Parathyroid involvement in thyroid cancer: an unforeseen event

Chrisoulidou, Alexandra; Mandanas, Stylianos; Mitsakis, Periklis; Iliadou, Paschalia K; Manafis, Kosmas; Flaris, Nikolaos; Boudina, Maria; Mathiopoulou, Lemonia; Pazaitou‐Panayiotou, Kalliopi

doi:10.1186/1477-7819-10-121

Cited by 14 publications

(22 citation statements)

References 11 publications

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“…The infiltrative or metastatic PTG involvement is a rare entity in patients with DTC. In our cohort, the frequency of PTG was 1.94%, which is consistent with other reported results [1][2][3]. However, the frequency was much higher among patients with histologically proven advertent or inadvertent Parathyroidectomy (8.38%).…”

Section: Discussionsupporting

confidence: 92%

“…The incidence of parathyroid glands (PTG) involvement in differentiated thyroid carcinoma (DTC) and its prognosis are not well known, since the invasion of the PTG is not routinely sought during surgery [1]. Reported incidence rate of PTG involvement in PTC is 0.5%-7.9% depending on number of retrieved PTG postthyroidectomy histopathological examination [2]. However the true prevalence of PTG infiltration is difficult to estimate during the thyroidectomy as special attention is paid to the preserve the PTG [3].…”

Section: Introductionmentioning

confidence: 99%

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Involvement of Parathyroid Glands by Differentiated Thyroid Cancers and its Influence on Treatment Outcome

Al‐Qahtani

Asiri²,

Tunio³

et al. 2014

Thyroid Disorders Ther

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Background: Parathyroid gland (PTG) involvement by differentiated thyroid cancer (DTC) patients is rare and its influence on disease outcome has been less studied. We aimed to evaluate the frequency and patterns of PTG involvement in DTC patients and to evaluate the influence of PTG infiltration by DTC on treatment outcome in our cohort. Methods: Demographic, clinicopathologic characteristics and treatment outcomes of sixteen patients of PTG involvement were reviewed in a series of consecutive 823 DTC patients treated during July 2001 and December 2012 with thyroidectomy followed by radioactive iodine therapy and radiation therapy. Data regarding the occurrence of locoregional recurrence (LRC) or distant metastasis (DM), disease free survival (DFS) and overall survival (OS) rates were recorded. LRC, DMC, DFS and OS rates were also compared to matched controls (T3, T4a and M1) using the log-rank test. Results: Mean age of cohort was 57.5 years (42.9-72.1) with female gender preponderance (75%). Sixteen cases of DTC with PTG involvement were found among the 823 patients (1.94%). Fourteen cases (87.5%) had direct extrathyroid extension (ETE) to PTG and 2 (12.5%) had metastatic foci. Majority of involved PTG were located within the thyroid capsule (intracapsular) (50%). PTG involvement was associated with extrathyroidal extension in 13 cases (81.3%). Median size of primary thyroid cancer was 3 cm (2.2-5.4). Fourteen patients (87.5%) with PTG involvement had positive cervical lymph nodes and 12 patients (75%) had lymphovascular space invasion. At 5 years, LRR, DMC, DFS and OS rates were 87.1%, 66.3%, 64.3% and 58.3% respectively. DTC patients with PTG involvement had similar DFS as compared to pT4a (62.5% vs. 60.4%: p 0.08). Conclusion: PTG involvement in DTC patients is rare and is associated with older age, advanced stage and with ETE. In the presence of ETE, PTG involvement can be high.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Involvement of Parathyroid Glands by Differentiated Thyroid Cancers and its Influence on Treatment Outcome

Al‐Qahtani

Asiri²,

Tunio³

et al. 2014

Thyroid Disorders Ther

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“…Metastases to the parathyroids are rare and are nearly always identified as part of extensive metastatic disease, with only 3.2% of cases reported as isolated metastases (Chrisoulidou et al 2012, Lee et al 2013, Shifrin et al 2015, Bauer et al 2018. Autopsy studies have suggested that the prevalence of the incidental involvement of the parathyroids by metastatic tumours varies between 5.3 and 19%, with breast carcinoma being the most common tumour (Bauer et al 2018) (Table 1).…”

