Standardized treatment protocols are hindered by the rarity of the PCas. However, literature concludes that optimal debulking is mandatory, whereas the efficacy of adjuvant chemotherapy remains to be elucidated.

Premize: Pacienţii cu operaţii tiroidiene trebuie evaluaţi ecografic preoperator iar în cazul leziunilor suspecte puncţia aspirativă cu ac fin (FNA) trebuie să completeze investigaţiile. În ţările vestice, chirurgii endocrini efectuează de rutină ecografii cervicale. Rolul limfadenectomiei profilactice de compartiment central (LPCC) în cazul carcinoamelor papilare tiroidiene (CPT) rămâne controversat. În anul 2014 am efectuat o schimbare de strategie în tratamentul CPT: introducerea LPCC efectuată pe baza criteriilor European Society of Endocrine Surgeons (ESES) şi ecografia preoperatorie efectuată de către chirurg (S-US). Material şi Metodă: Pentru înţelegerea rolului jucat de cele două metode nou introduse am efectuat un studiu retrospectiv a două periode succesive de 5 ani, din baza noastră de date menţinută prospectiv. Rezultate: Cele două grupuri analizate au fost similare din punct de vedere epidemiologic şi clinic. FNA s-a efectuat la doar 21,66% dintre pacienţi. Diagnosticul de CPT a fost stabilit la majoritatea cazurilor prin examen histopatologic extemporaneu (EHE). S-US au ghidat limfadenectomia laterocervicală selectivă ducând astfel la îndepărtarea unui număr mai mare de ganglioni metastazaţi, având în plus şi o valoare predictivă pozitivă superioară celor efectuate de către endocrinologi. Rata de complicaţii a LPCC a fost semnificativ mai mare doar pe seama hipoparatiroidismului tranzitor.

Aim: Parathyroid carcinoma (PC) is a rare endocrine malignancy that represents 0.005% of all malignant tumors. Associated PC and differentiated thyroid carcinoma (DTC) is an exceptionally rare condition, and the preoperative diagnostics and proper treatment are challenging. Almost all PCs and the majority of DTCs are diagnosed postoperatively, making correct surgical treatment questionable. Specific guidelines for parathyroid and thyroid carcinomas association treatment are lacking. The purposes of our study were to identify the association between parathyroid and thyroid carcinomas, to analyze the available published data, and to evaluate the possible relationship between preoperative diagnostic and surgical decision-making, and outcome-related issues. Material and methods: We performed a literature review of several databases from the earliest records to March 2022, using controlled vocabulary and keywords to search for records on the topic of PC and WDTC pathological association. The reference lists from the initially identified articles were analyzed to obtain more references. Results: We identified 25 cases of PC and DTC association, 14 more than the latest review from 2021. The mean age of patients was 55, with a female to male ratio of about 3:1. Exposure to external radiation was identified in only one patient, although it is considered a risk factor the development of both PC and DTC. The preoperative suspicion of PC was stated by the authors in only 25% of cases, but suspicion based on clinical, laboratory, ultrasound (US), and fine needle aspiration (FNA) criteria could have been justified in more than 50% of them. With neck ultrasound, 40% of patients presented suspicious features both for PC and thyroid carcinoma. Intra-operatory descriptions of the lesions revealed the highest suspicion (83.3%) of PC, but en bloc resection was recommended and probably performed in only about 50% of the cases. Histopathological examinations of the thyroid revealed different forms of papillary thyroid carcinoma (PTC) in most cases. Postoperative normocalcemia was achieved in 72% of patients, but follow-up data was missing in about 25% of cases. Conclusion: Associated PC and DTC is an exceptionally rare condition, and the preoperative diagnostic and treatment of the patients is a challenge. However, in most cases pre- and intraoperative suspicious features are present for identification by a highly specialized multidisciplinary endocrine team, who can thus perform the optimal treatment to achieve curability.