Parafibromin immunohistochemical staining to differentiate parathyroid carcinoma from parathyroid adenoma

Kim, Hee Kyung; Oh, Young Lyun; Kim, Seok-Hyung; Lee, Dong Youn; Kang, Ho‐Cheol; Lee, Ji In; Jang, Hye Won; Hur, Kyu Yeon; Kim, Jae Hyun; Min, Yong Ki; Chung, Jae Hoon; Kim, Sun Wook

doi:10.1002/hed.21716

Cited by 52 publications

(28 citation statements)

References 31 publications

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“…Recently, parafibromin, a protein encoded by the HRPT2. Its expression level is decreased or absent in PC in contrast to PA and PH in which HRPT2 expression is retained [21]. In our case, parafibromin expression was decreased in PC and not in PH, and this finding was consistent with the previous study.…”

supporting

confidence: 93%

Parathyroid carcinoma occurred in two glands in multiple endocrine neoplasia 1: a report on a rare case

et al. 2018

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Abstract. Primary hyperparathyroidism is the most common hormonal manifestation associated with multiple endocrine neoplasia 1 (MEN1). It is generally caused by parathyroid hyperplasia, and parathyroid carcinoma is rare. Here, we report a case of MEN1 with parathyroid carcinoma in two parathyroid glands causing primary hyperparathyroidism. A 40-year-old man with primary hyperparathyroidism due to MEN1 underwent a total parathyroidectomy. His corrected calcium and intact PTH (i-PTH) serum levels were 10.8 mg/dL and 203 pg/mL, respectively. Although three glands were successfully removed, the left upper parathyroid gland could not be detected. Since the right lower parathyroid lesion had invaded into the thyroid, right lobectomy was performed. A portion of the left lower parathyroid tissue was transplanted into his forearm. The histological findings of the left lower and the right upper parathyroid glands were consistent with hyperplasia while that of the right lower parathyroid gland was parathyroid carcinoma. Since the post-surgical i-PTH levels remained high, the intrathyroidal lesion of the left lobe, which was initally diagnosed as an adenomatous nodule, was suspected to contain parathyroid tumor. A fine needle aspiration of the tumor revealed a high concentration of i-PTH. One week after the first surgery, a left thyroid lobectomy was performed. The pathological diagnosis of the tumor was parathyroid carcinoma. After the surgery, calcium and i-PTH levels were normal. Although it is rare, parathyroid carcinoma should be considered as a cause of hyperparathyroidism in MEN1 patients. Since it is difficult to diagnose parathyroid carcinoma before surgery, intraoperative findings are important for the appropriate treatment. nancy that is found in less than 5% of PHPT patients [2]. PC occurs only in 2% of MEN1 patients that have received surgery for PHPT [3] in contrast to the 15% of PC found in hyperparathyroidism-jaw tumor syndrome patients [4]. Here, we report a case of MEN1 with PC causing primary hyperparathyroidism. Case presentationA 40-year-old man was referred for follow up of MEN1. His mother was diagnosed as PHPT due to MEN1, 3 years before by his previous doctor but she had not yet been treated. She also had non-functioning pancreatic tumor, lung cartinoid and was suspected as having prolactinoma as her serum PRL level elavated and pituitary gland swelled. At that time, the previous doctor examined his serum calcium (Ca) and intact-PTH (i-PTH) level and detected hypercalcemia and elevation of

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confidence: 93%

Parathyroid carcinoma occurred in two glands in multiple endocrine neoplasia 1: a report on a rare case

et al. 2018

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“…Diffuse or focal loss of nuclear parafibromin expression by immunohistochemistry has been found in the majority of parathyroid carcinomas but very rarely in parathyroid adenomas. 49,51,52,[64][65][66][67][68][69][70] A recent genome-wide study of DNA methylome from benign and malignant parathyroid tumors identified a number of genes with altered DNA methylation patterns independent of the tumor's nature, suggesting that other genes are involved in parathyroid carcinogenesis. 71 Costa-Guda et al have recently shown that allelic loss at chromosome 11q, the most common alteration in parathyroid adenomas, has never been detected in parathyroid cancers, suggesting that parathyroid malignancy arises de novo, rather than evolving from a pre-existing benign lesion.…”

Section: Pathogenesismentioning

confidence: 98%

Parathyroid Carcinoma

Cetani

Marcocci

2015

The Parathyroids

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“…Histological differences are useful for the differential diagnosis, such as the criteria for malignancy proposed by Schantz and Castleman [4]: 1) the presence of a trabecular growth pattern, mitotic figures, and capsular or vascular invasion; and 2) the presence of nodal or distant metastasis. Recently, loss of parafibromin immunostaining helped with the differential diagnosis of parathyroid carcinomas from adenomas in Asians and may serve as a prognostic marker in patients with parathyroid carcinomas [5]. In our case, the left parathyroid mass exhibited capsular invasion with extension into the adjacent soft tissue and trabeculum, clear cytoplasm, and atypical nuclei with atypical mitoses, suggesting carcinoma.…”

mentioning

confidence: 65%

“…The most effective treatment of parathyroid carcinoma is complete removal of the primary lesion during surgery [1,5]. If patients with benign adenomas or hyperplasia are suspected of having concurrent parathyroid carcinoma, the surgeon should explore all four parathyroid glands.…”

mentioning

confidence: 99%

Concurrent Parathyroid Carcinoma and Hyperplasia in Hyperparathyroidism

Seoung

et al. 2012

Korean J Intern Med

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Parafibromin immunohistochemical staining to differentiate parathyroid carcinoma from parathyroid adenoma

Abstract: Loss of parafibromin immunostating showed promising results in the differential diagnosis of parathyroid carcinoma from adenoma and may also serve as a prognostic marker.

Cited by 52 publications

References 31 publications

Parathyroid carcinoma occurred in two glands in multiple endocrine neoplasia 1: a report on a rare case

Parathyroid carcinoma occurred in two glands in multiple endocrine neoplasia 1: a report on a rare case

Parathyroid Carcinoma

Concurrent Parathyroid Carcinoma and Hyperplasia in Hyperparathyroidism

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