Section: Epidemiologymentioning

confidence: 99%

“…Autopsy studies have suggested that the prevalence of the incidental involvement of the parathyroids by metastatic tumours varies between 5.3 and 19%, with breast carcinoma being the most common tumour (Bauer et al 2018) (Table 1). A recent review (Bauer et al 2018) identified that 66.9% of parathyroid metastases originated from breast carcinoma, followed by melanoma (11.8%) and lung carcinoma (5.5%); approximately 5.5% were 'tumour-to-tumour' metastases to a parathyroid adenoma (Chrisoulidou et al 2012, Lee et al 2013, Shifrin et al 2015, Bauer et al 2018. Thymic neuroendocrine tumour metastatic to the parathyroids has been reported in a case of a patient with multiple endocrine neoplasia (MEN1) syndrome and an enlarged parathyroid gland (Shifrin et al 2015).…”

Section: Epidemiologymentioning

confidence: 99%

Neoplastic metastases to the endocrine glands

Angelousi

Alexandraki

Kyriakopoulos

et al. 2020

Endocrine-Related Cancer

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Endocrine organs are metastatic targets for several primary cancers, either through direct extension from nearby tumour cells or dissemination via the venous, arterial and lymphatic routes. Although any endocrine tissue can be affected, most clinically relevant metastases involve the pituitary and adrenal glands with the commonest manifestations being diabetes insipidus and adrenal insufficiency respectively. The most common primary tumours metastasing to the adrenals include melanomas, breast and lung carcinomas, which may lead to adrenal insufficiency in the presence of bilateral adrenal involvement. Breast and lung cancers are the most common primaries metastasing to the pituitary, leading to pituitary dysfunction in approximately 30% of cases. The thyroid gland can be affected by renal, colorectal, lung and breast carcinomas, and melanomas, but has rarely been associated with thyroid dysfunction. Pancreatic metastasis can lead to exo-/endocrine insufficiency with renal carcinoma being the most common primary. Most parathyroid metastases originate from breast and lung carcinomas and melanoma. Breast and colorectal cancers are the most frequent ovarian metastases; prostate cancer commonly affects the testes. In the presence of endocrine deficiencies, glucocorticoid replacement for adrenal and pituitary involvement can be life saving. As most metastases to endocrine organs develop in the context of disseminated disease, surgical resection or other local therapies should only be considered to ameliorate symptoms and reduce tumour volume. Although few consensus statements can be made regarding the management of metastases to endocrine tissues because of the heterogeneity of the variable therapies, it is important that clinicians are aware of their presence in diagnosis.

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“…Owing to their anatomic location, adjacent to the thyroid, parathyroid glands should be at high risk of tumor involvement in patients with TC. Unexpectedly, only four thyroidectomy-based series of adult patients have been as yet reported in the literature [ 4 – 7 ], describing parathyroid invasion by TC, of which three originated from the same institution, the Kuma Hospital in Japan [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Parathyroid Gland Involvement by Thyroid Cancer: Results from a Large Series of Thyroidectomies Performed in Two Italian University Hospitals and Review of the Literature

Papi¹,

Corrado

Fadda

et al. 2014

Journal of Thyroid Research

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Objectives.Parathyroid involvement by thyroid cancer (TC) has not been frequently investigated in thyroidectomy-based studies. We aimed to detect cases of parathyroid invasion by TC in a large series of thyroidectomies and to review the literature on this topic. Study Design. A 10-yr period database research was made from the files of the Section of Pathology of two Italian University Hospitals. Out of 22,310 thyroidectomies, 10 patients with parathyroid involvement by TC were found. Results. The 10 patients, 7 females and 3 males, aged 55 ± 14 years (range 34–76, median 56) had papillary thyroid carcinoma and accounted for 0.4% of subjects affected by all TCs and submitted to thyroidectomy. The tumor invaded perithyroid soft tissues in 6 patients and central neck (level VI) lymph nodes in 3. Parathyroid involvement by TC occurred by infiltration in 6 cases, extension through an intervening pseudocapsule in 1, and both patterns in 3. All patients are alive and disease free at 5.6 ± 3-yr follow-up. Conclusion. Limited to thyroidectomy series, our results and literature data suggest that parathyroid involvement by TC has a 0.4–3.9% incidence rate; mainly affects women in their sixth-seventh decade of life; is associated to a good prognosis, unless massive extrathyroid extension of TC occurs.

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Parathyroid involvement in thyroid cancer: an unforeseen event

Cited by 14 publications

References 11 publications

Involvement of Parathyroid Glands by Differentiated Thyroid Cancers and its Influence on Treatment Outcome

Involvement of Parathyroid Glands by Differentiated Thyroid Cancers and its Influence on Treatment Outcome

Neoplastic metastases to the endocrine glands

Parathyroid Gland Involvement by Thyroid Cancer: Results from a Large Series of Thyroidectomies Performed in Two Italian University Hospitals and Review of the Literature

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