A Single Center Experience of Parathyroid Carcinoma Which Is Less Common Among Parathyroid Tumors

INTRODUCTION: Parathyroid tumors can be divided into three groups: parathyroid adenoma, atypical parathyroid adenoma and parathyroid carcinoma. Parathyroid carcinoma is the less common one among these. Parathyroid carcinomas account for approximately 0,005% of all cancers and 1% of primary hyperparathyroidism cases. In this study, we wanted to share our experience of parathyroid carcinoma which is not common.
METHODS: Of 375 patients who were operated with pre-diagnosis of parathyroid adenoma in Ankara Numune Training and Research Hospital Department of General Surgery between 2008 and 2015; 12 patients whose pathology result could not clearly identify a parathyroid carcinoma and could differentiate a carcinoma from an adenoma were examined retrospectively.
RESULTS: Of the patients; 5 (41,6%) were observed to be male and 7 (58,4%) were observed to be female. Mean age was 54,5 (±8,40) and the age range was between 41 and 68. Mean preoperative calcium value was 12,3(±1,33) mg/dL and the range was between 10,9 and 15,3. The pathology results were as “a parathyroid carcinoma” in 4 patients, “a parathyroid neoplasm” in 4 patients, “a parathyroid neoplasm with undetermined malignant potential” in 3 patients and “malignancy could not be discarded” in 1 patient. Mean follow-up duration of the patients was 61,8 months (±17,05) and the range was between 35 and 96 months. 1 patient received chemotherapy and the same patient died on the month 55 during follow-ups.
DISCUSSION AND CONCLUSION: In those with severe preoperative hypocalcemia symptoms, those with a calcium value higher than 14mg/dL, in cases when parathormone level is significantly higher and in cases when parathyroid gland is palpated, parathyroid carcinomas are suspected. For treatment of a parathyroid carcinoma, neck exploration, en-bloc removal of the tumor and ipsilateral lobectomy of thyroid are required. If pathology results are suspicious in regard to malignancy, and then the patient is closely followed-up.

Paratiroid Tümörleri Ýçerisinde Az Karþýlaþýlan Paratiroid Karsinomu Tek Merkez Deneyimi

GÝRÝÞ ve AMAÇ: Paratiroid tümörleri; Paratiroid adenomu, atipik paratiroid adenomu ve paratiroid karsinomu þeklinde üç gruba ayrýlarak sýnýflandýrýlabilir. Paratiroid karsinomu bunlar içerisinde en az görülenidir. Paratiroid karsinomu, tüm kanserlerin yaklaþýk %0,005’ini, primer hiperparatirodi vakalarýnýn ise yaklaþýk %1‘ini oluþturur. Biz de bu çalýþmada, çok sýk rastlanmayan paratiroid karsinomu ile ilgili deneyimimizi paylaþmak istedik.
YÖNTEM ve GEREÇLER: Ankara Numune Eðitim Araþtýrma Hastanesi Genel Cerrahi Servisinde 2008-2015 yýllarý arasýnda paratioid adenomu ön tanýsý ile opere edilen 375 hasta içerisinden patoloji sonucu paratiroid karsinomu ve karsinom–adenom ayrýmý net yapýlamayan 12 hasta retrospektif olarak incelendi.
BULGULAR: Hastalarýn 5’i(%41,6) erkek, 7’si(%58,4) kadýn olarak izlendi. Yaþ ortalamasý 54,5 (±8,40) yaþ aralýðý 41 ile 68 arasýndaydý. Preoperatif kalsiyum deðeri ortalama 12,3(±1,33) mg/dL ve 10,9 ile 15,3 arasýndaydý. Patoloji sonucu; 4 hastanýn paratiroid karsinomu, 4 hastanýn paratiroid neoplazmý, 3 hastanýn malign potansiyeli belirlenemeyen paratiroid neoplazmý, 1 hastanýn malignite ekarte edilemedi, þeklinde idi. Hastalarýn ortalama takip süresi 61,8 ay (±17,05) ve 35 ile 96 ay arasýnda idi. 1 hasta kemoterapi aldý ve ayný hasta takiplerinde 55. ayda exitus oldu.
TARTIÞMA ve SONUÇ: Preoperatif olarak þiddetli hiperkalsemi semptomu olanlarda, kalsiyum deðerleri 14mg/dL’den yüksek olanlarda, parathormon seviyesinin anlamlý biçimde yüksek olduðunda ve paratiroid bezinin palpe edildiði durumlarda paratiroid karsinomlarýndan þüphelenilir. Paratiroid karsinomu tedavisinde boyun eksplorasyonu, tümörün un-blok çýkarýlmasý ve ayný taraf tiroide lobektomi yapýlmasý gerekir. Patoloji sonuçlarý malignite açýsýndan þüpheli ise yakýn takip edilebilir.