Successful Resection of Hepatic and Pulmonary Metastases in a Patient with Parathyroid Carcinoma

Abstract

We describe the effect of repeated surgical procedures in a patient with metastatic parathyroid carcinoma over a period of seven years. Initially a subtotal parathyroidectomy was performed for adenomatous hyperplasia. After two years of normocalcemia, hypercalcemia recurred. Two subsequent re-explorations, one of the neck and one of the mediastinum, showed no abnormalities. Histopathologic revision of the primary specimen demonstrated parathyroid carcinoma. Attention was then focused on extra-regional disease, and a hepatic metastasis was detected and successfully resected. Within one year, functional pulmonary metastases occurred. These metastases were treated by four thoracotomies, each providing effective palliation. Eventually the patient died of uncontrollable hypercalcemia seven years after the primary procedure. Even at the time of death there were no signs of recurrent disease in the neck. Parathyroid carcinoma is known to produce local and distant metastases causing severe hypercalcemia. Because medical treatment mostly offers only temporary success and surgery facilitates effective palliation with minimal morbidity, an aggressive surgical approach for functional metastases of parathyroid carcinoma is recommended.

Successful palliation of hypercalcemia secondary to metastatic parathyroid cancer: an unusual indication for hepatic resection

“…Recurrent or metastatic parathyroid cancer is managed surgically whenever possible ,. In fact, since even very small tumor deposits may produce sufficient parathyroid hormone to cause severe hypercalcemia; significant palliation may result from resection of lesions in the neck, lymph nodes, lungs, or liver . Due to the refractory nature of the hypercalcemia associated with metastatic parathyroid carcinoma, the resection of isolated metastases has been advocated to facilitate normocalcemia .…”

“…[3][4][5]7 In fact, since even very small tumor deposits may produce suffi cient parathyroid hormone to cause severe hypercalcemia; signifi cant pallia-tion may result from resection of lesions in the neck, lymph nodes, lungs, or liver. [5][6][7][8] Due to the refractory nature of the hypercalcemia associated with metastatic parathyroid carcinoma, the resection of isolated metastases has been advocated to facilitate normocalcemia. [5][6][7][8] Because of the rarity of parathyroid carcinoma itself, reports of successful palliation by hepatic metastatectomy are limited to case reports.…”

“…Hypercalcemia in patients with parathyroid carcinoma may be severe, and patients can require hemodialysis and calcium‐lowering agents until the parathyroid hormone‐secreting tumor is localized and excised . Due to the difficulty in treating hypercalcemia in this setting, an aggressive approach to the localization and resection of these lesions is warranted and can result in long‐term palliation and alleviation of symptoms …”

“…4 Due to the diffi culty in treating hypercalcemia in this setting, an aggressive approach to the localization and resection of these lesions is warranted and can result in long-term palliation and alleviation of symptoms. [5][6][7]…”

Current and Future Treatments for Parathyroid Carcinoma

“…Many patients with PC may undergo multiple resections, both for disease in the neck as well as for distant metastatic disease. Hepatic and pulmonary metastases have been successfully resected as palliative measures [47,48]. Complete clearance of disease remains the ultimate goal, and surgery remains the most effective treatment for recurrent disease.…”