World Journal of Endocrine Surgery

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VOLUME 15 , ISSUE 3 ( September-December, 2023 ) > List of Articles

CASE SERIES

Parathyroid Carcinoma: A Case Series and Review of Literature

Amit S Nachankar, Sachin Modi, Shilika Lalwani, Mantha Santosha, Vikram Singh Shekhawat

Keywords : Case report, Hungry bone syndrome, Hypercalcemia, Parathyroid adenoma, Parathyroid carcinoma, Primary hyperparathyroidism

Citation Information : Nachankar AS, Modi S, Lalwani S, Santosha M, Shekhawat VS. Parathyroid Carcinoma: A Case Series and Review of Literature. World J Endoc Surg 2023; 15 (3):82-87.

DOI: 10.5005/jp-journals-10002-1464

License: CC BY-NC 4.0

Published Online: 20-04-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: Parathyroid carcinoma (PC) is one of the least common endocrine malignancies seen in <1% of cases of primary hyperparathyroidism (PHPT). The most common presentation is in the form of parathyroid hormone (PTH) dependent hypercalcemia mimicking parathyroid adenoma (PA). However, the hypercalcemia is severe, associated with severe bony manifestations, and often associated with markedly elevated serum PTH. Case series: Our three cases of PC were detected in a single center within a short span of 3 years. All were female between 5th and 7th decade of life. All had initial symptoms of hypercalcemia with a fragility fracture in one. The initial biochemical evaluation showed PTH-dependent hypercalcemia. Two patients had localization of parathyroid swelling on ultrasonography (USG) with confirmation on the sestamibi parathyroid scan. One patient had PA on fine needle aspiration (FNA) of the thyroid nodule. All patients had severe osteoporosis, and one had nephrolithiasis. All had histopathological confirmation of PC postoperatively, but none had metastatic disease. Conclusion: Parathyroid carcinoma (PC) is an extremely rare malignancy that usually presents as PTH-dependent severe hypercalcemia and is often diagnosed postoperatively during histopathology. The most common clues to the diagnosis are markedly elevated serum PTH levels and hypercalcemia of >14 mg/dL.


