adenomas) of the thyroid. Twenty-six PCs and 30 control parathyroid adenomas (PAs) were collected. The PCs had been diagnosed based on capsular/vascular invasion (26/26 cases), extraparathyroid infiltration (16), local recurrence (9), and distant metastases (6). All cases were immunohistochemically tested for Gal-3 and for other markers claimed to be useful in the differential diagnosis of parathyroid neoplasms, namely, Ki67, p27, and bcl2. Gal-3 was expressed by 24 of the PC (92.3%), but only 1 PA (3.3%) (P < .001). All metastasizing PCs were Gal-3-positive. As expected, the Ki67 proliferative index was higher in PCs (mean, 6.7%) than in PAs (1.9%); p27 was down-regulated in 61.5% of PCs and only 33.3% of PAs, whereas bcl2 was strongly positive in most PAs and in 38.5% of PCs. In a suspected PC, the association of Gal-3 with Ki67 (using a cutoff of 6% for the proliferative activity) appeared the best marker combination (sensitivity 96.2%, specificity 90%), and the profile Gal-3-positive/Ki67 >6% was unique to PCs. We conclude that Gal-3 immunostaining is a valuable tool to support a diagnosis of PC in highly proliferating (Ki67 >6%) tumors affecting a single parathyroid gland.

Adenoma↗
PubMed2000

[Parathyroid carcinoma: diagnosis and treatment].

Pre operative and per-operative suspicion, and recognition of parathyroid carcinoma are essential in the effective approach and the prognosis of this type of tumor. On the basis of our experience over 20 years, helped by the literature we review our 179 cases of primary hyperparathyroidism out of which 5 were malignant tumors and the 174 others were benign (adenomas and hyperplasias). We conclude that patients with primary hyperparathyroidism, reflected by high levels of serum calcium (75%) and elevated levels of parathormone (100%) are suspect of carrying a parathyroid malignancy particularly when these levels are profoundly abnormal. Furthermore, a severe clinical presentation featuring, palpable cervical mass, renal symptoms in 30% to 60% of all, bone disease in 90%, is suspect of malignancy. The operative findings such as important size of tumour, local seeding, local invasion are also significant features of malignancy. All this data gathered by comparing carcinomas to adenomas suggest and confirm what many reviews on the subject have reported, early recognition of the parathyroid carcinoma is of primal importance, because aggressive initial surgical management should be applied, as total extirpation of the malignancy is the only treatment allowing maximal survival rates.

Aged↗
PubMed1985

Parathyroid carcinoma: pointers to successful management.

Five patients with parathyroid carcinoma are reported. In the first case the clinical and histological features of malignancy at initial surgery were not recognised and recurrence of the tumour occurred within two years. Referring to previously published series this sequence appeared to be typical and underlined the likely reasons for the poor prognosis of this rare tumour. A review of the diagnostic criteria to improve early diagnosis was undertaken and a treatment protocol drawn up. It was based on a more radical surgical extirpation to include the tumour bed together with postoperative radiotherapy. Four further cases have subsequently been identified, treated according to the protocol and at 16 to 49 months' follow up, show no sign of recurrence and have a normal serum calcium.

Aged↗
PubMed1993

Histopathological variables and DNA cytometry in parathyroid carcinoma.

To undertake an evaluation of histopathological variables in parathyroid carcinoma, 95 cases with this diagnosis were collected from 37 hospitals. Two tumor categories emerged from a review of tissue sections and follow-up information: 56 cases demonstrating extraglandular invasiveness or tumor recurrence were classified as definitive carcinomas, whereas 39 tumors lacking these criteria were classified as equivocal cases. Several morphological variables other than invasiveness differed between the two groups: Fibrosis, necrosis, nuclear atypia (especially macronucleoli), and mitotic figures were significantly more frequent in the carcinoma group. These variables also showed a positive correlation with an aberrant DNA pattern demonstrated by image cytometry. The triad macronucleoli, more than five mitoses per 50 high-power fields, and necrosis were associated with an aggressive behavior in terms of recurrent disease. A minority of the carcinomas had a bland cytologic appearance and differed from benign lesions only by their invasiveness. Certain patterns of fibrosis and necrosis were common but neither pathognomonic nor constant features of malignancy. Mitotic activity constituted a prognostic risk factor but was of limited diagnostic significance. In half of the carcinomas, the frequency of mitoses did not exceed values recorded in benign parathyroid lesions.

