Journal of Endocrinological Investigation

, Volume 31, Issue 10, pp 900–904

Hyperparathyroidism 2 gene (HRPT2, CDC73) and parafibromin studies in two patients with primary hyperparathyroidism and uncertain pathological assessment

  • F. Cetani
  • E. Pardi
  • E. Ambrogini
  • C. Banti
  • P. Viacava
  • S. Borsari
  • J. P. Bilezikian
  • A. Pinchera
  • C. Marcocci
Original Article

DOI: 10.1007/BF03346439

Cite this article as:
Cetani, F., Pardi, E., Ambrogini, E. et al. J Endocrinol Invest (2008) 31: 900. doi:10.1007/BF03346439

Abstract

HRPT2 and parafibromin studies improved the diagnostic accuracy in two patients with primary hyperparathyroidism (PHPT) referred to us after surgery, in whom the clinical data were at variance with the pathological diagnosis of adenoma and carcinoma, respectively. Patients were referred to us after parathyroidectomy. Patient #1 had had a 1.5-cm tumor easily removed with a histological diagnosis of parathyroid carcinoma and normocalcemia for 2 years. Re-examination of the histology showed no cardinal signs of parathyroid cancer. Patient #2, with severe PHPT, had had the removal of a 3.5-cm tumor described histologically as adenoma. Ten years later PHPT recurred and persisted despite removal of two mildly enlarged parathyroid glands that were histologically normal. Re-review of the initial histology showed a trabecular pattern, fibrous bands, and atypical mitoses, suggesting an atypical adenoma. Because of the suspicion that case #1 could be an atypical adenoma and case #2 a carcinoma further molecular studies were performed. No HRPT2 and parafibromin abnormalities were identified in patient #1, strongly indicating a benign lesion. In patient #2, an HRPT2 germline mutation was found (E115X in exon 4) and associated with no parafibromin staining. These data, together with the clinical features, supported the suspicion of a parathyroid carcinoma that was confirmed by histological examination of further slides of the tumor, showing capsular and vascular invasion. A lung 1.5-cm nodule detected by computed tomography was excised. Histology showed a metastasis of parathyroid carcinoma. HRPT2 gene studies improved the diagnostic accuracy in 2 parathyroid tumors that are of uncertain type.

Key-words

Atypical parathyroid adenomaHRPT2parafibrominparathyroid carcinomaprimary hyperparathyroidism

Copyright information

© Italian Society of Endocrinology (SIE) 2008

Authors and Affiliations

  • F. Cetani
    • 1
  • E. Pardi
    • 1
  • E. Ambrogini
    • 1
  • C. Banti
    • 1
  • P. Viacava
    • 2
  • S. Borsari
    • 1
  • J. P. Bilezikian
    • 3
  • A. Pinchera
    • 1
  • C. Marcocci
    • 1
  1. 1.Departments of EndocrinologyUniversity of PisaPisaItaly
  2. 2.Oncology (Section of Pathology)University of PisaPisaItaly
  3. 3.Department of Medicine and PharmacologyColumbia University College of Physicians & SurgeonsNew YorkUSA