Parathyroid carcinoma: A review

Abstract

Background. Parathyroid carcinoma is a rare entity, comprising fewer than 1% of cases of hyperparathyroidism. The disease generally presents with severe hyperparathyroidism and occasionally with vocal cord paralysis or a firm palpable cervical mass.Methods. The classic histopathologic features of trabecular pattern, mitotic figures, thick fibrous bands, and capsular and vascular invasion are not present in every case but are useful in assessing whether a particular hyperfunctional parathyroid lesion is a carcinoma. Nevertheless, recognition of malignancy at initial operation may be difficult. Management primarily involves complete surgical removal through en bloc resection, which may include adjacent central neck structures.Results. Adjuvant radiation therapy has not been proven to be uniformly effective, but several series show results suggestive of a possible survival advantage. Chemotherapy, genetic, and other biomodifying agents remain experimental. Long-term outcome for this neoplasm remains problematic, and complications from intractable hypercalcemia constitute the foremost cause of death. Reported 5-year survivals have ranged between 70% and 85%.Conclusions. Initial surgical success offers the greatest opportunity for cure. Reoperation for recurrence offers the potential for short-and intermediate-term relief from the sequelae of hypercalcemia, but rarely results in cure. Severely elevated calcium levels should be controlled before initial surgery, and much of the treatment for recurrent or persistent disease, including reoperative surgery, is directed at control of hypercalcemia.

Non-functional parathyroid carcinoma: a case report and review of the literature

“…49 However, FNA biopsy maybe used to distinguish thyroid from parathyroid tissue or to identify metastatic parathyroid carcinoma. 50 Frozen section analysis is of little value and unreliable because the histopathological features of parathyroid carcinoma may overlap with those of parathyroid adenoma. 40 During our operation, the frozen section analysis of resected material indicated rare malignant cells, and medullary thyroid carcinoma was considered for the following reasons: 1)non-functional parathyroid carcinoma is a rare malignant endocrine cancer, 2)patients have a history of thyroid adenoma, and 3)non-functioning parathyroid carcinoma and medullary thyroid cancer are both endocrine tumors and have similar pathology…”

“…60 Among these surgical treatments, en bloc resection of the carcinoma and the adjacent involved structures is the standard treatment for parathyroid carcinoma. 42,50,67 A selective neck dissection is necessary when cervical lymph nodes are involved. There seems to be dispute over the need for prophylactic central compartment lymphadenectomy.…”

Parathyroid carcinoma and oxyphil parathyroid adenoma: an uncommon case of misinterpretation in clinical practice

“…The prognosis of parathyroid carcinoma is extremely variable, depending on early diagnosis and success of the initial surgical procedure. Published data suggest that tumors without major invasion sites are likely to result in patients having a longer disease-free period [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Tumor size has no impact on prognosis and lymph nodes are rarely involved, with a questionable impact on prognosis [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…Furthermore, he had a history of gastric ulcer. There was no family history of primary hyperparathyovoid, with a brown color and yellowish undertones [3][4][5][6][7][12][13][14][15][16][17][18].…”

“…However, metastases to bone, pleura, pericardium and pancreas have been reported. In cases of recurrent disease, it is advisable to perform a neck and chest CT scan and sestamibi scintigraphy [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”