Use of a gamma probe to identify and guide resection of recurrent parathyroid carcinoma: Report of a case

Abstract

Parathyroid carcinoma (PC) accounts for less than 0.005% of all cancers and less than 5% of causes of hyperparathyroidism. This tumor is difficult to identify during surgery, which is detrimental to the oncologic results. Surgery is still the main treatment for the primary tumor and to control parathyroid hormone levels after recurrence. We report a case of recurrent parathyroid carcinoma in a 30-year-old man, identified and managed with the use of a gamma probe during surgery. To our knowledge, this is only the second report of a gamma probe being used to guide resection of a recurrent PC. We discuss the diagnosis and treatment, analyzing the current evidence-based literature.

Rak przytarczycy jako przedoperacyjny dylemat diagnostyczny – opis przypadku i przegląd piśmiennictwa

“…In general, the clinical manifestation of the disease is usually more advanced in PC than in benign adenoma [1,4,5,15,16]. Patients with PC often have a palpable neck mass, with an average tumour size of 3.3 cm, markedly elevated PTH (10-fold to 15-fold higher than the normal range) and total calcium levels (above 3.5 mmol/L), laryngeal nerve palsy, peptic ulcer disease, as well as nodal, skeletal and renal involvement [1,16].…”

“…It is the least common endocrine-related malignancy and accounts for less than 1% of all cases of primary hyperparathyroidism [1,2,3,4]. It has been suggested that a palpable neck mass of average size exceeding 3 cm, nodal involvement, a high degree of elevation of parathyroid hormone (PTH) and severe hypercalcemia may be more predictive for PC than parathyroid adenoma, but in clinical practice a wide overlap between benign and malignant tumours has been demonstrated [1].…”