Clinical Presentation, Treatment, and Outcome of Parathyroid Carcinoma

Abstract

on behalf of the NEKAR study groupObjective: In this retrospective cohort study, we describe the clinical presentation and workup of parathyroid carcinoma (PC) and determine its clinical prognostic parameters. Primary outcome was recurrence free survival. Summary Background Data: PC is an orphan malignancy for which diagnostic workup and treatment is not established. Methods: Eighty-three patients were diagnosed with PC between 1986 and 2018. Disease-specific and recurrence-free survivals were estimated with the Kaplan-Meier method. Risk factors for recurrence were identified by binary logistic regression with adjustment for age and sex. Thirty-nine tumors underwent central histopathological review. Results: Renal (39.8%), gastrointestinal (24.1%), bone (22.9%), and psychiatric (19.3%) symptoms were the most common symptoms. Surgical treatment was heterogeneous [parathyroidectomy [PTx)] alone: 22.9%; PTx and hemithyroidectomy: 24.1%; en bloc resection 15.7%; others 37.3%] and complications of surgery were frequent (recurrent laryngeal nerve palsy 25.3%; hypoparathyroidism 6%). Recurrence of PC was observed in 32 of 83 cases. In univariate analysis, rate of recurrence was reduced when extended initial surgery had been performed (P ¼ 0.04). In multivariate analysis low T status [odds ratio (OR) ¼ 2.65, 95% confidence interval (CI) 1.02-6.88, P ¼ 0.045], N0 stage at initial diagnosis (OR ¼ 6.32, 95% CI 1.33-30.01, P ¼ 0.02), Ki-67 <10% (OR ¼ 14.07, 95% CI 2.09-94.9, P ¼ 0.007), and postoperative biochemical remission (OR ¼ 0.023, 95% CI 0.001-0.52, P ¼ 0.018) were beneficial prognostic parameters for recurrence-free survival. Conclusion: Despite a favorable overall prognosis, PC shows high rates of recurrence leading to repeated surgery and postoperative recurrent laryngeal nerve palsy and hypoparathyroidism. In view of the reduced recurrence rate in cases of extended surgery, ipsilateral completion surgery may be considered when PC is confirmed.

Genomics and Epigenomics in Parathyroid Neoplasia: from Bench to Surgical Pathology Practice

“…Unlike parathyroid adenomas, which are more common in women than in men, parathyroid carcinomas affect woman and men equally. Clues to a parathyroid carcinoma diagnosis can be obtained preoperatively, as these tumors often are larger than adenomas, may be clinically palpable, and usually are associated with high serum calcium levels (often > 13.5 mg/dl) with patients exhibiting various symptoms related to hypercalcemia, such as nephrolithiasis and bone disease [20,21]. Perioperative findings of the tumor being adherent to adjacent structures can also be information of value when assessing these rare lesions, and for this reason, surgeons usually opt in for an en bloc resection of the afflicted ipsilateral thyroid lobe when suspecting parathyroid carcinoma ( Fig.…”

“…Perioperative findings of the tumor being adherent to adjacent structures can also be information of value when assessing these rare lesions, and for this reason, surgeons usually opt in for an en bloc resection of the afflicted ipsilateral thyroid lobe when suspecting parathyroid carcinoma ( Fig. 1d) [21]. However, one must be cautious in evaluating a parathyroid that may be adhesed to adjacent structures such as the thyroid gland, as parathyroid adenomas may also be firmly adhesed to this organ.…”

Chirurgie des Hyperparathyreoidismus

“…Zu den eingriffsspezifischen Komplikationen der HPT-Chirurgie zählen die zervikale Nachblutung, die Recurrensparese und der postoperative Hypoparathyreoidismus. Insgesamt ist die Komplikationsrate in Expertenhänden sehr niedrig, aber bei Rezidiveingriffen sind die Komplikationsraten erhöht [37,40,41]. Die Nachblutungsgefahr und die Kontrollbedürftigkeit des Kalziumspiegels bedingen eine postoperative Überwachungsnotwendigkeit, die idealerweise 24 h nicht unterschreiten sollte.…”

“…Die Nachblutungsgefahr und die Kontrollbedürftigkeit des Kalziumspiegels bedingen eine postoperative Überwachungsnotwendigkeit, die idealerweise 24 h nicht unterschreiten sollte. Die postoperative Untersuchung der Stimmlippenfunktion wird unabhängig vom Einsatz des intraoperativen Neuromonitorings zum Ausschluss einer Funktionsstörung und zur Qualitätskontrolle als guter Behandlungsstandard gefordert [37,40,41].…”

Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery

“…In 70-80% of cases, a single solitary parathyroid adenoma is causative for pHPT, while 20-30% of cases are accounted for by multiglandular disease. On the other hand, parathyroid carcinomas are relatively rare [2][3][4].…”