Correlation Between Clinical and Histological Findings in Parathyroid Tumors Suspicious for Carcinoma

Chang, Yeon-Jeen; Mittal, Vijay; Remine, Stephen; Manyam, Harish; Sabir, Mubashir; Richardson, Todd; Young, Shun
May 2006
American Surgeon;May2006, Vol. 72 Issue 5, p419
Academic Journal
Carcinoma of the parathyroid is a rare malignancy that can be cured surgically if the proper diagnosis and treatment is given initially. Arriving to the clinical suspicion of a malignancy preoperatively is by far the most important step for a good prognosis. Our goal is to review the correlation between clinical and final histopathological findings that can arouse the suspicion of such malignancy and their true predictive value in the diagnosis. All patients that underwent surgical removal of the parathyroid mass between March of 1992 and March of 2003 were reviewed retrospectively at Providence Hospital and Medical Centers. Among 168 patients who underwent parathyroid excision, 14 (8.3%) had hyperplasia of the parathyroid, 121 (72%) had benign adenoma, 25 (14.8%) had other benign lesions, and 8 (4.7%) patients had primary carcinoma of the parathyroid confirmed by pathology. Our mean serum calcium level was 11.57 mg/dL, which was lower than the mean level (12 mg/dL) for benign hyperparathyroidism. The mean tumor size was 2.18 cm, smaller than the proposed for malignant criteria, and none of the eight patients (0%) had any symptoms of hypercalcemia at the time of diagnosis. Seven of eight patients (87.5%) had frank signs of invasion together with other histological features, and two patients had associated papillary carcinoma of the thyroid. Five patients from our series did not meet clinical criteria for malignancy (tumor size > 3 cm, palpable mass, and serum calcium > 14 mg/dL), but had undisputable histological findings (high mitotic pattern, fibrous trabeculae, capsular invasion, vascular invasion, and nodular involvement). On the other hand, 17 patients with benign histology had tumors greater than 3 cm, and an additional 18 had palpable masses on physical examination. We believe that these patients need to be followed closely. The patients with diagnosis of parathyroid carcinoma, their kindred, and those with large adenomas may benefit from genetic screening for HRTP2 gene mutations in search of early detection of tumors suspicious for malignancy. This is based on the fact that we did not find correlation between the clinical presentation and the histological features in our patients with proven malignancy.


Related Articles

  • Cancer of ectopic parathyroid gland presentation of the disease with a case report. Pesovic, Jovan P.; Milosevic, Bojan Z.; Canovic, Dragan S.; Cvetkovic, Aleksandar M.; Milosavljevic, Milos Z.; Jevdjic, Jasna D.; Pavlovic, Mladen D.; Petrovic, Marko D. // International Journal of Clinical & Experimental Medicine;2013, Vol. 6 Issue 3, p227 

    Tc-99m-methoxyisobutylisonitril (MIBI) scintigraphy is localizing diagnostic methods that is used for detection of sicken parathyroid gland (PT). The use of this method for PT diseases diagnosis makes surgical treatment of a patient more successful. This is a report about the patient who was...

  • Lipohyperplasia of the parathyroid glands. Carter, John M.; Landry, April; Hinni, Michael // ENT: Ear, Nose & Throat Journal;Oct2012, Vol. 91 Issue 10, p441 

    Parathyroid lipohyperplasia is an extremely rare cause of hyperparathyroidism. According to a MEDLINE search, there have been only 9 previously reported cases of parathyroid lipohyperplasia in the English-language literature. We report a new case of parathyroid lipohyperplasia, with a brief...

  • Primary hyperparathyroidism, C-cell hyperplasia and papillary thyroid carcinoma in a patient with RET germline polymorphism S836S. Brauckhoff, Michael; Gimm, Oliver; Bilkenroth, Udo; Hinze, Raoul; Dralle, Henning // Langenbeck's Archives of Surgery;Oct2002, Vol. 387 Issue 5/6, p201 

    Background. In most examined populations the RET germline polymorphism S836S is found in about 3.6% of the normal population but in about 9% of patients suffering from sporadic C-cell hyperplasia or medullary thyroid carcinoma. The polymorphism S836S is thought to be involved in the development...

  • Surgical diagnosis and treatment of primary hyperparathyroidism: analysis of 19 cases. Bo Gao; Yan Jiang; Shu Zhang; Lingji Guo; Wuguo Tian; Yayuan Wen; Yujun He; Donglin Luo // International Journal of Clinical & Experimental Medicine;2015, Vol. 8 Issue 6, p9512 

    This study was to discuss the surgical diagnosis and treatment experience of primary hyperparathyroidism. Clinical data of 19 primary hyperparathyroidism patients who were treated surgically in our department from Jan. 2005 to Jul. 2014 were retrospectively analyzed. Besides, general data,...

  • Synchronous Sporadic Carcinoma and Primary Hyperplasia of the Parathyroid Glands: A Case Report and Review of the Literature. Sinha, S.; Sinha, A.; McPherson, G. A. D. // International Journal of Surgical Pathology;Oct2006, Vol. 14 Issue 4, p336 

    Parathyroid carcinoma is the least common endocrine malignancy. Although it has been noted to be associated with certain clinical factors, such as familial hyperparathyroidism, its etiology remains unknown. In rare instances, particularly in patients with chronic renal failure, it has been...

  • Synchronous Thyroid/Parathyroid Carcinomas. Amodi, Hosam; Makki, Fawaz M.; Taylor, S. Mark; Bullock, Martin J.; Hart, Robert D.; Trites, Jonathan R. // Journal of Otolaryngology -- Head & Neck Surgery;Oct2010, Vol. 39 Issue 5, pE42 

    The article presents a case study of a 48 year old woman who was referred to the otolaryngology clinic with primary hyperparathyroidism and mandibular lesions. A discussion of diagnostic testing which was conducted on the patient and resulted in a diagnosis of synchronous thyroid and parathyroid...

  • Parathyroid carcinoma: Diagnosis and management. Vazquez-Quintana, Enrique // American Surgeon;Nov1997, Vol. 63 Issue 11, p954 

    Presents a case of a patient with severe hypercalcemia and a palpable neck mass. Diagnosis of the severe hypercalcemia; Its management; Criteria for malignancy; Most common cause of hypercalcemia in nonhospitalized patients.

  • Parathyroid Carcinoma Encountered After Minimally Invasive Focused Parathyroidectomy may not Require Further Radical Surgery. O'Neill, Christine J.; Conan Chan; Symons, James; Learoyd, Diana L.; Sidhu, Stan B.; Delbridge, Leigh W.; Gill, Anthony; Sywak, Mark S. // World Journal of Surgery;Jan2011, Vol. 35 Issue 1, p147 

    Background: Parathyroid carcinoma accounts for <1% of tumors in primary hyperparathyroidism (PHPT). Distinguishing parathyroid malignancy from benign disease is difficult both before and after initial surgery. Despite the improved specificity of a malignant diagnosis with immunohistochemistry...

  • The management of acute parathyroid crisis secondary to parathyroid carcinoma: a case report. Rock, Kathy; Fattah, Nariman; O'Malley, Diarmuid; McDermott, Enda // Journal of Medical Case Reports;2010, Vol. 4 Issue 1, p1 

    Introduction: Hypercalcaemic hyperparathyroid crisis is a rare but life-threatening complication of primary hyperparathyroidism. Parathyroid carcinoma is a rare malignancy with an incidence of 0.5% to 4% of all reported cases of primary hyperparathyroidism. Case presentation: We report the case...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics