World Journal of Surgery

, Volume 34, Issue 11, pp 2611–2620 | Cite as

Lymph Node Involvement and Surgical Approach in Parathyroid Cancer

  • Klaus-Martin Schulte
  • Nadia Talat
  • John Miell
  • Caje Moniz
  • Prakash Sinha
  • Salvador Diaz-Cano



The best surgical approach to parathyroid cancer is disputed. Recommendations vary and are built on incoherent evidence. High rates of recurrence and death require an in-depth review of underlying findings.


This retrospective study includes 11 patients with parathyroid cancer who underwent surgery with central and/or lateral neck dissection by a single surgeon between 2005 and 2010. The diagnosis was based on histopathological criteria in all patients. Patterns of lymph node and soft tissue involvement of these and formerly reported patients were analysed based on full-text review of all published cases of parathyroid cancer.


In this series only 1 of 11 patients (9.1%) manifested lymph node metastasis. In the literature, lymph node metastases have been reported in only 6.5% of 972 published patients, or in 32.1% of the 196 in whom lymph node involvement was assessed by the authors. They were, with few exceptions, localised in the central compartment. Recurrence in soft tissue is more frequent than in locoregional lymph nodes.


Oncological en bloc clearance of the central compartment with meticulous removal of all possibly involved soft tissues, including a systematic central lymph node resection, may improve outcomes and should be included in the routine approach to the suspicious parathyroid lesion. There is no need for a prophylactic lateral neck dissection.



