Coexistent papillary thyroid carcinoma diagnosed in surgically treated patients for primary versus secondary hyperparathyroidism: same incidence, different characteristics

Abstract

Background The coexistence of hyperparathyroidism and thyroid cancer presents important diagnostic and management challenges. With minimally invasive parathyroid surgery trending, preoperative thyroid imaging becomes more important as concomitant thyroid and parathyroid lesions are reported. The aim of the study was to evaluate the rate of thyroid cancer in patients operated for either primary (PHPT) or secondary hyperparathyroidism (SHPT). Methods Our retrospective study included PHPT and SHPT patients submitted to parathyroidectomy and, when indicated, concomitant thyroid surgery between 2010 and 2017. Results Parathyroidectomy was performed in 217 patients: 140 (64.5%) for PHPT and 77 (35.5%) for SHPT. Concomitant thyroid surgery was performed in 75 patients with PHPT (53.6%), and 19 papillary thyroid carcinomas (PTC) were found, accounting for 13.6% from all cases with PHPT and 25.3% from PHPT cases with concomitant thyroid surgery. Thirty-one of operated SHPT patients (40.3%) also underwent thyroid surgery and 9 PTC cases were diagnosed (11.7% of all SHPT patients and 29% of patients with concomitant thyroid surgery). We found differences between PHPT and SHPT patients ( p < 0.001) with respect to age (54.6 ± 13y versus 48.8 ± 12y), female-to-male ratio (8:1 versus ~ 1:1), surgical technique (single gland parathyroidectomy in 82.8% PHPT cases; versus subtotal parathyroidectomy in 85.7% SHPT cases) and presurgical PTH (357.51 ± 38.11 pg/ml versus 1020 ± 161.38 pg/ml). Morphopathological particularities, TNM classification and multifocality incidence of PTC were similar in the two groups. All PTC from patients with SHPT were thyroid microcarcinomas (TMC, i.e. tumors with a diameter smaller than 1 cm), whereas seven out of the 19 cases with PTC and PHPT were larger than 1 cm. Conclusions PTC was frequently and similarly associated with both PHPT and SHPT irrespective of presurgical PTH levels. Thyroid tumors above 1 cm were found only in patients with PHPT. Investigators should focus also on associated thyroid nodular pathology in patients with PHPT.

Association of Hyperparathyroidism and Papillary Thyroid Cancer: A Multicenter Retrospective Study

“…In previous literature, the prevalence of concomitant PTC in pPHT ranged from 2% to 15%, consistent with our results. Preda et al [18] recently reported the incidence of thyroid cancer in patients with sHPT to be 11.7%, which was higher than our findings of 7.2%. Our study demonstrated that the incidence of PTC was high and similar in both patients with pHPT and sHPT.…”

Differences in Clinicopathological Characteristics of Papillary Thyroid Carcinoma between Symptomatic and Asymptomatic Patients with Primary Hyperparathyroidism

“…Despite the high incidence of PTC in PHPT patients, the association between sporadic PHPT and PTC is still controversial. Previous studies demonstrated that most of the PTC foci in PHPT patients were papillary microcarcinoma (PMC), which was consistent with our finding [ 15 , 20 ]. When compared with patients of PTC alone, the concomitant PTC in PHPT patients showed significantly smaller tumor diameters, leading some researchers to believe that the PTC was overdiagnosed in PHPT patients [ 7 , 21 ].…”

“…PTC is the most common type of the malignant thyroid lesions synchronous with PHPT [ 13 – 15 ]. Ogburn and Black were the first to report the concomitant PTC in PHPT patients in 1956 [ 16 ].…”

“…Thus far, more than 500 cases of concomitant PTC in PHPT patients have been reported. The prevalence of PTC in PHPT patients varies from 0.9% to 18.2% due to different variables including country, race, and age [ 15 , 17 ]. The incidence of PTC in Chinese PHPT patients is still unclear.…”

Tissue Engineering - Collagen Matrix Based Flaps - a Simple Construct. Experimental and Theoretical Aspects

“…with Ψ the complex conjugated of Ψ, is implicit and unmanifest, while in the presence of the growth factor it becomes explicit and manifest. For other details, see [22][23][24]; v)we prove that on a fractal medium, the implicit-explicit transition of information implies the fractal type spontaneous breaking symmetry (for general details, see [25][26][27]). Then, a specific calibration becomes functional, calibration which enables a holographic implementation of the interaction entity-fractal medium (for example celltissue).…”