Surgical treatment of ten cases of parathyroid carcinoma: Importance of an initial en bloc tumor resection

Fujimoto, Yoshihide; Obara, Takao; Ito, Yukio; Kanazawa, Kyotaro; Aiyoshi, Yuji; Nobori, Masakazu

doi:10.1007/bf01655086

Cited by 85 publications

(74 citation statements)

References 7 publications

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“…Segundo Fujimoto e col., a excisão cirúrgica pode ser curativa quando a natureza maligna do tumor é reconhecida de imediato na primeira cirurgia, proporcionando uma ressecção adequada do tumor, podendo incluir a remoção do istmo da tiróide e lobo ipsilateral, excisão de qualquer músculo esquelético intimamente envolvido pelo tumor e ressecção do nervo laríngeo recorrente se comprometido (41). É descrita uma incidência de 32% de metástase em linfonodos cervicais, sugerindo-se assim a retirada de todos os linfonodos do leito traqueoesofágico e uma dissecção cirúrgica cervical radical (41). Na nossa casuística, houve 2 recidivas com óbito, demonstrando a agressividade da doença.…”

Section: Discussionunclassified

Carcinoma de paratiróide: características clínicas e anátomo-patológicas de cinco casos

Morimitsu

Uyeno

Goulart

et al. 2001

Arq Bras Endocrinol Metab

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O carcinoma de paratiróide é uma entidade rara, havendo cerca de 535 casos descritos na literatura. Neste trabalho, revisamos a nossa casuística de 5 pacientes com carcinoma de paratiróide avaliados no período de 1983 a 1998 no serviço de Doenças Ósteo-Metabólicas da Universidade Federal de São Paulo, analisando critérios diagnósticos, conduta terapêutica e a evolução destes pacientes e comparando os nossos dados com os achados de literatura. Entre os nossos pacientes, 4 eram do sexo feminino e 1 do sexo masculino, com mediana ao diagnóstico de 52 anos de idade, variando de 10 a 77 anos. As queixas iniciais incluíam presença de dores ósseas acompanhada de perda de peso em 4 pacientes, presença de fratura não traumática em 3 pacientes e traumática em 2 e clínica de nefrolitíase em 1 paciente. Todos apresentavam nódulo palpável em região cervical, níveis de cálcio total bastante elevados com média(±DP) de 14,9±1,7mg/dL. PTH também se encontrava muito elevado, refletindo a magnitude da severidade da doença. Todos foram submetidos à exploração cirúrgica cervical com retirada da massa tumoral, que foi coincidente com o achado palpatório de nódulo cervical. O exame anátomo-patológico revelou o diagnóstico de carcinoma de paratiróide em todos estes casos. No seguimento, 2 pacientes apresentaram recidiva tumoral e evoluíram para óbito por complicações do hiperparatiroidismo. Os outros 3 casos encontram-se em acompanhamento ambulatorial no nosso hospital, sem evidências até o momento de recidiva tumoral.
Parathyroid carcinoma is a rare disease, with about 535 cases reported in the literature until now. In this paper, we reviewed 5 cases of parathyroid carcinoma followed at Universidade Federal de São Paulo from 1983 to 1998, and discuss aspects of clinical presentation, diagnosis and treatment. Four patients were female and 1 male, with median ages of 52 years (10 to 77 years). Initial clinical complains were bone pain and weight loss in 4 patients, traumatic fracture in 2, and fracture without trauma in 3. Kidney stone was present in 1 patient. All had a palpable mass in the cervical region and presented with high calcium levels: 14.9±1.7mg/dL (mean±SD). Parathyroid hormone (PTH) levels were extremely high, showing the severity of the disease. All patients had surgical exploration where a tumor mass was recognized and removed. Pathologic examination demonstrated parathyroid carcinoma in all. On follow-up, 2 patients had recurrence and died due to complications of hyperparathyroidism. To date, the other 3 patients have no evidences of recurrence

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Section: Discussionunclassified

Carcinoma de paratiróide: características clínicas e anátomo-patológicas de cinco casos

Morimitsu

Uyeno

Goulart

et al. 2001

Arq Bras Endocrinol Metab

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“…3 Since that time, several reviewers have confirmed that initial en bloc surgical excision provides the only chance for cure. 1,4 Several studies have reported that neither adjuvant chemotherapy nor radiation therapy (RT) plays a role in improving outcome. 2,[5][6][7] Postoperative progression of parathyroid carcinoma is often fatal.…”

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confidence: 99%

Parathyroid carcinoma: Is there a role for adjuvant radiation therapy?