Parathyroid hormone


Corrected serum calcium


Millimoles per litre


Confidence interval


Relative risk


Odds ratio


Tumour node metastasis


  1. 1.
    Talat N, Schulte KM (2010) Clinical presentation, staging and long-term evolution of parathyroid cancer. Ann Surg Oncol 17:2156–2174CrossRefPubMedGoogle Scholar
  2. 2.
    DeLellis RA, Mazzaglia P, Mangray S (2008) Primary hyperparathyroidism: a current perspective. Arch Pathol Lab Med 132(8):1251–1262PubMedGoogle Scholar
  3. 3.
    Wynne AG, van Heerden J, Carney JA et al (1992) Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore) 71(4):197–205Google Scholar
  4. 4.
    Okamoto T, Iihara M, Obara T et al (2009) Parathyroid carcinoma: etiology, diagnosis, and treatment. World J Surg 33:2343–2354CrossRefPubMedGoogle Scholar
  5. 5.
    Holmes EC, Morton DL, Ketcham AS (1969) Parathyroid carcinoma: a collective review. Ann Surg 169(4):631–640CrossRefPubMedGoogle Scholar
  6. 6.
    Clayman GL, Gonzalez HE, El-Naggar A et al (2004) Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer 100(5):900–905CrossRefPubMedGoogle Scholar
  7. 7.
    Obara T, Okamoto T, Kanbe M et al (1997) Functioning parathyroid carcinoma: clinicopathologic features and rational treatment. Semin Surg Oncol 13(2):134–141CrossRefPubMedGoogle Scholar
  8. 8.
    Rao SR, Shaha AR, Singh B et al (2002) Management of cancer of the parathyroid. Acta Otolaryngol 122(4):448–452CrossRefPubMedGoogle Scholar
  9. 9.
    Koea JB, Shaw JH (1999) Parathyroid cancer: biology and management. Surg Oncol 8(3):155–165CrossRefPubMedGoogle Scholar
  10. 10.
    Rodgers SE, Perrier ND (2006) Parathyroid carcinoma. Curr Opin Oncol 18(1):16–22CrossRefPubMedGoogle Scholar
  11. 11.
    Kulkarni PS, Parikh PM (2004) The carcinoma of parathyroid gland. Indian J Cancer 41(2):51–59PubMedGoogle Scholar
  12. 12.
    Fujimoto Y, Obara T (1987) How to recognize and treat parathyroid carcinoma. Surg Clin North Am 67(2):343–357PubMedGoogle Scholar
  13. 13.
    Shane E (2001) Parathyroid carcinoma. J Clin Endocrinol Metab 86(2):485–493CrossRefPubMedGoogle Scholar
  14. 14.
    Aldinger KA, Hickey RC, Ibanez ML et al (1982) Parathyroid carcinoma: a clinical study of seven cases of functioning and two cases of nonfunctioning parathyroid cancer. Cancer 49(2):388–397CrossRefPubMedGoogle Scholar
  15. 15.
    Obara T, Fujimoto Y (1991) Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 15(6):738–744CrossRefPubMedGoogle Scholar
  16. 16.
    Rawat N, Khetan N, Williams DW et al (2005) Parathyroid carcinoma. Br J Surg 92(11):1345–1353CrossRefPubMedGoogle Scholar
  17. 17.
    Wang CA, Gaz RD (1985) Natural history of parathyroid carcinoma. Diagnosis, treatment, and results. Am J Surg 149(4):522–527CrossRefPubMedGoogle Scholar
  18. 18.
    Anderson BJ, Samaan NA, Vassilopoulou-Sellin R et al (1983) Parathyroid carcinoma: features and difficulties in diagnosis and management. Surgery 94(6):906–915PubMedGoogle Scholar
  19. 19.
    Sandelin K, Auer G, Bondeson L et al (1992) Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16(4):724–731CrossRefPubMedGoogle Scholar
  20. 20.
    Levin KE, Galante M, Clark OH (1987) Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 101(6):649–660PubMedGoogle Scholar
  21. 21.
    Iihara M, Okamoto T, Suzuki R et al (2007) Functional parathyroid carcinoma: long-term treatment outcome and risk factor analysis. Surgery 142(6):936–943, discussion 943 e1CrossRefPubMedGoogle Scholar
  22. 22.
    Cohn K, Silverman M, Corrado J et al (1985) Parathyroid carcinoma: the Lahey Clinic experience. Surgery 98(6):1095–1100PubMedGoogle Scholar
  23. 23.
    Jarman WT, Myers RT, Marshall RB (1978) Carcinoma of the parathyroid. Arch Surg 113(2):123–125PubMedGoogle Scholar
  24. 24.
    Fujimoto Y, Obara T, Ito Y et al (1986) Localization and surgical resection of metastatic parathyroid carcinoma. World J Surg 10(4):539–547CrossRefPubMedGoogle Scholar
  25. 25.
    Flye MW, Brennan MF (1981) Surgical resection of metastatic parathyroid carcinoma. Ann Surg 193(4):425–435CrossRefPubMedGoogle Scholar
  26. 26.
    Masson EA, MacFarlane IA, Bodmer CW et al (1993) Parathyroid carcinoma presenting with a brown tumour of the mandible in a young man. Br J Oral Maxillofac Surg 31(2):117–119CrossRefPubMedGoogle Scholar
  27. 27.
    Kirkby-Bott J, Lewis P, Harmer CL et al (2005) One stage treatment of parathyroid cancer. Eur J Surg Oncol 31(1):78–83CrossRefPubMedGoogle Scholar
  28. 28.
    Cheah WK, Rauff A, Lee KO et al (2005) Parathyroid carcinoma: a case series. Ann Acad Med Singapore 34(7):443–446PubMedGoogle Scholar
  29. 29.
