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Preoperative localization of parathyroid carcinoma using Tc-99m MIBI.
A patient with parathyroid cancer is presented who underwent Tc-99m MIBI scintigraphy. The Tc-99m MIBI image demonstrated increased accumulation of activity at the lower pole of the left thyroid lobe which was later confirmed as a parathyroid cancer. Uptake by parathyroid cancer must be kept in mind as a cause of increased Tc-99m MIBI accumulation when a disease is in question in the thyroid or parathyroid gland.
The carcinoma of parathyroid gland.
Parathyroid carcinoma constitutes less than 1% of primary hyperparathyroidism. The exact etiology is not known. Prior radiation to neck, chronic renal failure and genetic factors are thought to play a role. The male to female ratio is one. Parathyroid carcinomas are slow growing, have a tendency to recur locally and metastasize late. 95% of parathyroid carcinomas are functioning. The major distinguishing features of malignant hyperparathyroidism are presence of a palpable mass in the neck and features of severe hypercalcemia. By far the most important test to diagnose primary hyperparathyroidism is serum level of Immunoreactive PTH. The diagnosis of primary hyperparathyroidism is essentially clinical and biochemical. Biopsy is not necessary before definitive surgery. CT scan appears to be the best investigation for detecting the primary tumor, its local extent and metastases. Most of the symptoms are attributable to hypercalcemia, which needs to be treated aggressively. Early surgery with 'en bloc' resection of the tumor is the only potentially curative treatment. Parathyroid carcinoma is traditionally said to be resistant to radiotherapy. Various chemotherapeutic agents have been used with partial anecdotal responses. The 5-year survival is about 50% and 10-year survival varies from 13-49%.
Metastatic parathyroid carcinoma in the superior vena cava.
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The effect of octreotide on parathyroid carcinoma.
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Uncommon mediastinal tumors. Report of two parathyroid adenomas, one nonfunctional parathyroid carcinoma and one "bronchial-type-adenoma".
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Fine-needle aspiration and parathyroid carcinoma.
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Predicting the presence of parathyroid carcinoma.
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Apparently nonfunctioning metastases of parathyroid carcinoma.
A 41-year-old woman was operated on for severe hyperparathyroid syndrome. At surgery a parathyroid tumor with the histopathologic pattern of carcinoma was found. After surgery serum calcium settled within normal limits (10.5 mg/dl, N.V. 8.5-10.8), whereas parathormone and calcitonin reached progressively high levels, respectively 400 ng/dl (N.V. up to 250) and 500 pg/ml (N.V. up to 100 ng/ml). Serum ultrafiltration analysis for parathormone and calcitonin showed many peaks of immunoreactivity with high molecular weight of both hormones. One year after surgery, metastases developed in the lymph nodes of the neck and the mediastinal, pleural and pancreatic regions. After death for tumor wasting, immunohistochemical study of the tumoral tissue with the peroxidase-antiperoxidase technique showed a relatively high density of calcitonin-containing cells. The findings in this case suggest that: several cells in this parathyroid cancer could secrete both parathormone and calcitonin; the hormonal secretion was impaired as suggested by the high molecular weight of both hormones found at gel-filtration analysis; the macromolecular profile of parathormone could explain the apparent function of the parathyroid cancer.
The management of parathyroid carcinoma.
PURPOSE OF REVIEW: To summarize the current treatment approaches to parathyroid malignancy. RECENT FINDINGS: Recent advances in molecular biology are aiding the understanding of the pathogenesis of this condition, and imaging modalities are contributing to localization of the abnormal parathyroid tissue. SUMMARY: The treatment of parathyroid malignancy is overwhelmingly surgical, comprising an initial en bloc resection of the tumor and adjacent structures. The risk of tumor recurrence is high and may require several metastasis resections in order to control symptoms of hypercalcemia.
Vital gene linked to parathyroid carcinoma.
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Visual vignette. Parathyroid carcinoma.
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Case reports: Hypercalcemic crisis in parathyroid carcinoma.
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Familial parathyroid carcinoma.
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Parathyroid carcinoma: a case report and review of the literature.
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A case of hyperparathyroidism caused by a parathyroid carcinoma. Case report and review of literature.
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