The Clinical Features and Treatment Strategy of Parathyroid Cancer: A Retrospective Analysis

Abstract

Objective. To review the features and treatment of parathyroid cancer in our series. Explore the suitable extent of initial surgery and the effect of adjuvant radiotherapy in local recurrence. Methods. Seven cases of parathyroid cancer presented from 2014 to 2021. The presenting features, diagnosis, and treatment are presented. Results. Only two patients had multiple manifestations of hypercalcemia. Marked hypercalcemia, which was revealed to be an average of 13.9 mg/dl (range from 11.8 mg/dl to 15.8 mg/dl), was observed in four patients (57%). The others’ serum calcium levels were in the normal range with an average of 9.9 mg/dl (range from 8.6 mg/dl to 10.8 mg/dl). All seven patients had hyperparathyroidism with an average of 733 pg/ml (range from 113 pg/ml to 3193 pg/ml). En bloc resection was performed in two patients with neighboring structure invasion, and four patients with complete tumor capsules underwent tumor resection with limited resection of the thyroid gland. Postoperative adjuvant radiotherapy appeared unsuccessful for local recurrence. Conclusion. High calcium, high PTH, parathyroid occupation by ultrasound, and intraoperative invasion should be considered to have the possibility of parathyroid cancer. Open surgery is recommended and protecting tumor integration is the elementary surgery principle. The initial surgical extent should be decided by the invasion of the tumor. When PC has a local recurrence, the debulking surgery and adjuvant radiotherapy are always fake.

Coincidence or Causality: Parathyroid Carcinoma in Chronic Kidney Disease—Case Report and Literature Review

“…Classically, very high calcium levels above 14–15 mg/dL accompanied by PTH levels more than five times above the upper normal limit, high ALP > 285 IU/L, significantly decreased 1/3 radius BMD or gland diameter > 3 cm should raise the suspicion of PC in PHPT patients [ 1 , 15 , 46 , 63 ]. However, these features do not apply to SHPT, where nodular hyperplasia can reach significant enlargement, the serum levels of ALP and PTH are highly elevated, and 1/3 radius BMD is compromised.…”

Diagnosis and management of parathyroid carcinoma: a state-of-the-art review

“…Emerging evidence from Hu et al (2022), Krupinova et al (2021) and Wang et al (2022), highlights the potential diagnostic role of microRNA-(miRNA) and microDNA-(miDNA) molecule expression in PC tumours. MiRNAs play an important role in the occurrence and metastasis of tumours as they are involved in almost all biological processes and affect cell proliferation, differentiation, adhesion, migration, invasion and apoptosis (Verdelli & Corbetta 2017).…”

“…The group detected a downregulation of serum miRNA-342-3p in PC patients when compared to patients with BPA, suggesting miRNA-342-3p as promising biomarker for improvement of diagnosis of PC. Wang et al (2022) investigated miRNAs from serum exosomes of PC and BPA patients and found exosomal hsa-miR-27a-5p in serum exosomes of PC patients as a putative tumuor marker for preoperative identification of PC.…”