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Hormones

, Volume 11, Issue 3, pp 368–376 | Cite as

Parathyroid carcinoma as a challenging diagnosis: Report of three cases

  • Alfredo Campennì
  • Rosaria Maddalena Ruggeri
  • Alessandro Sindoni
  • Salvatore Giovinazzo
  • Letterio Calbo
  • Antonio Ieni
  • Maurizio Monaco
  • Giovanni Tuccari
  • Salvatore Benvenga
  • Sergio Baldari
Case report

Abstract

Parathyroid carcinoma (PC) is a rare malignancy with an indolent but progressive course. This rare tumour is often difficult to diagnose preoperatively, thus limiting the efficacy of surgery. As long-term survival is largely dependent on the extent of the primary surgical resection, it is of great importance to consider PC in the differential diagnosis of hyperparathyroidism. We herein report three PC patients with different clinical histories who were followed up at our hospital for over a 5-year period, emphasizing the variability in clinical presentation of this rare tumour. Moreover, NORA (Nucleolar Organizer Regions, a standardised silver-stain, marker of proliferation rate) values encountered in these PC patients confirm that AgNOR analysis may be regarded as an additional tool when the pathologist encounters difficulties in defining parathyroid lesions which are not clearly benign.

Key words

AgNOR Hypercalcemia Ki-67 Parathyroid carcinoma Primary hyperparathyroidism 

References

  1. 1.
    Shane E, 2001 Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86: 485–493.CrossRefGoogle Scholar
  2. 2.
    Mittendorf EA, McHenry CR, 2005 Parathyroid carcinoma. J Surg Oncol 89: 136–142.CrossRefGoogle Scholar
  3. 3.
    Marcocci C, Cetani F, Rubin MR, Silverberg SJ, Pinchera A, Bilezikian JP, 2008 Parathyroid carcinoma. J Bone Min Res 23: 1868–1880.CrossRefGoogle Scholar
  4. 4.
    Hundahl SA, Fleming ID, Fremgen AM, Menck HR, 1999 Two hundred eighty-six cases of parathyroid carcinoma treated in the U.. between 1985–1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86: 538–544.PubMedGoogle Scholar
  5. 5.
    Witteveen JE, Haak HR, Kievit J, Morreau H, Romijn JA, Hamdy NA, 2010 Challenges and Pitfalls in the Management of Parathyroid Carcinoma: 17-Year Follow-Up of a Case and Review of the Literature. Horm Cancer 1: 205–214.CrossRefGoogle Scholar
  6. 6.
    Talat N, Schulte KM, 2010 Clinical Presentation, Staging and Long-Term Evolution of Parathyroid Cancer. Ann Surg Oncol 17: 2156–2174.CrossRefGoogle Scholar
  7. 7.
    Fernandez-Ranvier GG, Khanafshar E, Jensen K, et al, 2007 Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis? Cancer 110: 255–264.CrossRefGoogle Scholar
  8. 8.
    Sundelin K, Tullgren O, Farnebo LO, 1994 Clinical course of metastatic parathyroid cancer. World J Surg 18: 594–598.CrossRefGoogle Scholar
  9. 9.
    Koea JB, Shaw JH, 1999 Parathyroid cancer: Biology and management. Surg Onc 8: 155–165.CrossRefGoogle Scholar
  10. 10.
    Tuccari G, Abbona GC, Giuffrè G, et al, 2000 AgNOR quantity as a prognostic tool in hyperplastic and neo-plastic parathyroid glands. Virchows Arch 437: 298–303.CrossRefGoogle Scholar
  11. 11.
    Favia G, Lumachi F, Polistina F, D’Amico DF, 1998 Parathyroid carcinoma: sixteen new cases and suggestions for correct management. World J Surg 22: 1225–1230.CrossRefGoogle Scholar
  12. 12.
    Obara T, Fujimoto Y, 1991 Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 15: 738–744.CrossRefGoogle Scholar
  13. 13.
    Obara T, Okamoto T, Kanbe M, Iihara M, 1997 Functioning parathyroid carcinoma: clinicopathologic features and rational treatment. Semin Surg Oncol 13: 134–141.CrossRefGoogle Scholar
  14. 14.
    Levin KE, Galante M, Clark OH, 1987 Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 101: 649–660.PubMedGoogle Scholar
  15. 15.
    Campennì A, Ruggeri RM, Sindoni A, et al, 2012 Parathyroid carcinoma presenting as normocalcemic hyper-parathyroidism. J Bone Mineral Metab 30: 367–372.CrossRefGoogle Scholar
  16. 16.
    Wheeler MH, Williams ED, Wade JSH, 1987 The hyper-functioning intrathyroidal parathyroid gland: A potential pitfall in parathyroid surgery. World J Surg 11: 110–114.CrossRefGoogle Scholar
