Multiple Metastases of Parathyroid and Papillary Thyroid Carcinoma in a Female Patient Treated with Long-Term Hemodialysis

Abstract

Parathyroid cancer is a rare, clinically aggressive malignancy with a prevalence of approximately 0.005% relative to all carcinoma cases and 1–5% among patients with primary hyperparathyroidism. Prognosis largely depends on the extent of the primary surgery. Non-radical surgical treatment increases the risk of local and distant metastases of the parathyroid cancer associated with limited treatment options. The combination of thyroid and parathyroid disorders has been described rather well for the general population; however, cases of parathyroid and thyroid carcinoma in the same patient are extremely rare (1 case per 3000 patients with parathyroid disorders). We present a rare clinical case of combination of parathyroid and thyroid cancers with metastases of both tumors to the neck lymph nodes in a woman with a mutation in the MEN1 gene (NM_130799.2): c.658T > C p.Trp220Arg (W220R), who has been exposed to radiation for 20 years before diagnosis of thyroid cancer and received renal replacement therapy with long-term hemodialysis before the diagnosis of parathyroid cancer. The patient underwent several surgeries because of metastases of the parathyroid cancer in the neck lymph nodes. Surgeons used intraoperative navigation methods (single-channel gamma detection probe, Gamma Probe 2, and fluorescence angiography with indocyanine green (ICG)) to clarify the volume of surgery. Currently, the patient is still in laboratory remission, despite the structural recurrence of tumors.

Case report: Sagliker syndrome in the patient with recurrent tertiary hyperparathyroidism due to intrathyroidal parathyroid carcinoma

“…A total of 37 cases of PC associated with SHPT or THPT have been reported in English-language literature. Recent reports have suggested a possible relationship between long-term SHPT and malignant parathyroid cell transformation due to their hyperstimulation (33). Notably, nearly 3% of PCs were found in patients on hemodialysis (34).…”

Combination approach for CDC73-related parathyroid carcinoma in an adolescent female patient: a case report and literature review

“…Several cases of PC have been reported in patients with a history of neck irradiation and end-stage renal disease. 4 There is a hypothesis that the carcinoma may originate from long-term adenoma or a hyperplastic PTG, though the potential for such malignant transformation remains questionable. Another form of PC is familial, which can occur in hyperparathyroidism-jaw tumor syndrome (HPT-JT) and familial isolated PHPT, single cases have been described in multiple endocrine neoplasia type 1 and 2A (MEN1 and MEN 2A).…”