Large retrosternal parathyroid carcinoma with primary hyperparathyroidism (original) (raw)
Related papers
Parathyroid carcinoma: clinical course, diagnosis and management
Malta Medical …, 2010
Parathyroid carcinoma is a rare cause of primary hyperparathyroidism often resulting in severe hypercalcaemia. It tends to follow a rather aggressive course with a high propensity for locoregional spread and distant metastasis. En bloc resection is the mainstay of treatment, with surgery also playing a role in the palliation of hypercalcaemia for recurrent and metastatic disease. While adjuvant chemotherapy and radiotherapy have shown disappointing outcomes, bisphosphonates and calcimimetic agents are effective in the management of recalcitrant hypercalcaemia in parathyroid carcinoma. We report a case of parathyroid carcinoma in a lady who initially presented with a neck mass, severe hypercalcaemia, a bony swelling over the shin and elevated parathyroid hormone levels. The diagnosis was confirmed histologically following a thyroid lobectomy, isthmectomy and parathyroidectomy. In the three years which followed the patient received two courses of palliative radiotherapy, two thoracotomies for pulmonary metastatectomy, an extensive neck re-exploration and fashioning of a tracheostomy for aggressive local recurrence with invasion of the larynx.
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).
Hyperfunctioning intrathyroidal parathyroid carcinoma
Saudi medical journal, 2006
Intrathyroidal parathyroid carcinoma is an exceedingly rare cause of primary hyperparathyroidism with difficulties in the diagnosis and management. We report a case of hypercalcemia from intrathyroidal parathyroid carcinoma in a 63-year-old Saudi female. She was diagnosed 2 years earlier with osteoporosis in a primary care clinic and was on alendronate since then. This year she was noted to have hypercalcemia, but in retrospect she had more than 10 years history of multiple medical problems related to hypercalcemia. Parathyroid 99mTc-SestaMIBI scintigraphy revealed parathyroid adenoma in the left inferior parathyroid gland. She had successful video-assisted parathyroidectomy that relieved most of her symptoms. The extreme rarity of such a case, the interesting clinical presentation and review of the literature are discussed.
Parathyroid carcinoma: clinical presentation and treatment
International Congress Series, 2003
Carcinoma of the parathyroid gland is a rare cause of primary hyperparathyroidism, with incidence of less than 1%. Parathyroid carcinomas usually grow slowly, with a tendency for local invasion. The preoperative differential diagnosis between carcinoma and adenoma of parathyroid gland is often difficult because many of the signs and symptoms are similar. Patients with parathyroid carcinoma have a generally higher serum calcium level and PTH level, and incidence of renal and bone diseases, pancreatitis, peptic ulcer, and anemia. The most effective therapy for parathyroid cancer is complete resection of the tumor together with the ipsilateral thyroid lobe.
Parathyroid Carcinoma with Low Values of Elevated Parathyroid Hormone: A Case Report
INTERNATIONAL JOURNAL OF ANATOMY RADIOLOGY AND SURGERY
Parathyroid Carcinoma (PC) is a rare endocrine malignancy, accounting for <1% of sporadic Primary Hyperparathyroidism (PHPT) cases. A preoperative and even intraoperative diagnosis of PC is rarely reported due to its close resemblance to parathyroid adenoma with respect to symptoms- hypercalcaemia, renal stones and/or failure, osteoporosis, and cardiac/neurocognitive dysfunction. The mean serum calcium in PC is reported to be greater than 14 mg/dL along with serum Parathyroid Hormone (PTH) levels often above 1000 pg/mL. When serum PTH levels are 10 times the upper limit of the normal, it is considered diagnostic of PC. Surgical en-bloc resection without capsular breach is the only definitive cure for PC. The present case report included two patients who presented with features of single parathyroid glandular enlargement, hypercalcaemia, its consequences and with normal ionised calcium, but relatively low levels of elevated serum PTH (<300 pg/mL). They were operated and identif...
Hypercalcemia And Metastic Parathyroid Carcinoma: Diagnostic Challenge
Parathyroid carcinoma is an extremely rare neoplasm which typically is associated with hardened nodules in the parathyroid region, hypercalcemia and renal failure. A 69 year-old woman presented with knee pain at an emergency unity. On clinical examination the patient also presented a 2.0cm fibroelastic and mobile node in the left neck, level II. Serum total calcium and parathyroid hormone were increased, and the node was also detected by CT and 99mTc-sestamib scintigraphy. The patient had been surgically previously treated of parathyroid carcinoma misdiagnosed as a thyroid adenoma (eleven years ago), and a hyperplasia of parathyroid chief cells (nine years ago), that after revision was diagnosed as cervical metastasis of parathyroid carcinoma. She was surgically treated by neck dissection, confirming the second regional metastasis of parathyroid carcinoma. The diagnosis of parathyroid carcinoma is a challenge, and although rare, it should be considered in the presence of hypercalcemia and palpable neck nodule. Key Words: Parathyroid Carcinoma; Hypercalcemia; Hyperparathyroidism; Lymph Node Metastasis; Nodule
Malignancy of parathyroid: An uncommon clinical entity
Indian Journal of Endocrinology and Metabolism, 2013
Parathyroid carcinoma is a very rare cause of hyperparathyroidism. The diagnosis is usually established on histopathological grounds of capsular and vascular invasion, but a potential clue to the diagnosis is also offered by the severity of clinical profile, abrupt onset of symptoms, and a high degree of hypercalcemia and raised serum parathyroid hormone (PTH). We report a case of an elderly female with a prolonged history of generalized weakness and bone pain along with bilateral renal calculi, classical bony lesions, and a high serum calcium and PTH level who underwent a right inferior parathyroidectomy considering a parathyroid adenoma as our diagnosis. However, the biopsy report was consistent with a parathyroid carcinoma, and so, she was further subjected to an ipsilateral hemithyroidectomy as a completion procedure. So, we would like to emphasize that its preferable to have a high index of suspicion for parathyroid carcinoma when these clues are present, than to miss the opportunity for surgical cure in the first go by failing to consider it in the differential diagnosis.
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...
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.
Parathyroid Carcinoma: The Importance of High Clinical Suspicion for a Correct Management
International Journal of Surgical Oncology, 2012
Background. Parathyroid carcinoma is an infrequent clinical entity whose diagnosis is very challenge. Indeed a pre-operative or intraoperative diagnosis of parathyroid carcinoma is reported in less than half cases described in the literature. Patients and Methods. A systematic review of pathological reports of our secondary referral hospital was done. From 2003 to 2011 one hundred and forty-four patients were operated for hyperparathyroidism. One patient with atypical adenoma and three patients with parathyroid carcinoma were included in this paper. Results. An en bloc resection of the tumor was performed in three patients. Two of this patients with diagnosis of parathyroid carcinoma are alive with no evidence of recurrence or metastasis, respectively, 48 and 60 months after the operation; one patient with diagnosis of atypical adenoma died for other disease 16 months after the operation. In the last patient a simple parathyroidectomy was performed. After that histology revealed the diagnosis of parathyroid carcinoma the patient underwent reoperation for left hemithyroidectomy and central compartment lymph node clearance. After 30 months a lung lobectomy was done due to metastasis. Conclusion. Parathyroid carcinoma should be considered in the differential diagnosis of PTH-dependent hypercalcemia because optional outcomes are associated with complete resection of the tumor at the time of initial operation.