Distinguishing Parathyromatosis, Atypical Parathyroid Adenomas, and Parathyroid Carcinomas Utilizing Histologic and Clinical Features

Schulte, Jefree J.; Pease, Garrison; Taxy, Jerome B.; Hall, Curtis R.

doi:10.1007/s12105-020-01281-6

Cited by 21 publications

(21 citation statements)

References 41 publications

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“…[8] Compared to PC, APA has a lower proportion of fibrous bands (77% vs. 100%), less cellular atypia (18% vs. 33%), less necrosis (12% vs. 17%), and less tissue infiltration (23% vs. 83%). [10] These findings are compatible with what was observed in our patients. In the first case, cell pleomorphism, nuclear atypia, and vascular invasion were evidenced, while the second case showed cell pleomorphism and focal capsular invasion; in both cases, a giant adenoma (>4 cm) was evident.…”

Section: Discussionsupporting

confidence: 93%

“…83%). [ 10 ] These findings are compatible with what was observed in our patients. In the first case, cell pleomorphism, nuclear atypia, and vascular invasion were evidenced, while the second case showed cell pleomorphism and focal capsular invasion; in both cases, a giant adenoma (>4 cm) was evident.…”

Section: Discussionsupporting

confidence: 93%

“…[4] The clinical and biochemical differences between APA and PC are nil, making differential diagnosis difficult without histopathological analysis. [10] It has been reported that the differences between APA and PC by imaging studies are minimal: parathyroid adenomas are generally solid, hypoechoic lesions with well-defined margins and dimensions usually not >2 cm. In contrast, PCs are lesions with irregular and poorly defined margins, large dimensions (>2-3 cm), and increased vascularity.…”

Section: Discussionmentioning

confidence: 98%

“…[ 4 ] The clinical and biochemical differences between APA and PC are nil, making differential diagnosis difficult without histopathological analysis. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

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Parathyroid Crisis as Presentation of Atypical Parathyroid Adenoma: Two Diagnostically Challenging Cases

et al. 2022

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Atypical parathyroid adenoma (APA) is a rare cause of primary hyperparathyroidism (PHPT) and represents a diagnostic challenge since it is an intermediate form of parathyroid neoplasm of uncertain malignant potential with atypical histological features that require differential diagnosis of parathyroid carcinoma (PC). We present 2 cases of parathyroid crisis as a presentation of APA. The first case was that of a 56-year-old man with parathyroid crisis, constitutional syndrome, and anemia, with evidence of APA after en bloc resection, evolving with hungry bone syndrome after surgery and curation criteria at 6 months after parathyroidectomy (PTX). The second case was a 64-year-old woman with acute chronic kidney disease and parathyroid crisis, with evidence of APA after selective PTX and >50% reduction in parathyroid hormone levels after surgery; however, persistent PHPT at 6 months post-surgery was observed. These cases represented a diagnostic challenge due to their rare clinical presentation (parathyroid crisis), with a heterogeneous spectrum of target organ damage and infrequent symptoms (constitutional syndrome and acute chronic renal disease), in turn caused by a rare pathology (APA). The presentation of these patients may be indicative of PC; however, histopathological diagnosis is a key to the diagnosis of APA. The differential diagnosis of APA vs. PC in clinical practice is indispensable.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 98%

“…[ 4 ] The clinical and biochemical differences between APA and PC are nil, making differential diagnosis difficult without histopathological analysis. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

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Parathyroid Crisis as Presentation of Atypical Parathyroid Adenoma: Two Diagnostically Challenging Cases

et al. 2022

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“…Atypical parathyroid adenoma (APA) and parathyroid carcinoma (PC) occur rarer with PC being the rarest type (~1% in the western world and up to 8% in Asia) (3)(4)(5). Up to now, a total of less than 1, 000 cases of APA have been reported in different cohorts with only several studies including over 50 patients (6)(7)(8)(9)(10)(11). Due to its rarity, there is still no general consensus on treatment and follow-up.…”

Section: Introductionmentioning

confidence: 99%

Clinical and genetic analysis of atypical parathyroid adenoma compared with parathyroid carcinoma and benign lesions in a Chinese cohort

Chen

Song²,

Nie³

et al. 2023

Front. Endocrinol.

