Escaping sestamibi detection: a case report of aggressive and recurrent metastatic parathyroid carcinoma.

Background: Parathyroid carcinoma is exceedingly rare. This cancer does not metastasize in a predictable manner and has in fact been noted to spread both hematogenously and lymphatically. There are currently no cases in the literature that report metastasis to a contralateral level II lymph node. Case Description: We report a case of recurrent parathyroid carcinoma in which the patient underwent several surgeries for right-sided parathyroid carcinoma and hyperparathyroidism, including 2 redo parathyroidectomies, 4 neck dissections, and auto transplantation and re-excision of the autotransplanted tissue. Almost a decade after initial surgery, parathyroid hormone (PTH) levels rose significantly, but nuclear medicine (NM) sestamibi scan, positron emission tomography-computed tomography (PET-CT), and ultrasound (US) could not identify the source of recurrent disease. Finally, neck US revealed a suspicious contralateral level II lymph node; fine needle aspiration (FNA) of the lymph node revealed parathyroid tissue, and PTH aspirate noted an elevated PTH washout. After left lateral neck dissection, pathology confirmed recurrent metastatic parathyroid carcinoma, and serum calcium and PTH levels improved. This case was further complicated by chronic kidney disease and pT1N0M0 colon cancer, all before the age of 45. Conclusions: In cases where a sestamibi scan is not able to localize a metastatic focus in a patient with known parathyroid carcinoma, FNA and PTH washout are important secondary studies.

Multi-institutional Analysis of the Clinical and Genomic Characteristics of Black Patients with Metastatic Hormone-Sensitive Prostate Cancer.

BACKGROUND: The outcomes of metastatic hormone-sensitive prostate cancer (mHSPC) have significantly improved through treatment intensification, yet Black representation in those studies is suboptimal. METHODS: A multi-institutional, retrospective analysis of Black men with mHSPC was conducted, focusing on baseline demographics, treatment patterns, genomic profiles, clinical outcomes including prostate-specific antigen response, time to castrate-resistant prostate cancer (CRPC), and subsequent treatments. RESULTS: A total of 107 patients, median age 64 years, 62% with de novo metastases at diagnosis and 64% with high-volume disease, were included. Twenty-nine patients (27%) were treated with androgen deprivation therapy (ADT) with and without first generation anti-androgens, while 20%, 38% and 5% received chemotherapy, abiraterone, and enzalutamide, respectively. At time of data cut-off, 57 (54%) patients had developed CRPC, with a median time to CRPC of 25.4 months (95% CI 20.3-30.4). The median time to CRPC was 46.3 months (18.9-73.7) and 23.4 months (18.6-28.2) for patients who received ADT with or without first-generation anti-androgens and treatment intensification, respectively. The 2-year survival rate was 93.3%, and estimated median overall survival of was 74.9 months (95% CI, 68.7-81.0). Most patients (90%) underwent germline testing; the most frequent known alterations were found within the DNA repair group of genes. Somatic testing revealed pathogenic alterations of interest, notably TP53 (24%) and CDK12 (12%). CONCLUSION: In our cohort, Black men with mHSPC presented with a high proportion of de novo metastases and high-volume disease. Treatment outcomes were very favorable with ADT-based regimens. The genomic landscape suggests different molecular profile relative to White patients with potential therapeutic implications.

Thyroid lobectomy as a cost-effective approach in low-risk papillary thyroid cancer versus active surveillance.

BACKGROUND: An ongoing debate exists over the optimal management of low-risk papillary thyroid cancer. The American Thyroid Association supports the concept of active surveillance to manage low-risk papillary thyroid cancer; however, the cost-effectiveness of active surveillance has not yet been established. We sought to perform a cost-effectiveness analysis comparing active surveillance versus surgical intervention for patients in the United States. METHODS: A Markov decision tree model was developed to compare active surveillance and thyroid lobectomy. Our reference case is a 40-year-old female who was diagnosed with unifocal (<15 mm), low-risk papillary thyroid cancer. Probabilistic outcomes, costs, and health utilities were determined using an extensive literature review. The willingness-to-pay threshold was set at $50,000/quality-adjusted life year gained. Sensitivity analyses were performed to account for uncertainty in the model's variables. RESULTS: Lobectomy provided a final effectiveness of 21.7/quality-adjusted life years, compared with 17.3/quality-adjusted life years for active surveillance. Furthermore, incremental cost effectiveness ratio for lobectomy versus active surveillance was $19,560/quality-adjusted life year (