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Diagnosis and treatment of patients with parathyroid carcinoma: An update and review

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Abstract

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. However, to our best knowledge, at least 163 cases of functioning parathyroid carcinoma appeared in the English literature from 1981 to 1989. We summarize the available information obtained from the reports of those patients and compare it with previous descriptions of the disease. The etiology of parathyroid carcinoma is usually obscure, but the possibility of a radiation-induced malignant change in the parathyroid gland became evident in a few patients. Clinical manifestations, including age, sex, symptoms, and biochemical findings in this review were comparable to those in previous reviews. Noninvasive localization studies such as ultrasonography may offer a diagnostic clue to parathyroid carcinoma. Measurement of DNA content is a useful adjunct for making the histologic diagnosis of parathyroid carcinoma and prediction of the clinical outcome. Since the initial operation offers the best chance for cure, preoperative suspicion and intra-operative recognition of the parathyroid cancer are essential. The initial operation should been bloc resection of the tumor, avoiding rupture of the tumor capsule and spillage of tumor cells. As parathyroid carcinoma is a slow-growing but tenacious malignancy, repeated resection of local recurrent tumors or even distant métastases is effective for palliation of recurrent hypercalcemia and occasional cure. When hypercalcemia is refractory to surgical therapy or no recurrent tumor can be identified, other modalities of therapy must be considered. New drugs to control hypercalcemia by inhibiting bone resorption may hold promise in patients with recurrent parathyroid carcinoma.

Résumé

Le cancer de la parathyroÏde est une cause rare d'hyperpararthyroÏdie. A notre connaissance, au moins 163 cas de cancer avec hyperparathyroÏdie ont été publiés dans la littérature Anglosaxonne entre 1981 et 1989. Nous avons résumé ici ces observations pour les comparer aux descriptions antérieures à 1981. L'étiologie du cancer de là parathyroÏde reste inconnue, mais la possibilité d'une transformation maligne secondaire à une irradiation a pu Être retenue dans quelques cas. Les manifestations cliniques, l'âge, le sexe, les symptÔmes, ainsi que les données biochimiques, étaient tout à fait similaires à ceux d'avant 1981. La localisation de la parathyroÏde pathologique par les ultrasons, méthode noninvasive, peut Être utile au diagnostic. La quantification du taux d'ADN est également utile pour le diagnostic histologique de cancer et pour prédire l'évolution. Puisque l'intervention initiale réprésente pour lé patient les meilleurs chances de guérison, la suspicion préopératoire et la reconnaissance peropératoire du cancer de la parathyroÏde sont essentielles. L'intervention doit comporter la résection en bloc de la tumeur, en évitant la rupture de la capsule et la diffusion des cellules tumorales. Puisque le cancer de la parathyroÏde est un cancer qui évolue lentement, il est toujours possible de proposer des résections locales répétées ou celle des métastases à distance pour contrÔler l'hypercalcémie, voire pour obtenir une guérison. Lorsque l'hypercalcémie persiste malgré le traitement chirurgical, et qu'aucune récidive tumoral ne peut Être identifiée, d'autres modalités thérapeutiques peuvent Être envisagées. De nouveaux médicaments pour contrÔler l'hypercalcémie, en inhibant la résorption osseuse, semblent prometteuses en cas de récidive.

Resumen

El carcinoma paratiroideo es causa rara de hiperparatiroidismo primario. Sin embargo, segÚn nuestro mejor conocimiento, por lo menos 163 casos de carcinoma paratiroideo funcionante han aparecido en la literatura en el idioma ingles entre 1981 y 1989. Hemos resumido la información disponible en los reportes sobre esos pacientes para compararla con descripciones previas de la enfermedad. La etiología del carcinoma paratiroideo es generalmente oscura, aunque la posibilidad de degeneration maligna inducida por irradiación aparece evidente en algunos casos. Las manifestaciones clínicas, incluyendo edad, sexo, síntomas y hallazgos bioquimicos en los pacientes en nuestra serie son comparables con aquellos en revisiones previas. Estudios no invasivos de localización, taies como ultrasonografía, pueden significar la clave diagnóstica en el carcinoma paratiroideo. La medición del contenido de DNA es un método Útil complementario para establecer el diagnóstico histológico del carcinoma paratiroideo y en la prediction del resultado clínico. Puesto que la operatión inicial ofrece la mejor oportunidad de curación, la sospecha preoperatoria y el reconocimiento intraoperatorio del cáncer paratiroideo son de importancia esencial. La operación inicial debe consistir en la resección en bloque del tumor, evitando la ruptura de la cápsula y la contaminación con células tumorales. Siendo que el carcinoma paratiroideo es una enfermedad de crecimiento lento pero tenaz, la resección repetida de tumores localmente recurrentes, o aÚn de metastasis distantes, es eficaz en la paliación de la hipercalcemia recurrente o aÚn en su curación ocasional. Cuando la hipercalcemia aparece refractaria a la terapia quirÚrgica o cuando no es posible identificar tumor recurrente, se deben considerar otras modalidades terapéuticas. Nuevas drogas para el control de la hipercalcemia por inhibición de la resorción ósea pueden ser promisorias en pacientes con carcinoma paratiroideo recurrente.

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  1. Department of Endocrine Surgery, Institute of Clinical Endocrinology, Tokyo Women's Medical College, 162, Tokyo, Japan

    Takao Obara M.D. & Yoshihide Fujimoto M.D.

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Obara, T., Fujimoto, Y. Diagnosis and treatment of patients with parathyroid carcinoma: An update and review. World J. Surg. 15, 738–744 (1991). https://doi.org/10.1007/BF01665308

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