Parathyroid carcinoma
{{short description|Cancerous tumor of the parathyroid gland}}
{{Infobox medical condition (new)
| name = Parathyroid carcinoma
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| image = File:Parathyroid es.svg
| caption = Parathyroid gland anatomy(green marks)
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| field = Oncology, ENT surgery
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Parathyroid carcinoma is a rare cancer resulting in parathyroid adenoma to carcinoma progression.Hu MI, Vassilopoulou-Sellin R, Lustig R, Lamont JP. [http://www.cancernetwork.com/cancer-management-11/chapter05/article/10165/1402668 "Thyroid and Parathyroid Cancers"] in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) [http://www.cancernetwork.com/cancer-management-11/ Cancer Management: A Multidisciplinary Approach]. 11 ed. 2008. It forms in tissues of one or more of the parathyroid glands (four pea-sized glands in the neck that make parathyroid hormone (PTH). PTH helps the body maintain normal levels of serum calcium by promoting calcium reabsorption from bone. It is antagonized by the hormone calcitonin, which prompts calcium storage.).
It is rare, with documented cases of less than one thousand since its first discovery in 1904;{{cite journal | vauthors = Givi B, Shah JP | title = Parathyroid carcinoma | language = English | journal = Clinical Oncology | volume = 22 | issue = 6 | pages = 498–507 | date = August 2010 | pmid = 20510594 | pmc = 3781923 | doi = 10.1016/j.clon.2010.04.007 }}{{cite journal | vauthors = Wei CH, Harari A | title = Parathyroid carcinoma: update and guidelines for management | journal = Current Treatment Options in Oncology | volume = 13 | issue = 1 | pages = 11–23 | date = March 2012 | pmid = 22327883 | doi = 10.1007/s11864-011-0171-3 | s2cid = 39872789 }}{{cite journal | vauthors = Dudney WC, Bodenner D, Stack BC | title = Parathyroid carcinoma | journal = Otolaryngologic Clinics of North America | volume = 43 | issue = 2 | pages = 441–53, xi | date = April 2010 | pmid = 20510726 | doi = 10.1016/j.otc.2010.01.011 | series = Thyroid and Parathyroid Surgery }}{{cite journal | vauthors = Beus KS, Stack BC | title = Parathyroid carcinoma | journal = Otolaryngologic Clinics of North America | volume = 37 | issue = 4 | pages = 845–54, x | date = August 2004 | pmid = 15262520 | doi = 10.1016/j.otc.2004.02.014 | series = Parathyroids }}{{Cite journal | vauthors = Healy SJ, Soe KK |date=2016-06-01 |title=Parathyroid Cancer Cases: A Single Center's Experience |url=https://www.aaceclinicalcasereports.com/article/S2376-0605(20)30590-3/abstract |journal=AACE Clinical Case Reports |language=English |volume=2 |issue=3 |pages=e221–e227 |doi=10.4158/EP15857.CR |issn=2376-0605|doi-access=free }}{{cite journal | vauthors = Lee JE | title = Predicting the presence of parathyroid carcinoma | journal = Annals of Surgical Oncology | volume = 12 | issue = 7 | pages = 513–514 | date = July 2005 | pmid = 15952075 | doi = 10.1245/ASO.2005.03.904 | s2cid = 195245925 }} and much less common than parathyroid adenoma.
It can be difficult to excise.{{cite web |url=http://library.med.utah.edu/WebPath/ENDOHTML/ENDO112.html |title=Endocrine Pathology |access-date=2009-05-08}} The rate of occurrence of parathyroid carcinoma is between 0.5% to 5%{{cite journal | vauthors = Wynne AG, van Heerden J, Carney JA, Fitzpatrick LA | title = Parathyroid carcinoma: clinical and pathologic features in 43 patients | journal = Medicine | volume = 71 | issue = 4 | pages = 197–205 | date = July 1992 | doi = 10.1097/00005792-199207000-00002 | pmid = 1518393 | s2cid = 25457018 | doi-access = free }}{{cite journal | vauthors = Mohebati A, Shaha A, Shah J | title = Parathyroid carcinoma: challenges in diagnosis and treatment | journal = Hematology/Oncology Clinics of North America | volume = 26 | issue = 6 | pages = 1221–1238 | date = December 2012 | pmid = 23116578 | doi = 10.1016/j.hoc.2012.08.009 | series = Rare Cancers }}{{cite journal | vauthors = Givi B, Shah JP | title = Parathyroid carcinoma | language = English | journal = Clinical Oncology | volume = 22 | issue = 6 | pages = 498–507 | date = August 2010 | pmid = 20510594 | pmc = 3781923 | doi = 10.1016/j.clon.2010.04.007 }}
Signs and symptoms
Risk factors
Parathyroid cancer occurs in midlife at the same rate in men and women. {{cite journal | vauthors = Givi B, Shah JP | title = Parathyroid carcinoma | language = English | journal = Clinical Oncology | volume = 22 | issue = 6 | pages = 498–507 | date = August 2010 | pmid = 20510594 | pmc = 3781923 | doi = 10.1016/j.clon.2010.04.007 }}
Conditions that appear to result in an increased risk of parathyroid cancer include multiple endocrine neoplasia type 1,{{cite web | url = http://www.cancer.gov/cancertopics/pdq/treatment/parathyroid/HealthProfessional/page1 | title = Parathyroid Cancer Treatment | work = National Cancer Institute | date = 11 March 2009 }} autosomal dominant familial isolated hyperparathyroidism and hyperparathyroidism-jaw tumor syndrome (which also is hereditary). Parathyroid cancer has also been associated with external radiation exposure, but most reports describe an association between radiation and the more common parathyroid adenoma.