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ContextThe malignant potential and molecular signature of atypical parathyroid adenoma (APA) remain elusive. Data from Asia are still lacking.Design and settingThis was a retrospective study on a large APA cohort in a single center from mainland China.MethodsA total of 320 patients with primary hyperparathyroidism (PHPT), containing 79 APA, 79 Parathyroid cancer (PC) and 162 benign lesions cases, were enrolled after surgery for collection of clinical data and genetic analysis.ResultsAPA patients showed earlier mean onset age than benign group (46.9 ± 17.1 vs. 52.0 ± 14.3 yrs). Less bone involvement and gastrointestinal symptoms were presented in APA compared to PC (35.4% vs. 62.0%, and 17.7% vs. 41.8%), while more urolithiasis was seen in APA than in benign lesions (57.0% vs. 29.6%). The APA group had moderate hypercalcemia (mean 3.02 ± 0.44mmol/L) with elevated serum PTH (median 593.0pg/ml) and proportion of hypercalcemic crisis as 22.8%, all higher than those of benign lesions but lower than those of PC group. The recurrence/no remission rate of the APA group was significantly lower than that of the PC and similar to the benign group (5.1% vs. 31.6% vs. 3.1%). Germline CDC73 mutation was the most common molecular abnormality in both PC and APA subjects. APA patients with nonsynonymous germline variants showed earlier onset age (28.5 ± 16.9 vs. 48.1 ± 17.7 yrs) and more cases developing no remission/recurrence (25.0% vs. 0.0%).ConclusionsPatients with APA presented clinical and biochemical characteristics much less severe than PC and resembling the benign neoplasms, with a relatively good prognosis. Germline gene variations were associated with earlier onset and probably more recurrence of PHPT in APA.

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Late recurrence of a single gland primary hyperparathyroidism—Atypical parathyroid adenoma or misdiagnosed parathyroid carcinoma

Kotliarevskaia,

Siebolts,

Dralle

et al. 2024

Clinical Case Reports

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Key Clinical MessageThis case report aims to raise awareness of differential diagnoses of hypercalcemia and primary hyperparathyroidism, including parathyroid carcinoma and atypical adenoma, and to highlight the diagnostic challenges.AbstractParathyroid carcinoma is a rare and often fatal cause of primary hyperparathyroidism and hypercalcemia. To date, there is still no clear‐cut diagnostic pathway for parathyroid carcinoma established, which results in major diagnostic ambiguity and complexity. Clinical differentiation between benign parathyroid adenoma and carcinoma is challenging and ultimately the diagnosis remains histopathological. We present a case of a 58‐year‐old female patient with parathyroid tumor recurrence after parathyroidectomy because of primary hyperparathyroidism. The first tumor was histologically classified as an atypical parathyroid adenoma by a specialized endocrine pathologist. Eleven years after the primary tumor resection a new tumor recurred. Retrospectively, after the tumor recurrence, the primary diagnosis of the atypical adenoma was questioned, and the tumor was temporarily classified to rather be a parathyroid carcinoma. This case aims to raise awareness for the diagnostic challenge of parathyroid carcinomas as a rare cause of primary hyperparathyroidism and therewith to improve treatment and prognosis.

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Distinguishing Parathyromatosis, Atypical Parathyroid Adenomas, and Parathyroid Carcinomas Utilizing Histologic and Clinical Features

Cited by 21 publications

References 41 publications

Parathyroid Crisis as Presentation of Atypical Parathyroid Adenoma: Two Diagnostically Challenging Cases

Parathyroid Crisis as Presentation of Atypical Parathyroid Adenoma: Two Diagnostically Challenging Cases

Clinical and genetic analysis of atypical parathyroid adenoma compared with parathyroid carcinoma and benign lesions in a Chinese cohort

Late recurrence of a single gland primary hyperparathyroidism—Atypical parathyroid adenoma or misdiagnosed parathyroid carcinoma

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