Adenoma↗
PubMed1992

Parathyroid carcinoma in a patient with non-secretory pituitary tumor: a variant of multiple endocrine neoplasia type-I?

We report a case of pituitary adenoma in association with parathyroid carcinoma as an unusual combination of multiple endocrine neoplasia (MEN). A 48-year-old man had a trans-sphenoidal hypophysectomy and transcranial partial removal of a recurrent pituitary chromophobe adenoma followed by a course of radiotherapy in 1980. Four years later, he developed hypercalcemic crisis from a parathyroid carcinoma with invasion to the adjacent thyroid gland and skeletal muscle. A hemithyroidectomy and resection of the left lower parathyroid gland was performed. Three years later, he had local recurrence and anterior chest wall metastasis accompanied by hypercalcemia. After resection of the remnant and metastatic lesion, eucalcemia was achieved. There was no family history of endocrine tumors. This case illustrates the rare association of a malignant parathyroid tumor and a chromophobe adenoma of the pituitary as a variant of MEN syndrome.

Adenoma, Chromophobe↗
PubMed1984

Successful combination chemotherapy for metastatic parathyroid carcinoma.

A 54-year-old patient with metastatic parathyroid carcinoma and severe hypercalcemia refractory to conventional treatment was treated with chemotherapy consisting of fluorouracil, 500 mg/sq m intravenously (IV) daily for four days (24-hour infusion), cyclophosphamide, 500 mg/sq m IV daily for four days, and dacarbazine (imidazole carboxamide), 200 mg/sq m IV daily for four days. Complete objective and partial biochemical responses were noted, with the response duration being 5.0 + months. The toxic reaction was moderate and predominantly gastrointestinal.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

Parathyroid carcinoma: problems in diagnosis and the need for radical surgery even in recurrent disease.

INTRODUCTION: From 1986 to 1999 we operated on 963 patients with primary hyperparathyroidism (pHPT). METHODS AND RESULTS: Parathyroid carcinoma was diagnosed clinically and histologically in four patients (0.4%). In two of these patients diagnosis of parathyroid cancer was delayed by misinterpretation of the histopathology leading to an autotransplantation of malignant parathyroid tissue in one case. In two patients multivisceral surgery was performed: beside thyroidectomy, neck dissection, tracheal wall resection and resection of the muscular layer of the oesophagus one patient received oesophagectomy and gastric transposition and one patient a lung wedge resection. Both patients had a temporary palliation of tumour-associated symptoms after multivisceral surgery. The first patient died 2 years after oesophagectomy and 12 years after primary diagnosis from local tumour recurrence and cachexia. The second patient is living with tumour recurrence presenting a serum calcium level of 4.2 mmol/l (normal range 2.0 to 2.5 mol/l) and multiple brown tumours 2 years after lung resection and 6 years after the primary diagnosis. CONCLUSIONS: We conclude that parathyroid carcinomas, being difficult to diagnose, warrant radical surgery, including multivisceral resection to prolong survival and reduce tumour and hypercalcaemia associated symptoms.

Adolescent↗
PubMed1997

Parathyroid carcinoma and primary autoimmune hypothyroidism in an elderly woman.

Severe hyperparathyroidism due to parathyroid carcinoma and Hashimoto's thyroiditis was observed in a 69-yr-old Sardinian woman. To our knowledge, this association has not been reported so far. Given the high prevalence of autoimmune disease in elderly women, a random occurrence of the two conditions could represents the most probable explanation.

Aged↗
PubMed1998

Cytologic characteristics of parathyroid carcinoma: a case report.

A 44-yr-old man with a preoperative diagnosis of malignant mediastinal goiter underwent a preoperative fine-needle aspiration (FNA) biopsy. Fine-needle aspiration biopsy showed enlarged uniform nuclei, prominent nucleoli, few mitotic figures, karyolysis, anuclear cells, hyalinized nonepithelial cell clusters with hemosiderin deposits, and a perivascular pseudorosette pattern. This study reviewed the current literature dealing with this cytologic feature of parathyroid carcinoma. To our knowledge, this is the first report of an oxyphilic cell type of parathyroid carcinoma detected by FNA in the English-language literature.

Adenocarcinoma↗
PubMed1986

Nuclear diameter in parathyroid carcinomas.

Nuclear diameter was measured and mean nuclear diameter calculated in 18 parathyroid carcinomas. In 11 of the 18 tumours mean nuclear diameter was above the range previously reported for 55 parathyroid chief cell adenomas and provides a useful discriminant in histological diagnosis.

Adenoma↗