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Large retrosternal parathyroid carcinoma with primary hyperparathyroidism

Tan GC, Shiran MS, Swaminathan M, Phang KS, Rohaizak M

Asian J Surg, 2007 Oct;30(4):286-9.

Parathyroid carcinoma is an uncommon cause of parathyroid hormone (PTH)-dependent hypercalcaemia, accounting for less than 1% of all cases of hyperparathyroidism. Parathyroid carcinoma is an indolent tumour with rather low malignant potential. Consideration of parathyroid carcinoma in the differential diagnosis of hypercalcaemic disorders is important because the morbidity and mortality are substantial and the best prognosis is associated with early recognition and surgical resection. Clinical indicators favouring parathyroid carcinoma over benign disease include markedly raised serum calcium levels, PTH and alkaline phosphatase. A palpable neck mass with both kidney and skeletal manifestations also give a high index of suspicion of parathyroid carcinoma. Histopathology alone is not sufficient to diagnose parathyroid cancer; it has to be correlated with the clinical findings. The initial and most effective treatment for parathyroid carcinoma is complete resection of the primary lesion, and repeated operations for recurrence are useful. The prognosis of parathyroid carcinomas is quite variable; 5-year survival rates vary from 40% to 86%, while the 10-year survival rate is approximately 49%. We report a case of parathyroid carcinoma occurring in a 55-year-old woman who presented with bone pain and hypercalcaemia.

Matched MeSH terms: Parathyroid Neoplasms/complications*; Parathyroid Neoplasms/diagnosis; Parathyroid Neoplasms/pathology; Parathyroid Neoplasms/surgery

Fulltext Primary hyperparathyroidism--a surgical review of 12 cases

Meah FA, Tan TT, Taha A, Khalid BA

Med J Malaysia, 1991 Jun;46(2):144-9.

PMID: 1839418

Twelve cases of primary hyperparathyroidism operated by the Universiti Kebangsaan Malaysia Surgical Team from 1978 to 1989 were reviewed. There was a preponderance of Indian females in this series. The majority of the cases presented late and with complications. Renal calculi and bone disease were the commonest complications noted. Of the 12 patients, 9 had single parathyroid adenoma of which 4 were ectopically located, and 2 had hyperplasia of the parathyroids. These were all successfully operated. The remaining patient had 2 failed neck explorations. Failure at initial exploration was due to ectopic location of the glands. Meticulous surgical technique, knowledge of the anatomical variations of location of the parathyroid glands and availability of frozen section facility are essential for successful outcome.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis; Parathyroid Neoplasms/surgery

Denosumab as a long-term palliative therapy in parathyroid carcinoma

Tong CV, Loh LT, Hussein Z

QJM, 2017 01;110(1):55.

PMID: 28011854 DOI: 10.1093/qjmed/hcw207

Matched MeSH terms: Parathyroid Neoplasms*

Fulltext Parathyroid carcinoma with steroid-suppressible plasma immunoreactive parathyroid hormone and human chorionic gonadotrophin

Chng SL, Krishnan MM, Ramachandran, Chan CH, Zain Z

Singapore Med J, 1990 Feb;31(1):83-4.

PMID: 2333552

A 31-year old male presented with bone pain, polyuria and a palpable nodule in the neck. Radiological examination showed generalised osteopenia, subperiosteal erosion and presence of bilateral renal stones. The essential chemical pathological changes were increased plasma calcium, mid-molecule immuno-reactive parathyroid hormone (iPTH), human chorionic gonadotrophin (hCG) levels. Surgical excision of the nodule revealed a parathyroid carcinoma. The uniqueness of this case is the steroid-suppressible plasma calcium, iPTH, and hCG levels. The diagnostic implications of the findings are discussed.

Matched MeSH terms: Parathyroid Neoplasms/surgery*

A case report of primary hyperparathyroidism with severe bony involvement and nephrolithiasis

Chan SP, Hew FL, Jayaram G, Kumar G, Chang KW, Tay A

Ann Acad Med Singap, 2001 Jan;30(1):66-70.

PMID: 11242630

INTRODUCTION: Although the majority of patients with primary hyperparathyroidism have a relatively asymptomatic benign disorder, there are patients who have a more aggressive disorder.

CLINICAL PICTURE: We report a case of primary hyperparathyroidism presenting during pregnancy complicated by antepartum haemorrhage and severe prematurity. The diagnosis was made postpartum, when her problems rapidly progressed to result in severe neuromuscular weakness, bilateral pathological hip fractures as well as nephrolithiasis.

TREATMENT: Surgical parathyroidectomy was performed. The underlying lesion was a large solitary parathyroid adenoma with cystic elements.

CONCLUSION: Primary hyperparathyroidism is not an innocuous disease and can result in severe morbidity if left untreated.

Matched MeSH terms: Parathyroid Neoplasms/complications; Parathyroid Neoplasms/diagnosis*; Parathyroid Neoplasms/surgery

Fulltext Parathyroid carcinoma in a 30-year-old man: a diagnostic and management challenge

Ng SH, Lang BH

World J Surg Oncol, 2013;11:83.