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  1. Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the US between 1985–1995: a National Cancer Data Base Report. Cancer 1999;86(3):538–544. DOI: 10.1002/(sici)1097-0142(19990801)86:3<538::aid-cncr25>3.0.co;2-k
  2. Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 2005;132(3):359–372. DOI: 10.1016/j.otohns.2004.10.005
  3. Roser P, Leca BM, Coelho C, et al. Diagnosis and management of parathyroid carcinoma: a state-of-the-art review. Endocr Relat Cancer 2023;30(4). DOI: 10.1530/ERC-22-0287
  4. Fingeret AL. Contemporary evaluation and management of parathyroid carcinoma. JCO Oncol Pract 2021;17(1):17–21. DOI: 10.1200/JOP.19.00540
  5. Shane E. Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 2001;86(2):485–493. DOI: 10.1210/jcem.86.2.7207
  6. Nayyar SS, Thiagarajan S, Chaukar D, et al. Parathyroid carcinoma-an experience of the enigma over 10 years. Indian J Endocrinol Metab 2020;24(2):137–142. DOI: 10.4103/ijem.IJEM_588_19
  7. Mukherjee S, Arya AK, Bhadada SK, et al. Parathyroid carcinoma: an experience from the Indian primary hyperparathyroidism registry. Endocr Pract 2021;27(9):881–885. DOI: 10.1016/j.eprac.2021.01.014
  8. Busaidy NL, Jimenez C, Habra MA, et al. Parathyroid carcinoma: a 22-year experience. Head Neck 2004;26(8):716–726. DOI: 10.1002/hed.20049
  9. Wynne AG, Van Heerden J, Carney JA, et al. Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine 1992;71(4):197–205.
  10. Favia G, Lumachi F, Polistina F, et al. Parathyroid carcinoma: sixteen new cases and suggestions for correct management. World J Surg 1998;22(12):1225–1230. DOI: 10.1007/s002689900549
  11. Koea JB, Shaw JH. Parathyroid cancer: biology and management. Surg Oncol 1999;8(3):155–165. DOI: 10.1016/s0960-7404(99)00037-7
  12. Wilkins BJ, Lewis JS Jr. Non-functional parathyroid carcinoma: a review of the literature and report of a case requiring extensive surgery. Head Neck Pathol 2009;3(2):140–149. DOI: 10.1007/s12105-009-0115-4
  13. Mishra SK, Agarwal G, Kar DK, et al. Unique clinical characteristics of primary hyperparathyroidism in India. Br J Surg 2001;88(5):708–714. DOI: 10.1046/j.0007-1323.2001.01775.x
  14. Nachankar AS, Kotwal N, Bansal N, et al. Pancreatitis due to primary hyperparathyroidism: a case series and review of literature. World J Endo Surg 2022 Sep;14(3):87–91. DOI: 10.5005/jp-journals-10002-1431
  15. Shekhawat VS, Bhansali A. Vanishing metatarsal: a rare manifestation of primary hyperparathyroidism. BMJ Case Rep 2017;2017: DOI: 10.1136/bcr-2017-220676
  16. Sawhney S, Vaish R, Jain S, et al. Parathyroid carcinoma: a review. Indian J Surg Oncol 2022;13(1):133–142. DOI: 10.1007/s13193-021-01343-3
  17. Kebebew E. Parathyroid carcinoma. Curr Treat Options Oncol 2001;2(4):347–354. DOI: 10.1007/s11864-001-0028-2
  18. Bae JH, Choi HJ, Lee Y, et al. Preoperative predictive factors for parathyroid carcinoma in patients with primary hyperparathyroidism. J Korean Med Sci 2012;27(8):890–895. DOI: 10.3346/jkms.2012.27.8.890
  19. Hara H, Igarashi A, Yano Y, et al. Ultrasonographic features of parathyroid carcinoma. Endocr J 2001;48(2):213–217. DOI: 10.1507/endocrj.48.213
  20. Nam M, Jeong HS, Shin JH. Differentiation of parathyroid carcinoma and adenoma by preoperative ultrasonography. Acta Radiol 2017;58(6):670–675. DOI: 10.1177/0284185116666418
  21. Liu J, Zhan WW, Zhou JQ, et al. Role of ultrasound in the differentiation of parathyroid carcinoma and benign parathyroid lesions. Clin Radiol 2020;75(3):179–184. DOI: 10.1016/j.crad.2019.10.004
  22. Agarwal G, Dhingra S, Mishra SK, et al. Implantation of parathyroid carcinoma along fine needle aspiration track. Langenbecks Arch Surg 2006;391(6):623–626. DOI: 10.1007/s00423-006-0095-8
  23. Obara T, Fujimoto Y. Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 1991;15(6):738–744. DOI: 10.1007/BF01665308
  24. Schantz A, Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer 1973;31(3):600–605. DOI: 10.1002/1097-0142(197303)31:3<600::aid-cncr2820310316>3.0.co;2-0
  25. Kameyama K, DeLellis RA, Lloyd RV, et al. Parathyroid carcinomas: can clinical outcomes for parathyroid carcinomas be determined by histologic evaluation alone? Endocr Pathol 2002;13(2):135–139. DOI: 10.1385/ep:13:2:135
  26. Kameyama K, Takami H. Proposal for the histological classification of parathyroid carcinoma. Endocr Pathol 2005;16(1):49–52. DOI: 10.1385/ep:16:1:049
  27. Uljanovs R, Sinkarevs S, Strumfs B, et al. Immunohistochemical profile of parathyroid tumours: a comprehensive review. Int J Mol Sci 2022;23(13). DOI: 10.3390/ijms23136981
  28. Cohn K, Silverman M, Corrado J, et al. Parathyroid carcinoma: the Lahey Clinic experience. Surgery 1985;98(6):1095–1100. DOI: 10.1097/00006534-198610000-00075
  29. Sali AP, Motghare P, Bal M, et al. Parathyroid carcinoma: a single-institution experience with an emphasis on histopathological features. Head Neck Pathol 2021;15(2):544–554. DOI: 10.1007/s12105-020-01244-x
  30. Young S, Wu JX, Li N, et al. More extensive surgery may not improve survival over parathyroidectomy alone in parathyroid carcinoma. Ann Surg Oncol 2016;23(9):2898–2904. DOI: 10.1245/s10434-016-5256-6
  31. Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 1992;16(4):724–731. DOI: 10.1007/BF02067369
  32. Munson ND, Foote RL, Northcutt RC, et al. Parathyroid carcinoma: is there a role for adjuvant radiation therapy? Cancer 2003;98(11):2378–2384. DOI: 10.1002/cncr.11819
  33. Limberg J, Stefanova D, Ullmann TM, et al. The use and benefit of adjuvant radiotherapy in parathyroid carcinoma: a national cancer database analysis. Ann Surg Oncol 2021;28(1):502–511. DOI: 10.1245/s10434-020-08825-8
  34. Fujimoto Y, Obara T, Ito Y, et al. Localization and surgical resection of metastatic parathyroid carcinoma. World J Surg 1986;10(4):539–547. DOI: 10.1007/BF01655520
  35. Bukowski RM, Sheeler L, Cunningham J, et al. Successful combination chemotherapy for metastatic parathyroid carcinoma. Arch Int Med 1984;144(2):399–400. DOI: 10.1001/archinte.1984.00350140229032
  36. Silva-Figueroa AM, Hess KR, Williams MD, et al. Prognostic scoring system to risk stratify parathyroid carcinoma. J Am Coll Surg 2017; DOI: 10.1016/j.jamcollsurg.2017.01.060
  37. Schulte KM, Talat N. Diagnosis and management of parathyroid cancer. Nat Rev Endocrinol 2012;8(10):612–622. DOI: 10.1038/nrendo.2012.102
  38. Harari A, Waring A, Fernandez-Ranvier G, et al. Parathyroid carcinoma: a 43-year outcome and survival analysis. J Clin Endocrinol Metab 2011;96(12):3679–3686. DOI: 10.1210/jc.2011-1571
  39. Gatta G, Capocaccia R, Botta L, et al. Burden and centralised treatment in Europe of rare tumours: results of RARECAREnet-a population-based study. Lancet Oncol 2017;18(8):1022–1039. DOI: 10.1016/S1470-2045(17)30445-X
  40. Ullah A, Khan J, Waheed A, et al. Parathyroid carcinoma: incidence, survival analysis, and management: a study from the SEER database and insights into future therapeutic perspectives. Cancers (Basel) 2022;14(6). DOI: 10.3390/cancers14061426
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