Locally Recurrent Parathyroid Neoplasms as a Cause for Recurrent and Persistent Primary Hyperparathyroidism (original) (raw)
Related papers
Parathyroid carcinoma in primary hyperparathyroidism: single institution experience
European Surgery, 2012
Background Parathyroid carcinoma as a cause of primary hyperparathyroidism is very rare. Clear consensus regarding the optimal management of patients with this condition is not available. We aimed to report our experience with this entity. Methods We analyzed medical records of patients who were operated for primary hyperparathyroidism and parathyroid carcinoma in the Centre for Endocrine Surgery in Belgrade, between January 2000 and December 2007. Results Seven patients (four men and three women) were operated for parathyroid carcinoma and primary HPT in our institution in this period. The age at initial diagnosis (mean ± SD) was 53.5 ± 7.6 years. All patients had hypercalcemia (mean 3.53 mmol/l) and very elevated parathyroid hormone (mean 1,530 pg/ml). Extirpation of the parathyroid tumor was performed in two patients, while in five patients parathyroidectomy was performed en block with all involved tissue. Average follow up was 47 months. One patient died for another disease, one was found to have increased calcium and parathyroid hormone levels postoperatively, while the remaining five were free of disease. Conclusions Surgery remains central in the management of patients with parathyroid carcinoma. Still, further multicentric studies should be performed for consistent treatment guidelines.
Localization and Reoperation Results for Persistent and Recurrent Parathyroid Carcinoma
Archives of Surgery, 2001
Hypothesis: Reoperation is safe and benefits patients with persistent and recurrent parathyroid carcinoma. Design: Retrospective study. The mean follow-up time was 8.1 years (median, 7 years; range, 1-23 years). Setting: A university tertiary referral center. Patients: Eighteen patients treated for parathyroid carcinoma from 1966 to 1999. Results: The mean serum calcium level was 13.7 mg/dL (3.43 mmol/L), and the parathyroid hormone (PTH) level was 1.6 to 20 times the upper limit of normal. Fourteen of 18 patients had persistent or recurrent parathyroid carcinoma and underwent 54 reoperations (28 at our institution). Mean time to recurrence was 4.8 years (range, 1-20 years). Symptoms of hyperparathyroidism were relieved in 86% of patients who had reoperation (PϽ.05). Reoperation for parathyroid carcinoma (25 locoregional and 3 distant) significantly reduced and normalized the serum calcium and PTH levels in 75% and 62% of the cases, respectively (PϽ.001). The preoperative serum calcium level was a significant predictor of postreoperative normalization of the serum calcium level but
Parathyroid Carcinoma: Sixteen New Cases and Suggestions for Correct Management
World Journal of Surgery, 1998
We undertook a retrospective study in 16 patients with parathyroid carcinoma, with the aim of conveying experience from management of this rare cause of hyperparathyroidism (HPT). From 1980 to 1996 we operated on 309 patients with HPT, 290 of whom had primary HPT, and parathyroid carcinoma was diagnosed in 16 (5.2%) cases. In none was the malignancy diagnosed preoperatively. The average serum calcium and parathyroid hormone levels were significantly higher (p < 0.05) than in patients with parathyroid adenoma, and the mean tumor size was 2.9 cm (median 2.5 cm, range 1.5-4.5 cm). Twenty-eight operations were performed with resulting normalization of serum calcium levels for more than 6 months in 11 patients. Six patients presented prolonged postoperative hypocalcemia (2-10 months), and five patients had persistent HPT. Ten patients experienced recurrent disease; the median disease-free period was 24 months (range 4 -72 months). None of the patients was treated with chemotherapy, one patient underwent radiation therapy (50 Gy in 25 sessions) but required reoperation for local recurrence 4 months later. Three patients are still alive (two with recurrence). Average survival was 40 months (median 31 months, range 11-131 months).
Benign Recurrent Primary Hyperparathyroidism After Parathyroid Carcinoma
Journal of Endocrine Surgery
This report describes the rare occurrence of a parathyroid adenoma 15 years after the resection of a right-sided parathyroid carcinoma, with recurrence of clinical manifestations of hyperparathyroidism. We report the case of a 41-year-old female who returned to the clinic with bone pain, memory difficulties and fatigue. After a thorough assessment, a hyperechoic nodule of parathyroid origin was detected and resected. The resected lesion was located inferior to the left thyroid lobe, measuring 1.3×0.7×0.6 cm and weighing 602 mg; histopathology was consistent with a parathyroid adenoma. Recurrent primary hyperparathyroidism due to benign adenoma, after prior surgery for parathyroid carcinoma, is a rare phenomenon. Early recognition, diagnosis and intervention are essential to prevent and/or reduce associated morbidity and mortality.
