Résumé
ABSTRACT Objective Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical histopathologic features and don’t fulfill criteria for carcinoma are classified as atypical adenomas (APA). The purpose of this study was to determine a biochemical or ultrasonographic feature that can predict aggressive disease requiring more extensive surgery and closer follow-up. Subjects and methods Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients) or carcinoma (5 patients) were enrolled in this study. The control group consisted of 102 patients operated between the same dates and diagnosed with classical PA. Classical adenomas, atypical adenomas, and carcinomas were compared according to their biochemical and ultrasonographic parameters. Results Serum Ca levels were significantly higher in the PC group compared with the APA and classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the APA and carcinoma groups compared to the classical PA group. ROC analysis was made to determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05 pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic appearance were independent predictors for aggressive disease. Conclusion Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally invasive surgery.
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Tumeurs de la parathyroïde/sang , Tumeurs de la parathyroïde/imagerie diagnostique , Marqueurs biologiques tumoraux/sang , Adénomes/chirurgie , Adénomes/anatomopathologie , Adénomes/sang , Adénomes/imagerie diagnostique , Hormone parathyroïdienne/sang , Tumeurs de la parathyroïde/chirurgie , Tumeurs de la parathyroïde/anatomopathologie , Soins préopératoires , Études cas-témoins , Calcium/urine , Calcium/sang , Valeur prédictive des tests , Échographie/méthodes , Phosphatase alcaline/sangRésumé
We report a rare case of distant subcutaneous parathyroid carcinoma recurrence. A 50-year-old woman was referred to our hospital because of sustained hypercalcemia despite surgical removal of a parathyroid carcinoma. A focal uptake in the upper mediastinal area was detected in a 99mTc-sestamibi scan, and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) imaging demonstrated a subcutaneous mass. She underwent tumor resection, and the pathological findings were consistent with a parathyroid carcinoma. The postoperative serum parathyroid hormone (PTH) level remained within normal limits. However, a new palpable solitary mass was identified in the upper portion of the left breast 1 year postoperatively. Both a 99mTc-sestamibi scan and 18F-FDG PET/CT imaging revealed an abnormal lesion in the upper breast, and subsequent pathology reports confirmed parathyroid carcinoma metastasis. Serum PTH and calcium levels fell within normal ranges after tumor resection. Two subcutaneous recurrent lesions appeared likely due to tumor seeding during the previous endoscopic operation at a local hospital.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Marqueurs biologiques/sang , Tumeurs du sein/sang , Carcinomes/sang , Fluorodésoxyglucose F18 , Imagerie multimodale , Hormone parathyroïdienne/sang , Tumeurs de la parathyroïde/sang , Tomographie par émission de positons , Valeur prédictive des tests , Radiopharmaceutiques , Technétium (99mTc) sestamibi , Facteurs temps , Tomodensitométrie , Résultat thérapeutiqueRésumé
No abstract available.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Marqueurs biologiques/sang , Cytoponction , Calcium/sang , Hypercalcémie/étiologie , Hyperparathyroïdie/sang , Immunohistochimie , Hormone parathyroïdienne/sang , Tumeurs de la parathyroïde/sang , Parathyroïdectomie , Tomographie par émission de positons couplée à la tomodensitométrie , Radiothérapie adjuvante , Insuffisance rénale/étiologie , Résultat thérapeutiqueRésumé
No abstract available.
Sujets)
Sujet âgé , Femelle , Humains , Marqueurs biologiques/sang , Biopsie , Calcium/sang , Hyperparathyroïdie/sang , Hyperplasie , Glandes parathyroïdes/métabolisme , Hormone parathyroïdienne/sang , Tumeurs de la parathyroïde/sang , Parathyroïdectomie , Résultat thérapeutique , Régulation positiveRésumé
We report a 59 years old female with a history of nephrolithiasis and progressive worsening of her bone mineral density. High serum PTH levels were detected, with normal serum calcium. Causes of secondary hyperparathyroidism were discarded. The patient was followed during six years, period in which she maintained elevated serum PTH and normal serum calcium. During the second year of follow up, hydrochlorothiazide was indicated. Serum calcium raised progressively and after six years, it became abnormally high. The patient was subjected to a total left lobe and subtotal right lobe thyroidectomy. The surgeon found a 1.6 mm diameter left parathyroid nodule. After surgery the patient is asymptomatic and is receiving levothyroxine supplementation.