The Clinicopathological Spectrum of Parathyroid Carcinoma
Background: Parathyroid carcinoma is rare, representing <1% of primary hyperparathyroidism cases.Methods: Retrospective data of patients referred for evaluation of parathyroid disease between 2001 and 2018 were reviewed. The goal was to describe the clinical presentation, histopathologic char...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-10-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fendo.2019.00731/full |
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| author | Amit Akirov Amit Akirov Amit Akirov Sylvia L. Asa Vincent Larouche Vincent Larouche Ozgur Mete Anna M. Sawka Raymond Jang Shereen Ezzat |
| author_facet | Amit Akirov Amit Akirov Amit Akirov Sylvia L. Asa Vincent Larouche Vincent Larouche Ozgur Mete Anna M. Sawka Raymond Jang Shereen Ezzat |
| author_sort | Amit Akirov |
| collection | DOAJ |
| description | Background: Parathyroid carcinoma is rare, representing <1% of primary hyperparathyroidism cases.Methods: Retrospective data of patients referred for evaluation of parathyroid disease between 2001 and 2018 were reviewed. The goal was to describe the clinical presentation, histopathologic characteristics, and treatment outcomes of parathyroid carcinoma.Results: We identified 8 cases of parathyroid carcinoma from the outpatient practice of a quaternary care Endocrine Oncology practice in Toronto, Canada. The clinical presentation was as follows: 5/8 cases (62.5%) of symptomatic hypercalcemia and 3/8 cases (37.5%) of a suspicious thyroid nodule. Hypercalcemia was evident in all 7 cases with pre-operative calcium measurements. Histopathologic features included: vascular invasion in 7/8 cases (87.5%) and immunohistochemical loss of either parafibromin, retinoblastoma, or p27 in all 8 cases. Additional treatment included: external beam radiotherapy in 5/8 cases (62.5%), chemotherapy for 2/8 patients (25%), and additional surgery for 3/8 patients (37.5%). Only 2 patients (25%) had long-term remission following surgical treatment, and the others had either persistent (3 patients) or recurrent disease (3 patients). Five patients developed metastatic disease, all involving lung. In one of two patients treated with Sorafenib there was evidence of regression of lung metastases. One patient died of disease progression.Conclusion: In this series of patients with parathyroid carcinoma largely presenting with symptomatic hypercalcemia and angioinvasive disease, only a minority achieved a durable remission. Lung was the most common site of distant metastasis. Surgery led to remission in two cases, but none of the six patients with persistent or recurrent disease ultimately achieved disease remission. |
| first_indexed | 2024-12-11T20:01:46Z |
| format | Article |
| id | doaj.art-e6863d72498c4dc9910dff598b96d3c4 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-11T20:01:46Z |
| publishDate | 2019-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-e6863d72498c4dc9910dff598b96d3c42022-12-22T00:52:31ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922019-10-011010.3389/fendo.2019.00731487685The Clinicopathological Spectrum of Parathyroid CarcinomaAmit Akirov0Amit Akirov1Amit Akirov2Sylvia L. Asa3Vincent Larouche4Vincent Larouche5Ozgur Mete6Anna M. Sawka7Raymond Jang8Shereen Ezzat9Department of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, ON, CanadaInstitute of Endocrinology, Beilinson Hospital, Petach Tikva, IsraelSackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelDepartment of Pathology, University Health Network, University of Toronto, Toronto, ON, CanadaDepartment of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, ON, CanadaDivision of Endocrinology and Metabolism, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, CanadaDepartment of Pathology, University Health Network, University of Toronto, Toronto, ON, CanadaDivision of Endocrinology, University Health Network and University of Toronto, Toronto, ON, CanadaDepartment of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaDepartment of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, ON, CanadaBackground: Parathyroid carcinoma is rare, representing <1% of primary hyperparathyroidism cases.Methods: Retrospective data of patients referred for evaluation of parathyroid disease between 2001 and 2018 were reviewed. The goal was to describe the clinical presentation, histopathologic characteristics, and treatment outcomes of parathyroid carcinoma.Results: We identified 8 cases of parathyroid carcinoma from the outpatient practice of a quaternary care Endocrine Oncology practice in Toronto, Canada. The clinical presentation was as follows: 5/8 cases (62.5%) of symptomatic hypercalcemia and 3/8 cases (37.5%) of a suspicious thyroid nodule. Hypercalcemia was evident in all 7 cases with pre-operative calcium measurements. Histopathologic features included: vascular invasion in 7/8 cases (87.5%) and immunohistochemical loss of either parafibromin, retinoblastoma, or p27 in all 8 cases. Additional treatment included: external beam radiotherapy in 5/8 cases (62.5%), chemotherapy for 2/8 patients (25%), and additional surgery for 3/8 patients (37.5%). Only 2 patients (25%) had long-term remission following surgical treatment, and the others had either persistent (3 patients) or recurrent disease (3 patients). Five patients developed metastatic disease, all involving lung. In one of two patients treated with Sorafenib there was evidence of regression of lung metastases. One patient died of disease progression.Conclusion: In this series of patients with parathyroid carcinoma largely presenting with symptomatic hypercalcemia and angioinvasive disease, only a minority achieved a durable remission. Lung was the most common site of distant metastasis. Surgery led to remission in two cases, but none of the six patients with persistent or recurrent disease ultimately achieved disease remission.https://www.frontiersin.org/article/10.3389/fendo.2019.00731/fullhyperparathyroidismparathyroid carcinomathyroid noduleparathyroidectomyparathyroid diseaseEndocrine Oncology |
| spellingShingle | Amit Akirov Amit Akirov Amit Akirov Sylvia L. Asa Vincent Larouche Vincent Larouche Ozgur Mete Anna M. Sawka Raymond Jang Shereen Ezzat The Clinicopathological Spectrum of Parathyroid Carcinoma Frontiers in Endocrinology hyperparathyroidism parathyroid carcinoma thyroid nodule parathyroidectomy parathyroid disease Endocrine Oncology |
| title | The Clinicopathological Spectrum of Parathyroid Carcinoma |
| title_full | The Clinicopathological Spectrum of Parathyroid Carcinoma |
| title_fullStr | The Clinicopathological Spectrum of Parathyroid Carcinoma |
| title_full_unstemmed | The Clinicopathological Spectrum of Parathyroid Carcinoma |
| title_short | The Clinicopathological Spectrum of Parathyroid Carcinoma |
| title_sort | clinicopathological spectrum of parathyroid carcinoma |
| topic | hyperparathyroidism parathyroid carcinoma thyroid nodule parathyroidectomy parathyroid disease Endocrine Oncology |
| url | https://www.frontiersin.org/article/10.3389/fendo.2019.00731/full |
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