J Endocr Surg.  2019 Jun;19(2):35-44. 10.16956/jes.2019.19.2.35.

Parathyroid Cancer: Comparison with Benign Hyperparathyroidism

Affiliations
  • 1Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
  • 2Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea. dryooseung@gilhospital.com, dryooseung@hanmail.net
  • 3Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.

Abstract

PURPOSE
The preoperative diagnosis of parathyroid cancer (PC) is challenging. The purpose of this study was to identify the differences between PC and benign primary hyperparathyroidism.
METHODS
The medical records of 85 hyperparathyroidism patients that underwent surgery between 2001 and 2017 were retrospectively reviewed.
RESULTS
Seven of the 85 were diagnosed with PC. Mean age was 53.0±13.0 years and 66 (77.6%) were women. Follow-up duration was 52.9±44.4 months. Tumors were larger (3.50±1.26 cm vs. 2.10±0.84 cm, P=0.002), and intact parathyroid hormone (iPTH) (1,142.8±524.5 pg/mL vs. 461.2±513.5 pg/mL, P=0.002) and alkaline phosphatase (ALP) (398.6±493.6 U/L vs. 166.7±181.1 U/L, P=0.01) levels were higher in cancer patients than in benign primary hyperparathyroidism. Intraoperatively, adhesion to surrounding soft tissue or the thyroid gland was detected more frequently in cancer (85.7% vs. 12.8%, P<0.001). Two patients experienced recurrences and one of them died from PC.
CONCLUSION
PC patients had larger tumors size, and higher serum iPTH and ALP levels. Intraoperative detection of adhesion to surrounding soft tissue/thyroid importantly raised suspicion of PC. Surgeons operating for hyperparathyroidism should be prepared to perform an appropriate en bloc resection initially upon suspicion of PC.

Keyword

Parathyroid neoplasms; Hyperparathyroidism; Parathyroid cancer

MeSH Terms

Alkaline Phosphatase
Diagnosis
Female
Follow-Up Studies
Humans
Hyperparathyroidism*
Hyperparathyroidism, Primary
Medical Records
Parathyroid Hormone
Parathyroid Neoplasms*
Recurrence
Retrospective Studies
Surgeons
Thyroid Gland
Alkaline Phosphatase
Parathyroid Hormone

Figure

  • Fig. 1 Left lower parathyroid gland was adherent to lower pole of left thyroid gland (thick arrow) and surrounding soft tissue (thin arrow) (case 6).

  • Fig. 2 The parathyroid cancer shows whitish firm fibrotic cut surface with infiltrative margin (case 6).

  • Fig. 3 The parathyroid cancer has a thick fibrous tumor capsule and the peritumoral soft tissue invasion is extensive (astrix) (case 6). (hematoxylin and eosin, ×12).


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