Munson

Foote

Northcutt

et al. 2003

Cancer

160

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BACKGROUNDThe authors proposed to determine risk factors associated with postoperative progression of parathyroid carcinoma within the neck (locoregional) and to assess the efficacy of postoperative adjuvant radiation therapy in preventing disease progression within the neck.METHODSA retrospective review of patients with pathologically confirmed parathyroid carcinoma who underwent surgical resection was performed. Risk factors identified on univariate analysis were applied in a proportional hazards analysis to identify significant independent predictors of locoregional disease progression and cause‐specific survival after surgical resection. Fifty‐seven patients were treated with surgery alone (no adjuvant radiation therapy [RT]) and were determined to have sufficient follow‐up and pathologically confirmed features to be included in the current analysis. Four patients were treated with surgery and adjuvant RT. Four patients received RT to the neck and mediastinum for unresectable locoregional disease progression. Patients were followed for a median of 75.6 months (range, 8.4–358 months).RESULTSTwenty‐five patients (44%) developed locoregional disease progression at a median of 27.1 months after surgery (range, 6.2–138.3 months). The univariate analysis revealed that surgical margin status and the institution at which the initial surgery was performed were predictive of locoregional progression‐free survival. The institution at which the initial surgery was performed was found to be an independent predictor of cause‐specific survival. Of the four patients treated with surgery and adjuvant RT, all were alive and without disease at the time of last follow‐up. All four patients who received RT for locoregional disease progression after initial surgery achieved locoregional disease control.CONCLUSIONSPatients with parathyroid carcinoma are reported to have a significant risk of locoregional disease progression after surgery alone. The results of the current study demonstrated that the risk of postoperative disease progression can be predicted by surgical margin status and the institution at which the initial surgery is performed. Patients treated with surgery and postoperative RT may have a lower risk of locoregional disease progression and improved cause‐specific survival. RT can be used to provide locoregional control of recurrent disease. Cancer 2003. © 2003 American Cancer Society.

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“…Unfortunately, intraoperative frozen-section is ineffective in order to confirm diagnosis of cancer [9]. If carcinoma is suspected on laboratory investigation, and the findings intraoperatively reveal the existence of carcinoma, en bloc resection should be conducted at initial surgery because of the confirmation of PC following pathological evaluation [12,19]. Patients for whom no en bloc resection was performed but diagnosed with PC via pathological examination should be re-assessed for surgery due to thyroidectomy, isthmectomy, paratracheal and central lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Atypical Parathyroid Adenoma and Parathyroid Carcinoma in a Case With Severe Hypercalcemia

Baser

2013

J Med Cases

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Atypical parathyroid adenoma is among the tumors diagnosed difficultly and including some histological features of parathyroid carcinoma. In literature, no definite criteria have been considered to be present to distinguish atypical parathyroid adenoma preoperatively from parathyroid carcinoma. A 65-year-old woman was admitted to our clinic with complaints of arthralgia, myalgia, fatigue and loss of appetite. She had severe hypercalcemia (serum calcium 17.2 mg/dL) and hypophosphatemia (serum phosphate 1.9 mg/dL) along with an elevated intact parathyroid hormone level of 879 pg/mL. Renal functions were within normal limits. The patient was administered with intravenous hydration and diuretic treatments because of severe hypercalcemia. Six sessions of hemodialysis were performed. In neck ultrasonography, multinodular goitre was detected. Tc-99m sestamibi scintigraphy revealed a focal involvement at the middle-inferior region of left thyroid lobe. Neck magnetic resonance imagination revealed a nodular lesion in size of 22 × 14 mm at the posterior region of left thyroid lobe. Parathyroidectomy guided by intraoperative gamma probe was performed. The lesion was histopathologically consistent with atypical parathyroid adenoma. In the postoperative period, serum calcium and intact parathyroid hormone levels were decreased as levels of 7 mg/dL and 42.6 pg/mL, respectively. We reported an atypical parathyroid adenoma accompanied by severe hypercalcemia and hyperparathyroidism.

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Surgical treatment of ten cases of parathyroid carcinoma: Importance of an initial en bloc tumor resection

Cited by 85 publications

References 7 publications

Carcinoma de paratiróide: características clínicas e anátomo-patológicas de cinco casos

Carcinoma de paratiróide: características clínicas e anátomo-patológicas de cinco casos

Parathyroid carcinoma: Is there a role for adjuvant radiation therapy?

Differential Diagnosis of Atypical Parathyroid Adenoma and Parathyroid Carcinoma in a Case With Severe Hypercalcemia

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