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Articole Multimedia Jurnalul de Chirurgie, Iaşi, 2008, Vol. 4, Nr. 2 [ISSN 1584 – 9341] UNIVERSITY of PADUA UNIVERSITY of PADUA Chief: Prof.G.Favia Parathyroid Carcinoma: Personal experience IASI 2008 2 Parathyroid Carcinoma PARATHYROID CARCINOMA: PERSONAL EXPERIENCE G. Favia Endocrine Surgery Unit University of Padova Abstract Parathyroid carcinoma (PC) is a rare disease; experience with its management is limited. The aim of this retrospective study was to evaluate a relatively large series of patients suffering from PC. METHODS: Since 1980, PC was diagnosed in the 4.4 % of cases of primary hyperparathyroidism (HPT) (23 patients). Clinical and biochemical features, and surgical outcome were analyzed. RESULTS: In patients with PC, the mean serum calcium was 3.34 mmol/L; the tumor size 30.5 mm. Malignancy was never diagnosed preoperatively. Thirty-two operations were performed; six patients underwent repeated surgery. Recurrence of HPT was observed in 100% of patients. The median disease-free interval was 15 months (range 2-74 months). Fifteen patients died because of the disease; 5 years survival was 24 %. A significant correlation was found between late recurrences and prolonged survival; less advanced age and higher preoperative calcium levels predicted early recurrences. CONCLUSIONS: Preoperative diagnosis of PC is difficult. Preoperative severe hypercalcemia should alert the surgeon. En bloc resection of the PC and the adjacent structures is the treatment of choice. Unfortunately, recurrences are common and long-term survival rate is low. Historical Notes 1909 A. De Quervain non functioning PT cancer 1929 R. Wilder “malignant adenoma” 1932 W. Mayer parathyroid carcinoma KEY WORDS: PARATHYROID CARCINOMA, HYPERPARATHYROIDISM, PARATHYROIDECTOMY 3 Parathyroid Carcinoma Epidemiology 0.5-5.2% 5.2% OF PRIMARY HPT MEAN AGE: 40-50 YEARS = Fujimoto 1984 Wynne 1992 Favia 1998 4 Parathyroid Carcinoma Incidence Author Year pHPT Carcinomas % Van Heerden 1979 2013* 12 0.6% Fujimoto 1984 165 7 4.6% Wanz & Gaz 1985 1200* 28 2.3% Cohn 1985 310 9 3.0% Palneas 1991 700* 8 1.1% Shortell 1991 197 11 5.6% Sandelin 1991 1650* 6 0.3% Hakaim 1993 1260* 7 0.5% Dotzenrath 2001 963* 4 0.4% Favia 2004 404 19 4.7% 8862 111 1.25% * Historical data 5 127
Articole Multimedia Jurnalul de Chirurgie, Iaşi, 2008, Vol. 4, Nr. 2 [ISSN 1584 – 9341] Parathyroid Carcinoma Parathyroid Carcinoma Remarks ENDOCRINE SURGERY UNIT University of Padua, Italy A rare cause (0.5-5.2%) 5.2%) of hyperparathyroidism Difficult diagnosis Undefined natural history Lack of useful adjuvant therapies Holmes 1969 Obara 1991 Favia 1998 Shane 2001 6 7 Parathyroid Carcinoma ENDOCRINE SURGERY UNIT (1985-2007) 516 patients with pHPT 23 carcinomas (4.4%) 441 adenomas (85,6%) 52 multiglandular disease (10%) Parathyroid Carcinoma OUR EXPERIENCE 447 516 patients with pHPT 441 adenomas (85,6%) Median age = 61 years (range 9-799 years) 23 carcinomas (4.4%) Median age = 59 years (range 30-78 years) 14 9 M:F=1:4.2 M:F=1.55 8 9 Parathyroid Carcinoma Laboratory Findings Reported exp. Our experience • s-calcium (mmol( mmol/L) 3.19 ± 0.72 3.34 ± 0.49 • PTH (ng( ng/L) 352.8 ± 326.2 506 ± 417 • Alkaline phosphatase (U/L) 176 ± 98 188 ± 108 Obara,1991 Vetto,1993 Wynne,1992 Hakaim,1993 10 Parathyroid Carcinoma Laboratory Findings OUR EXPERIENCE PT adenoma p PT carcinoma •Females 302 (80.7%) 9 (39%)
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