    Munson ND, Foote RL, Northcutt RC et al (2003) Parathyroid carcinoma: is there a role for adjuvant radiation therapy? Cancer 98(11):2378–2384CrossRefPubMedGoogle Scholar
  30. 30.
    Chow E, Tsang RW, Brierley JD et al (1998) Parathyroid carcinoma—the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys 41(3):569–572CrossRefPubMedGoogle Scholar
  31. 31.
    Ou HY, Hung CJ, Hsu WH et al (2003) Variability of clinical presentations in three cases of parathyroid carcinoma. J Formos Med Assoc 102(4):266–269PubMedGoogle Scholar
  32. 32.
    Bhansali A, Kataria RN, Dutta P et al (2002) Parathyroid carcinoma: difficult management options. Indian J Cancer 39(3):119–122PubMedGoogle Scholar
  33. 33.
    Busaidy NL, Jimenez C, Habra MA et al (2004) Parathyroid carcinoma: a 22-year experience. Head Neck 26(8):716–726CrossRefPubMedGoogle Scholar
  34. 34.
    Fujimoto Y, Obara T, Ito Y et al (1984) Surgical treatment of ten cases of parathyroid carcinoma: importance of an initial en bloc tumor resection. World J Surg 8(3):392–400CrossRefPubMedGoogle Scholar
  35. 35.
    Kameyama K, DeLellis RA, Lloyd RV et al (2002) Parathyroid carcinomas: can clinical outcomes for parathyroid carcinomas be determined by histologic evaluation alone? Endocr Pathol 13(2):135–139CrossRefPubMedGoogle Scholar
  36. 36.
    Aso Y, Sato A, Tayama K et al (1996) Parathyroid carcinoma with metastatic calcification identified by technetium-99 m methylene diphosphonate scintigraphy. Intern Med 35(5):392–395CrossRefPubMedGoogle Scholar
  37. 37.
    McKeown PP, McGarity WC, Sewell CW (1984) Carcinoma of the parathyroid-gland—is it over-diagnosed?—a report of 3 cases. Am J Surg 147(2):292–298CrossRefPubMedGoogle Scholar
  38. 38.
    Au WY (1975) Calcitonin treatment of hypercalcemia due to parathyroid carcinoma. Synergistic effect of prednisone on long-term treatment of hypercalcemia. Arch Intern Med 135(12):1594–1597CrossRefPubMedGoogle Scholar
  39. 39.
    Vetto JT, Brennan MF, Woodruf J et al (1993) Parathyroid carcinoma: diagnosis and clinical history. Surgery 114(5):882–892PubMedGoogle Scholar
  40. 40.
    Black BK (1954) Carcinoma of the parathyroid. Ann Surg 139(3):355–363CrossRefPubMedGoogle Scholar
  41. 41.
    Saunders KB, Richardson J (1970) Carcinoma of the parathyroid. Proc R Soc Med 63(5):453–454PubMedGoogle Scholar
  42. 42.
    Sandelin K, Thompson NW, Bondeson L (1991) Metastatic parathyroid carcinoma: dilemmas in management. Surgery 110(6):978–986 discussion 986-988PubMedGoogle Scholar
  43. 43.
    Barnes AD (1984) The changing face of parathyroid surgery. Ann R Coll Surg Engl 66(2):77–80PubMedGoogle Scholar
  44. 44.
    Ehrlich A, McDonald J, Zitani A Jr (1961) Carcinoma of the parathyroid with hyperparathyroidism and metastases. JAMA 176:453–455PubMedGoogle Scholar
  45. 45.
    de Papp AE, Kinder B, LiVolsi V et al (1994) Parathyroid carcinoma arising from parathyroid hyperplasia: autoinfarction following intravenous treatment with pamidronate. Am J Med 97(4):399–400CrossRefPubMedGoogle Scholar
  46. 46.
    de la Garza S, de la Flores Garza E, Hernandez Batres F (1985) Functional parathyroid carcinoma cytology, histology, and ultrastructure of a case. Diagn Cytopathol 1(3):232–235CrossRefPubMedGoogle Scholar
  47. 47.
    Solorzano CC, Carneiro-Pla DM, Lew JI et al (2007) Intra-operative parathyroid hormone monitoring in patients with parathyroid cancer. Ann Surg Oncol 14(11):3216–3222CrossRefPubMedGoogle Scholar
  48. 48.
    Neumann DR, Esselstyn CB, Kim EY (1996) Recurrent postoperative parathyroid carcinoma: FDG-PET and sestamibi-SPECT findings. J Nucl Med 37(12):2000–2001PubMedGoogle Scholar
  49. 49.
    Dotzenrath C, Goretzki PE, Sarbia M et al (2001) Parathyroid carcinoma: problems in diagnosis and the need for radical surgery even in recurrent disease. Eur J Surg Oncol 27(4):383–389CrossRefPubMedGoogle Scholar
  50. 50.
    Ito Y, Iwase H, Tanaka H et al (2001) Metachronous primary hyperparathyroidism due to a parathyroid adenoma and a subsequent carcinoma: report of a case. Surg Today 31(10):895–898CrossRefPubMedGoogle Scholar
  51. 51.
    Obara T, Okamoto T, Ito Y et al (1993) Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 114(6):1040–1048, discussion 1048-1049PubMedGoogle Scholar
  52. 52.
    Davies DR, Dent CE, Ives DR (1973) Successful removal of single metastasis in recurrent parathyroid carcinoma. Br Med J 1(5850):397–398CrossRefPubMedGoogle Scholar
  53. 53.
    Weinstein RS (1991) Parathyroid carcinoma associated with polycythemia vera. Bone 12(4):237–239CrossRefPubMedGoogle Scholar
  54. 54.
    Rufener JB, Cohen JI (2003) Metachronous spread of parathyroid carcinoma to a retropharyngeal lymph node. Head Neck 25(11):968–971CrossRefPubMedGoogle Scholar
  55. 55.
