Modern Experience with Aggressive Parathyroid Tumors in a High-Volume New England Referral Center

Gibson, Courtney; Healy, James M.; Lebastchi, Amir H.; Brown, Taylor C.; Stein, Juliana Escobar; Prasad, Manju L.; Callender, Glenda G.; Carling, Tobias; Udelsman, Robert

doi:10.1016/j.jamcollsurg.2014.10.007

Cited by 67 publications

(79 citation statements)

References 19 publications

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“…A study by Quinn et al regarding the utility of parafibromin and Ki-67 in the differential diagnostics of parathyroid tumours resulted in the conclusion that loss of parafibromin expression and extent of Ki-67 staining has not been shown to distinguish between PC and atypical adenoma [42]. Those findings are contrary to our data confirming higher proliferation fraction by Ki-67 expression and invariable diffuse loss of parafibromin in PC.…”

Section: Discussioncontrasting

confidence: 99%

Evaluation of malignant parathyroid tumours in two European cohorts of patients with sporadic primary hyperparathyroidism

Ozolins

Narbuts

Vanags

et al. 2015

Langenbecks Arch Surg

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Purpose Parathyroid carcinoma (PC) is remarkable for its rare occurrence and challenging diagnostics. PC accounts for 0.1-5 % cases of primary hyperparathyroidism (PHPT). The differentiation from benign tumours is difficult even by morphological criteria. To address these issues, we assessed the PC frequency in two separate European PHPT cohorts and evaluated the demographic, clinical, morphological and molecular background. Methods A retrospective study was carried out, using continuously maintained database (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) of PHPT patients from two tertiary referral university hospitals in Europe. The demographic, clinical data and frequency of PC among surgically treated PHPT was detected. Immunohistochemistry (IHC) was performed to detect parafibromin, representing protein product of HRPT2 gene and proliferation marker Ki-67. Results Both PHPT cohorts were characterised by close mean age values (58.6 and 58.0 years) and female predominance. The frequency of PC differed significantly between the cohorts: 2.1 vs. 0.3 %; p=0.004. PC was characterised by invariable complete loss of parafibromin contrasting with parathyroid adenomas. The proliferation fraction was similar in both PC cohorts (10.6 and 11.0 %). PC showed significantly higher proliferation fraction than typical parathyroid adenomas (1.6 %), atypical adenomas (1.6 %) or adenomas featuring focal loss of parafibromin (2.2 %). Conclusions PC frequency can range significantly between the two European cohorts. The differences can be attributable to selection bias of patients referred for surgery and are not caused by discordant definition of malignant parathyroid histology. Diffuse loss of parafibromin and increased proliferation fraction by Ki-67 are valuable adjuncts in PC diagnostics due to significant differences with various clinical and morphological subtypes of adenoma.

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Section: Discussioncontrasting

confidence: 99%

Evaluation of malignant parathyroid tumours in two European cohorts of patients with sporadic primary hyperparathyroidism

Ozolins

Narbuts

Vanags

et al. 2015

Langenbecks Arch Surg

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“…In our study, the median serum Ca level was significantly higher in the carcinoma group than in the APA and classical PA groups, similar to results of a previous report (12). All but one patient with PC had severe hypercalcemia, defined as serum Ca > 14 mg/dL.…”

Section: Discussionsupporting

confidence: 91%

Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker?

Çakır

Polat

Kılıç

et al. 2016

Arch. Endocrinol. Metab.

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Objective: Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical histopathologic features and don't fulfill criteria for carcinoma are classified as atypical adenomas (APA). The purpose of this study was to determine a biochemical or ultrasonographic feature that can predict aggressive disease requiring more extensive surgery and closer follow-up. Subjects and methods: Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients) or carcinoma (5 patients) were enrolled in this study. The control group consisted of 102 patients operated between the same dates and diagnosed with classical PA. Classical adenomas, atypical adenomas, and carcinomas were compared according to their biochemical and ultrasonographic parameters. Results: Serum Ca levels were significantly higher in the PC group compared with the APA and classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the APA and carcinoma groups compared to the classical PA group. ROC analysis was made to determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05 pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic appearance were independent predictors for aggressive disease. Conclusion: Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally invasive surgery. Arch Endocrinol Metab. 2016;60(6):537-44

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“…Up to 15% of patients present with dehydration and/or altered mental status due to the hypercalcemia [36]. The clinical manifestations of the hypercalcemia from PC at presentation in several reported series are shown in Table 1 [8,[37][38][39][40][41]. The organ systems most commonly affected are the skeletal and renal.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Current Understanding and Management of Parathyroid Carcinoma

Arrangoiz¹

2017

JCTR

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Parathyroid adenomas are a very common endocrine entity, whereas parathyroid carcinomas (PC) are extremely rare. With an estimated incidence of 0.015 per 100,000 population and an estimated prevalence of 0.005% in the United States, parathyroid cancer is one of the rarest of all human malignancies. PC is an extremely rare cause of primary hyperparathyroidism (PHPT). Men and women are equally affected, usually in the fourth or fifth decade of life. The exact etiology has not been identified, but mutations in the CDC73 gene appear to have a critical role in its pathogenesis. The morbidity and mortality of PC is secondary to the hypercalcemia resulting from tumor overproduction of PTH. The primary management objectives are complete removal of the cancer and prevention of recurrences. This review will talk about the epidemiology, etiology, clinical manifestations, and management of PC.

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Modern Experience with Aggressive Parathyroid Tumors in a High-Volume New England Referral Center

Cited by 67 publications

References 19 publications

Evaluation of malignant parathyroid tumours in two European cohorts of patients with sporadic primary hyperparathyroidism

Evaluation of malignant parathyroid tumours in two European cohorts of patients with sporadic primary hyperparathyroidism

Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker?

Current Understanding and Management of Parathyroid Carcinoma

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