PMID: 23566353 DOI: 10.1186/1477-7819-11-83

Parathyroid carcinoma is a rare endocrine malignancy, accounting for less than 1% of cases of primary hyperparathyroidism. Patient-related factors such as age and sex, as well as the biological features and management of the cancer, influence mid-term and long-term survival. We report a case of a young man with an unusual presentation of parathyroid carcinoma. The patient presented with left thigh swelling, which had been present for 6 months without other symptoms of hypercalcemia. On computed tomography scan a hypodense lesion, 30 × 20 × 20 mm in size, was seen in the posterior thyroid. There was no evidence of cervical lymphadenopathy or local infiltration. On a Sestamibi scan, a hot spot was seen in the lower pole of left thyroid lobe. Cervical neck exploration was performed. The patient subsequently underwent surgery and a parathyroid tumor was excised. The tumor was adherent to the thyroid capsule, but there was no evidence of invasion. After surgery, the patient's calcium and parathyroid hormone levels normalized, but histology confirmed parathyroid carcinoma with capsular and vascular invasion. The patient was offered reoperation, but declined, and developed recurrent parathyroid carcinoma 2 years later. In this report, we aim to present the challenges in managing parathyroid carcinoma and discuss factors that might contribute to future locoregional recurrences. This case also highlighted several issues, including the challenge of ascertaining the diagnosis before surgery and the dilemma of reoperation after simple excision.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis; Parathyroid Neoplasms/surgery*

Fulltext Primary hyperparathyroidism with carcinoma of the right breast--a case report

Muin IA, Meah FA

Med J Malaysia, 1994 Sep;49(3):301-2.

PMID: 7845286

A patient with carcinoma of the right breast and coincidental primary hyperparathyroidism is presented. The distinction between hypercalcemia of malignant and hyperparathyroid origins is based on biochemical analysis and localisation of parathyroid adenoma on a computer tomogram of the neck.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis; Parathyroid Neoplasms/pathology

Primary hyperparathyroidism presenting with pathological fracture

Deshmukh RG, Alsagoff SA, Krishnan S, Dhillon KS, Khir AS

J R Coll Surg Edinb, 1998 Dec;43(6):424-7.

PMID: 9990797

Primary hyperparathyroidism (PHPT) is an intriguing condition. Routine automated biochemical screening has made the diagnosis commonplace in developed countries and the disease is diagnosed early in its course when it is often asymptomatic. In developing countries or in recent immigrants from these countries, PHPT is often seen in an advanced stage with bone involvement. Associated dietary deficiencies may alter the biochemical profile and cause a diagnostic dilemma. It is important to include it in the differential diagnosis of pathological fractures. We report three cases of PHPT presenting with pathological fractures and discuss their diagnosis and management.

Matched MeSH terms: Parathyroid Neoplasms/complications; Parathyroid Neoplasms/surgery

Fulltext Mediastinal parathyroid adenoma: diagnostic and management challenges

Che Kadir S, Mustaffa BE, Ghazali Z, Hasan Z, Imisairi AH, Mustafa S

Singapore Med J, 2011 Apr;52(4):e70-4.

PMID: 21552777

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis*; Parathyroid Neoplasms/surgery*; Parathyroid Neoplasms/ultrasonography

Fulltext Bilateral Genu Valgum in an Adolescent with Primary Hyperparathyroidism: A Case Report and Review of Literature

Lee SP, Chai ST, Loh LT, Ali NM

J ASEAN Fed Endocr Soc, 2020;35(2):220-223.

PMID: 33442194 DOI: 10.15605/jafes.035.02.07

Primary hyperparathyroidism in children and adolescents is rare and often symptomatic at presentation. A 15-year-old bo presented with bilateral genu valgum for two years. Biochemical results were consistent with primary hyperparathyroidism Calcium levels normalized two months after removal of a left inferior parathyroid adenoma.

Matched MeSH terms: Parathyroid Neoplasms

Use of denosumab in parathyroid carcinoma with refractory hypercalcemia

Tong CV, Hussein Z, Noor NM, Mohamad M, Ng WF

QJM, 2015 Jan;108(1):49-50.

PMID: 25099611 DOI: 10.1093/qjmed/hcu166

Matched MeSH terms: Parathyroid Neoplasms/complications*

Fulltext Unexpected rare metastases of renal cell carcinoma

Khoo ACH, Cheong YT

World J Nucl Med, 2020 01 14;19(1):89-91.

PMID: 32190033 DOI: 10.4103/wjnm.WJNM_14_19

Renal cell carcinomas (RCCs) commonly metastasize to the lungs and bones and rarely to the parathyroid, maxillary sinus, and adrenals. It is indeed very rare to have these all these metastases occurring simultaneously in an individual. We share a case of 67-year-old woman provisionally treated for parathyroid carcinoma but subsequently found to actually have metastatic RCC to the left maxillary sinus, parathyroid, lungs, and adrenals on 18F-fluorodeoxyglucose positron emission tomography-computed tomography.