    Pollack S, Goldin RR, Cohen M (1961) Parathyroid carcinoma. A report of two cases and a review of the literature. Arch Intern Med 108:583–587PubMedGoogle Scholar
  56. 56.
    Caley JP, Jones EE, Collins DH (1962) Fatal recurrence of parathyroid carcinoma after seven years. J Clin Pathol 15:438–445CrossRefPubMedGoogle Scholar
  57. 57.
    Placzkowski K, Christian R, Chen H (2007) Radioguided parathyroidectomy for recurrent parathyroid cancer. Clin Nucl Med 32(5):358–360CrossRefPubMedGoogle Scholar
  58. 58.
    Qvist N, Krøll L, Ladefoged C et al (1986) Parathyroid carcinoma: a case with recurrence treated with extensive vascular surgery to the neck. Eur J Surg Oncol 12(2):187–191PubMedGoogle Scholar
  59. 59.
    Sheehan JJ, Hill AD, Walsh MF et al (2001) Parathyroid carcinoma: diagnosis and management. Eur J Surg Oncol 27(3):321–324CrossRefPubMedGoogle Scholar
  60. 60.
    Dubost C, Jehanno C, Lavergne A et al (1984) Successful resection of intrathoracic metastases from two patients with parathyroid carcinoma. World J Surg 8(4):547–551CrossRefPubMedGoogle Scholar
  61. 61.
    Hundahl SA, Fleming ID, Fremgen AM et al (1999) Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86(3):538–544CrossRefPubMedGoogle Scholar
  62. 62.
    Kebebew E, Arici C, Duh QY et al (2001) Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg 136(8):878–885CrossRefPubMedGoogle Scholar
  63. 63.
    Cordeiro AC, Montenegro FL, Kulcsar MA et al (1998) Parathyroid carcinoma. Am J Surg 175(1):52–55CrossRefPubMedGoogle Scholar
  64. 64.
    Ippolito G, Palazzo FF, Sebag F et al (2007) Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenoma. Br J Surg 94(5):566–570CrossRefPubMedGoogle Scholar
  65. 65.
    Fernandez-Ranvier GG, Khanafshar E, Jensen K et al (2007) Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis? Cancer 110(2):255–264CrossRefPubMedGoogle Scholar
  66. 66.
    Lee PK, Jarosek SL, Virnig BA et al (2007) Trends in the incidence and treatment of parathyroid cancer in the United States. Cancer 109(9):1736–1741CrossRefPubMedGoogle Scholar
  67. 67.
    Agarwal G, Prasad KK, Kar DK et al (2006) Indian primary hyperparathyroidism patients with parathyroid carcinoma do not differ in clinicoinvestigative characteristics from those with benign parathyroid pathology. World J Surg 30(5):732–742CrossRefPubMedGoogle Scholar
  68. 68.
    Robbins KT, Shaha AR, Medina JE et al (2008) Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 134(5):536–538CrossRefPubMedGoogle Scholar
  69. 69.
    Iacobone M, Lumachi F, Favia G (2004) Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 88(4):223–228CrossRefPubMedGoogle Scholar
  70. 70.
    Robert JH, Trombetti A, Garcia A et al (2005) Primary hyperparathyroidism: can parathyroid carcinoma be anticipated on clinical and biochemical grounds? Report of nine cases and review of the literature. Ann Surg Oncol 12(7):526–532CrossRefPubMedGoogle Scholar
  71. 71.
    Sadowski BM, Snyder SK, Lairmore TC (2009) Routine bilateral central lymph node clearance for papillary thyroid cancer. Surgery 146(4):696–703, discussion 703–705CrossRefPubMedGoogle Scholar
  72. 72.
    Alvarado R, Sywak MS, Delbridge L et al (2009) Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery 145(5):514–518CrossRefPubMedGoogle Scholar
  73. 73.
    Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95(1):14–21PubMedGoogle Scholar
  74. 74.
    Wang C (1976) The anatomic basis of parathyroid surgery. Ann Surg 183(3):271–275CrossRefPubMedGoogle Scholar
  75. 75.
    Dixon E, McKinnon JG, Pasieka JL (2000) Feasibility of sentinel lymph node biopsy and lymphatic mapping in nodular thyroid neoplasms. World J Surg 24(11):1396–1401CrossRefPubMedGoogle Scholar
  76. 76.
    Nobori M, Saiki S, Tanaka N et al (1994) Blood supply of the parathyroid gland from the superior thyroid artery. Surgery 115(4):417–423PubMedGoogle Scholar
  77. 77.
    Machens A, Holzhausen HJ, Dralle H (2004) Skip metastases in thyroid cancer leaping the central lymph node compartment. Arch Surg 139(1):43–45CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Klaus-Martin Schulte
    • 1
  • Nadia Talat
    • 1
  • John Miell
    • 4
  • Caje Moniz
    • 2
  • Prakash Sinha
    • 5
  • Salvador Diaz-Cano
    • 3
  1. 1.Department of Endocrine SurgeryKing’s College Hospital, King’s Health PartnersLondonUK
  2. 2.Department of Clinical ChemistryKing’s College Hospital, King’s Health PartnersLondonUK
  3. 3.Department of PathologyKing’s College Hospital, King’s Health PartnersLondonUK
  4. 4.Department of EndocrinologyUniversity Hospital LewishamLewishamUK
  5. 5.Department of SurgeryPrincess Royal University Hospital BromleyKentUK

Personalised recommendations