Parathyroid carcinoma: A 22-year experience
Head and Neck-journal for The Sciences and Specialties of The Head and Neck - HEAD NECK-J SCI SPEC HEAD NEC, 2004
Purpose.Because parathyroid carcinoma is rare, clear consensus is not available regarding the optimal management of patients with this condition. Treatment strategies generally derive from clinical and anecdotal experiences. We report our experience with this entity.Because parathyroid carcinoma is rare, clear consensus is not available regarding the optimal management of patients with this condition. Treatment strategies generally derive from clinical and anecdotal experiences. We report our experience with this entity.Methods.We included all patients with parathyroid carcinoma seen at The University of Texas M. D. Anderson Cancer Center since January 1, 1980. The medical records and pathology specimens were reviewed and verified in all cases.We included all patients with parathyroid carcinoma seen at The University of Texas M. D. Anderson Cancer Center since January 1, 1980. The medical records and pathology specimens were reviewed and verified in all cases.Results.Since 1980, 27 patients (16 men and 11 women) registered at M. D. Anderson Cancer Center with parathyroid carcinoma and a minimum follow-up of 2 years. The age at initial diagnosis (mean ± SD) was 46.7 ± 15.3 years. All patients were seen with hypercalcemia (mean calcium, 13.4 ± 1.5 mg/dL). Eighteen patients had locally invasive disease, eight had localized disease, and one had distant metastasis. Parathyroid cancer was treated with complete surgical excision with curative intent in 18 patients. In the other nine patients, who had clinical and/or radiographic evidence of soft tissue extension, the tumor was treated by comprehensive “en bloc” soft tissue resection. Of six patients who received adjuvant radiotherapy after initial surgery, only one had a local relapse. In contrast, of 20 patients who did not receive adjuvant radiotherapy, 10 had a local relapse, excluding the one patient who had distant metastases. The 5-year survival was 85%, and the 10-year survival was 77%. Five patients died of parathyroid carcinoma; all deaths were hypercalcemia related.Since 1980, 27 patients (16 men and 11 women) registered at M. D. Anderson Cancer Center with parathyroid carcinoma and a minimum follow-up of 2 years. The age at initial diagnosis (mean ± SD) was 46.7 ± 15.3 years. All patients were seen with hypercalcemia (mean calcium, 13.4 ± 1.5 mg/dL). Eighteen patients had locally invasive disease, eight had localized disease, and one had distant metastasis. Parathyroid cancer was treated with complete surgical excision with curative intent in 18 patients. In the other nine patients, who had clinical and/or radiographic evidence of soft tissue extension, the tumor was treated by comprehensive “en bloc” soft tissue resection. Of six patients who received adjuvant radiotherapy after initial surgery, only one had a local relapse. In contrast, of 20 patients who did not receive adjuvant radiotherapy, 10 had a local relapse, excluding the one patient who had distant metastases. The 5-year survival was 85%, and the 10-year survival was 77%. Five patients died of parathyroid carcinoma; all deaths were hypercalcemia related.Conclusions.Parathyroid carcinoma can be an indolent disease with morbidity and mortality related to hypercalcemia. Adjuvant radiotherapy may improve local control and limit the occurrence of local relapse. A comprehensive multidisciplinary approach with surgery, radiation therapy, and medical treatment for hypercalcemia is needed to optimize patient outcome. © 2004 Wiley Periodicals, Inc. Head Neck26: 716–726, 2004Parathyroid carcinoma can be an indolent disease with morbidity and mortality related to hypercalcemia. Adjuvant radiotherapy may improve local control and limit the occurrence of local relapse. A comprehensive multidisciplinary approach with surgery, radiation therapy, and medical treatment for hypercalcemia is needed to optimize patient outcome. © 2004 Wiley Periodicals, Inc. Head Neck26: 716–726, 2004
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2021