  17. 17.
    Crescenzo DG, Shabahnag M, Garvin, Evans SRT, 1998 Intrathyroidal Parathyroid Cancer Presenting as a Left Neck Mass. Thyroid 8: 597–599.CrossRefGoogle Scholar
  18. 18.
    Schmidt JL, Perry RC, Philippsen LP, Wu HH, 2002 Intrathyroidal parathyroid carcinoma presenting with only hypercalcemia. Otolaryngol Head Neck Surg 127: 352–353.CrossRefGoogle Scholar
  19. 19.
    Foppiani L, Del Monte P, Sartini G, et al, 2007 Intrathyroidal parathyroid carcinoma as cause of hypercalcemia and pitfall of localization techniques: clinical and biologic features. Endocr Pract 13: 176–181.CrossRefGoogle Scholar
  20. 20.
    Kruljac I, Pavic I, Matesa N, et al, 2011 Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls. Jpn J Clin Oncol 41: 1142–1146.CrossRefGoogle Scholar
  21. 21.
    DeLellis RA 2006 Parathyroid carcinoma. In: R.A. DeLellis, R.V. Lloyd, P.U. Heitz, and C. Eng, Eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Endocrine Organs. IARC Press, Lyon, France.Google Scholar
  22. 22.
    Schantz A, Castleman B, 1973 Parathyroid carcinoma: a study of 70 cases. Cancer 31: 600–605.CrossRefGoogle Scholar
  23. 23.
    Bondeson L, Sandelin K, Grimelius L, 1993 Histopathological variables and DNA cytometry in parathyroid carcinoma. Am J Surgical Pathol 17: 820–829.CrossRefGoogle Scholar
  24. 24.
    Juhlin CC, Villablanca A, Sandelin K, et al, 2007 Parafibromin immunoreactivity: Its use as an additional diagnostic marker for parathyroid tumor classification. Endocr Relat Cancer 14: 501–512.CrossRefGoogle Scholar
  25. 25.
    Kayath MJ, Martin LC, Vieira JGH, Roman LM, Nos´e-Alberti V, 1998 A comparative study of p53 immunoex-pression in parathyroid hyperplasias secondary to uremia, primary hyperplasias, adenomas and carcinomas. Eur J Endocrinology 139: 78–83.CrossRefGoogle Scholar
  26. 26.
    Vasef MA, Brynes RK, Sturm M, Bromley C, Robinson RA, 1999 Expression of cyclin D1 in parathyroid carcinomas, adenomas, and hyperplasias: a paraffin immunohistochemical study. Mod Pathol 12: 412–416.PubMedGoogle Scholar
  27. 27.
    Abbona GC, Papotti M, Gasparri G, Bussolati G, 1995 Proliferative activity in parathyroid tumors as detected by Ki-67 immunostaining. Hum Pathol 26: 135–138.CrossRefGoogle Scholar
  28. 28.
    Lloyd RV, Carney JA, Ferreiro JA, et al, 1995 Immunohistochemical analysis of the cell cycle-associated antigens Ki- 67 and retinoblastoma protein in parathyroid carcinomas and adenomas. Endocrine Pathol 6: 279–287.CrossRefGoogle Scholar
  29. 29.
    Farnebo F, Auer G, Farnebo LO, et al, 1999 Evaluation of retinoblastoma and Ki-67 immunostaining as diagnostic markers of benign and malignant parathyroid disease. World J Surgery 23: 68–74.CrossRefGoogle Scholar
  30. 30.
    Boquist LL, 1990 Nucleolar organizer regions in normal, hyperplastic and neoplastic parathyroid glands. Virchows Arch A Pathol Anat Histopathol 417: 237–241.CrossRefGoogle Scholar
  31. 31.
    Kanematsu E, Matsui H, Deguchi T, et al, 1997 Significance of AgNOR counts for distinguishing carcinoma from adenoma and hyperplasia in parathyroid gland. Hum Pathol 28: 421–427.CrossRefGoogle Scholar

Copyright information

© Hellenic Endocrine Society 2012

Authors and Affiliations

  • Alfredo Campennì
    • 1
  • Rosaria Maddalena Ruggeri
    • 2
  • Alessandro Sindoni
    • 1
  • Salvatore Giovinazzo
    • 2
  • Letterio Calbo
    • 3
  • Antonio Ieni
    • 4
  • Maurizio Monaco
    • 5
  • Giovanni Tuccari
    • 4
  • Salvatore Benvenga
    • 2
    • 6
  • Sergio Baldari
    • 1
  1. 1.Department of Radiological Sciences, Nuclear Medicine UnitUniversity of MessinaPadiglione EMessinaItaly
  2. 2.Department of Clinical and Experimental Medicine and Pharmacology, Section of EndocrinologyUniversity of MessinaItaly
  3. 3.Department of Human Pathology, Section of SurgeryUniversity of MessinaItaly
  4. 4.Department of Human PathologyUniversity of MessinaItaly
  5. 5.Cardiovascular and Thoracic DepartmentUniversity of MessinaItaly
  6. 6.Program of Molecular and Clinical Endocrinology and Women’s HealthA.O.U. Policlinico G. MartinoMessinaItaly

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