Matched MeSH terms: Parathyroid Neoplasms

Fulltext Isolated Hypophosphataemia Mimicking Cerebrovascular Accident

Hanizah Ngadiron, Razrim Rahim, Firdaus Hayati, Nornazirah Azizan, Affirul Chairil Ariffin

Borneo Journal of Medical Sciences, 2019;13(1):29-32.

MyJurnal

Hypophosphataemia occurs in an abnormally low serum phosphate level. Three main mechanisms are postulated: decreased intestinal absorption, increased renal excretion, and extracellular shifts to intracellular compartments. It is potentially a fatal disease if not intervene. The management is merely treating the underlying disorder, giving phosphate supplement and requiring close biochemical monitoring. The incidence of symptomatic isolated hypophosphataemia is extremely rare. In this case report, a 33-year-old man presented with three days history of dysphagia, inability to complete sentences and generalized muscle weakness. He developed blurred vision especially upon exposure to bright light. He had a history of single parathyroidectomy for parathyroid adenoma 2 years ago. Physical examinations were unremarkable. Laboratory investigations were normal except for phosphate level of 0.30 mmol/L. Intravenous KH2PO4 with a dosage of 10 mmol was administered in slow bolus in 3 hours. His symptoms resolved slowly after correction. Although isolated hypophosphataemia is rare but need to recognize the symptoms and signs of hypophosphataemia and treat accordingly.

Matched MeSH terms: Parathyroid Neoplasms

Fulltext Primary hyperparathyroidism with hungry bone syndrome - A Case Report

Norazmi, K., Khairul, A.J.

International Medical Journal Malaysia, 2007;6(2):1-7.

MyJurnal

Primary hyperparathyroidism with severe bone disease as a result of excessive parathyroid hormone ( PTH ) release and severe hypercalcaemia can lead to 'hungry bone syndrome' (HBS) post operatively. This is due to sudden cessation of PTH and drop in serum calcium. We reported a case a young man with primary hyperparathyriodism due to a single parathyroid adenoma with severe bone disease and post operatively developed hungry bone syndrome.

Matched MeSH terms: Parathyroid Neoplasms

Fulltext Parathyroid Carcinoma: Analysis of Patient Characteristics and Outcomes in a Retrospective Review of Eight Cases seen in a Single Center

Shahar S, Lim KP, Mohamad M

J ASEAN Fed Endocr Soc, 2019;34(2):229-232.

PMID: 33442162 DOI: 10.15605/jafes.034.02.17

Eight cases of parathyroid carcinoma were identified (8 females; median age 45 years, range 28-72). Half of whom were diagnosed preoperatively. Hypercalcemic symptoms were seen in 87.5% of the patients and the main complication was nephrolithiasis. At presentation, the median calcium was 3.675 mmol/L, median phosphate of 0.68 mmol/L, median intact parathyroid hormone (iPTH) was 211 pmol/L. Five patients had regional nodes metastasis and 1 had distant metastasis to the lungs. Parathyroid gland invasion to adjacent structures was seen in 62.5% of cases while another 62.5% showed capsular or vascular infiltration on histology with median tumour size of 3.2 cm. Recurrent hypercalcemia occurred in 50% of the patients with median time of recurrence of 21 months. In this case series, we found that patients with severe hypercalcemia and high iPTH also exhibited a high index suspicion of PC.

Matched MeSH terms: Parathyroid Neoplasms

Intrathyroidal oxyphilic parathyroid carcinoma: A potential diagnostic caveat in cytology?

Wong YP, Sharifah NA, Tan GC, Gill AJ, Ali SZ

Diagn Cytopathol, 2016 May 26.

PMID: 27229757 DOI: 10.1002/dc.23493

Oxyphilic (oncocytic) parathyroid lesions are very uncommon and their cytological features are rarely described. Due to the similarities in anatomical location and indistinguishable cytomorphological features, these lesions are easily confused with neoplastic and non-neoplastic thyroid lesions on fine needle aspiration (FNA). The diagnosis becomes more challenging in cases of unusual intrathyroidal location of the parathyroid lesions in the absence of clinical evidence of hyperparathyroidism, which simulate thyroid nodules clinically. We describe a case of intrathyroidal oxyphilic parathyroid carcinoma in a 66-year-old female, who presented with a dominant left "thyroid" nodule. FNA smears were cellular, comprising predominantly of oxyphilic cells arranged in papillary-like architecture with occasional nuclear grooves, which was mistaken for oncocytic variant of papillary carcinoma of the thyroid. The histological diagnosis of oxyphilic parathyroid "adenoma" was made following total thyroidectomy. The tumor, unfortunately, recurred 7 years later with associated multiple lung metastases. When dealing with thyroid lesions comprising predominantly of oncocytic cells, one should consider oxyphilic parathyroid neoplasms as one of the differential diagnosis. In difficult equivocal cases, a panel of immunocytochemical stains (PTH, GATA3, TTF-1, PAX8, and thyroglobulin) can be helpful. In addition, a combination of valuable clinical, radiological, and laboratory data, including serum calcium and parathyroid hormone levels are key to arriving at an accurate cytological diagnosis. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc.

Matched MeSH terms: Parathyroid Neoplasms

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