P rimary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by an increase in calcium (Ca) and parathyroid hormone (PTH) or an increase in one of these, as a result of impaired regulation of serum calcium regulation due to excessive PTH production by gaining inappropriate autonomy of one or more parathyroid glands. [1] PHPT is the third most common endocrine disorder after diabetes mellitus and thyroid diseases. [2] Objectives: The curative treatment of primary hyperparathyroidism (PHPT) is surgery. Persistent and recurrent disease may develop after surgical treatment. In this study, we aimed to evaluate the surgical cure rate in patients who underwent surgery for PHPT in our clinic. Methods: The data of patients who underwent parathyroidectomy for PHPT by two experienced surgeons between 2000 and 2015 in our clinic were retrospectively evaluated. Patients who were followed for at least 6 months after their first parathyroidectomy were included in the study. Surgical cure and persistent and recurrent disease rates were evaluated in patients. Results: During this period, 368 interventions were performed in 357 patients (293 F and 64 M) who were operated for PHPT in our clinic, with a mean age of 54.9±13.1 years. In the first surgery, 116 patients (32.5%) had bilateral neck exploration, 251 patients (67.5%) had unilateral neck exploration (UNE) or focused parathyroid surgery (FPS). In the first operation, 343 patients (96.1%) had cure, 14 patients (13 F and 1 M) remained persistent. Secondary surgical intervention was performed in 11 patients. UNE or FPS was performed to 10 patients (90.9%); partial sternotomy was performed to one patient. Ten of the patients had cure. Three of these patients had a solitary parathyroid adenoma that was not removed in the first surgery, and seven patients had a second adenoma. Four patients remained persistent (1.1%). Recurrent disease developed in four patients during follow-up (1.1%). Total cure rate was 97.8%. Conclusion: The only definitive treatment for PHPT is surgery. High surgical cure can be achieved by pre-operative evaluation and appropriate surgical planning. However, persistent PHPT may develop, especially due to double adenoma or ectopic location. Patients with persistent PHPT can be evaluated with repeat imaging methods and with appropriate surgical planning, a high cure rate can be obtained in secondary surgery, which can increase the total surgical cure rate. Recurrence rate is rare.
Hormones & cancer, 2010
A 29-year-old man presented to his primary care physician with nausea, severe weight loss and muscle weakness. He had a hard, fixed neck swelling. He was severely hypercalcaemic with 10-fold increased parathyroid hormone (PTH) concentrations. A diagnosis of primary hyperparathyroidism was established and the patient was referred for parathyroidectomy. At neck exploration, an enlarged parathyroid gland with invasive growth into the thyroid gland was found and removed, lymph nodes were cleared and hemithyroidectomy was performed. A suspected diagnosis of parathyroid carcinoma was confirmed histologically. Serum calcium and PTH levels normalised post-operatively, but hyperparathyroidism recurred within 3 years of surgery. Over the following 17 years, control of hypercalcaemia represented the most difficult challenge despite variable success achieved with repeated surgical interventions, embolisations, radiofrequency ablation of metastases and treatment with calcimimetics, bisphosphonat...
Surgical pathology of hyperparathyroidism
Biomedicine Pharmacotherapy, 2000
The pathological diagnosis of the causes of primary hyperparathyroidism is often quite difficult, similar to other endocrine disorders, because the diagnostic criteria for hyperplasia, adenoma, and carcinoma of the parathyroid is still controversial. Pathologists often have difficulty making a definitive diagnosis due to the discrepancy between the histologic features and the clinical condition of the patients. Thus, clinicopathologic correlation is often required for diagnosis.
European Journal of Endocrinology, 2009
ObjectiveCure rate for primary hyperparathyroidism (PHPT) is reported to be 94–100% 1 year after surgery, but recent data suggest recurrence in 4% of the patients 1–5 years post-operatively. The aim of our study was to establish the cure rate and its maintenance in the long-term after parathyroidectomy (PTx) in patients with sporadic PHPT.DesignEvaluation of recurrence in patients with sporadic hyperparathyroidism who underwent PTx 1–24 years prior to the study.Patients and methodsWe identified 111 patients who underwent initial PTx between 1984 and 2008, and had no MEN-1, MEN-2, or CaR mutation; parathyroid carcinoma; a history of lithium use; or renal failure. Thirty-eight patients were lost to follow-up or were unwilling or unable to participate in the study. Cure was defined as maintenance of normal serum calcium and parathyroid hormone concentrations 6 months after PTx.ResultsCure was achieved in 68 of 73 patients studied (93%) and was sustained in all for 6±5 years.ConclusionT...