Diagnosis
On Sestamibi parathyroid scan, intense radioactivity greater than submandibular gland on delayed image, no washout between early and delayed images, and high concentration of parathyroid hormone concentration in blood in those who age more than 40 years is suggestive of parathyroid carcinoma.{{cite journal | vauthors = Cheon M, Choi JY, Chung JH, Lee JY, Cho SK, Yoo J, Park SB, Lee KH, Kim BT | display-authors = 6 | title = Differential findings of tc-99m sestamibi dual-phase parathyroid scintigraphy between benign and malignant parathyroid lesions in patients with primary hyperparathyroidism | journal = Nuclear Medicine and Molecular Imaging | volume = 45 | issue = 4 | pages = 276–284 | date = December 2011 | pmid = 24900018 | pmc = 4043053 | doi = 10.1007/s13139-011-0103-y }} Some authors suggest high levels of HCG as a marker for parathyroid carcinoma in the right context.{{Cite journal | vauthors = Valdes-Socin H, Betea D, Daly A, Delanaye P, Souberbielle JC, Beckers A, Cavalier E |date=2018-05-08 |title=Human Chorionic Gonadotrophin (hCG) as a diagnostic test to differentiate between Parathyroid Carcinoma, Primary Benign Hyperparathyroidism and Secondary Hyperparathyroidism. |url=https://www.endocrine-abstracts.org/ea/0056/ea0056p214 |journal=Endocrine Abstracts |language=en |publisher=Bioscientifica |volume=56 |doi=10.1530/endoabs.56.P214}} However, other thyroid diseases such as multinodular goitre, Hashimoto thyroiditis, thyroid adenoma, and thyroid carcinoma also retains the radiotracer because of high metabolic nature of these diseases.{{cite journal | vauthors = Nguyen BD | title = Parathyroid imaging with Tc-99m sestamibi planar and SPECT scintigraphy | journal = Radiographics | volume = 19 | issue = 3 | pages = 601–614 | date = May 1999 | pmid = 10336191 | doi = 10.1148/radiographics.19.3.g99ma10601 }} Thus, the final diagnosis always requires pathological examination of the tissue in question.
Treatment
Parathyroid carcinoma is sometimes diagnosed during surgery for primary hyperparathyroidism. If the surgeon suspects carcinoma based on severity or invasion of surrounding tissues by a firm parathyroid tumor, aggressive excision is performed, including the thyroid and surrounding tissues as necessary.
Agents such as calcimimetics (for example, cinacalcet) are used to mimic calcium and are able to activate the parathyroid calcium-sensing receptor (making the parathyroid gland "think" we have more calcium than we actually do), therefore lowering the calcium level, in an attempt to decrease the hypercalcemia.{{citation needed|date=August 2020}}
References
{{reflist}}
External links
- [http://www.cancer.gov/dictionary?CdrID=446529 Parathyroid cancer] entry in the public domain NCI Dictionary of Cancer Terms
- [http://emedicine.medscape.com/article/280908-overview#showall Parathyroid Carcinoma (Medscape eMedicine)]
- [http://www.cancernetwork.com/cancer-management-11/chapter05/article/10165/1402668 Cancer Management Handbook: Thyroid and Parathyroid Cancers]
{{Medical resources
| DiseasesDB = 9628 |
|ICD10 = {{ICD10|C|75|0|c|73}} |
|ICD9 = {{ICD9|194.1}} |
|ICDO = |
|OMIM = |
|MedlinePlus = 007264 |
|eMedicineSubj = med |
|eMedicineTopic = 1754 |
|MeshID = D010282 |
}}
{{NCI-cancer-dict}}
{{Endocrine gland neoplasia}}