Refractory recurrent metastatic parathyroid carcinoma: MDT of a case and literatures review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SU Yanjun ¹ , ZHAO Wei ² , ZHU Gaohong ³ , HE Bo ⁴ , XU Yushan ⁵ , ZHOU Hua ⁶ , QIAN Jun ¹ , ZHANG Ming ¹ ,  CHENG Ruochuan ¹

1. Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, P.R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;
3. Department of Nuclear Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;
4. Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;
5. Department of Endocrinology, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;
6. Department of Radiotherapy, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;

Corresponding author：

CHENG Ruochuan, Email: cruochuan@foxmail.com

Keywords：

parathyroid carcinoma; hypercalcemia; surgery; radiotherapy; chemotherapy

DOI：

10.7507/1007-9424.201903122

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Objective To summarize the experience of comprehensive treatment of parathyroid carcinoma (PTC).Method The clinicopathologic data of patient with PTC admitted to the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed.Results The patient was a 42-year-old male, who was diagnosed with the primary hyperparathyroidism after suffering from systemic joint pain for more than 2 years. The patient accepted the first operation in a primary hospital, including the resection of the PTC and ipsilateral thyroid lobectomy, and the PTC was confirmed pathologically. The second operation was performed due to the tumor relapse within thyroid bed. The third operation was performed with the palliative resection of the recurrent tumor in the right neck and the three-dimensional conformal radiation therapy was performed. The fourth operation was performed in the left neck with lateral lymph node dissection of level Ⅲ and level Ⅳ. The lower left lung cuneiform resection was performed in the fifth operation. For the last operation, the mediastinal metastatic tumor was removed with thoracoscopy. The multiple imaging evaluation showed no evidence of recurrence in the neck, but the extensive pulmonary metastasis occurred.Conclusions Surgery is the only effective treatment for PTC. En bloc excision consists of resection of primary tumor, ipsilateral thyroid lobectomy, other surrounding structures involved by the tumor and central neck dissection. During operation, tumor rupture should be avoided. Accessible metastatic tumor should be resected when possible. Radiotherapy should be performed in patient with local infiltration or unresectable tumor. Effect of chemotherapy for PTC is poor. Supportive medical care should be given for fatal hypercalcemia in patient when treatment failed to control tumor.

Citation： SU Yanjun, ZHAO Wei, ZHU Gaohong, HE Bo, XU Yushan, ZHOU Hua, QIAN Jun, ZHANG Ming, CHENG Ruochuan. Refractory recurrent metastatic parathyroid carcinoma: MDT of a case and literatures review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(11): 1330-1336. doi: 10.7507/1007-9424.201903122 Copy

1.	Cetani F, Pardi E, Marcocci C. Update on parathyroid carcinoma. J Endocrinol Invest, 2016, 39(6): 595-606.
2.	Marcocci C, Cetani F, Rubin MR, et al. Parathyroid cancer. J Bone Miner Res, 2008, 23(12): 1869-1880.
3.	Fraker DL. Update on the management of parathyroid tumors. Curr Opin Oncol, 2000, 12(1): 41-48.
4.	Kassahun WT, Jonas S. Focus on parathyroid carcinoma. Int J Surg, 2011, 9(1): 13-19.
5.	Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985–1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer, 1999, 86(3): 538-544.
6.	Iacobone M, Lumachi F, Favia G. Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol, 2004, 88(4): 223-228.
7.	Shane E. Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab, 2001, 86(2): 485-493.
8.	Givi B, Shah JP. Parathyroid carcinoma. Clin Oncol (R Coll Radiol), 2010, 22(6): 498-507.
9.	Wang P, Xue S, Wang S, et al. Clinical characteristics and treatment outcomes of parathyroid carcinoma: A retrospective review of 234 cases. Oncol Lett, 2017, 14(6): 7276-7282.
10.	Koea JB, Shaw JH. Parathyroid cancer: biology and management. Surg Oncol, 1999, 8(3): 155-165.
11.	Santiago Chinchilla A, Ramos Font C, Muros de Fuentes MA, et al. False negative of the scintigraphy with ^99mTc-sestamibi in parathyroid carcinoma with associated brown tumors. Contributions of the ¹⁸F-FDG-PET/CT. Rev Esp Med Nucl, 2011, 30(3): 174-179.
12.	Pasieka JL. What’s new in general surgery: endocrine surgery. J Am Coll Surg, 2004, 199(3): 437-445.
13.	Evangelista L, Sorgato N, Torresan F, et al. FDG-PET/CT and parathyroid carcinoma: Review of literature and illustrative case series. World J Clin Oncol, 2011, 2(10): 348-354.
14.	Hatzl M, Röper-Kelmayr JC, Fellner FA, et al. ¹⁸F-fluorocholine, ¹⁸F-FDG, and ¹⁸F-fluoroethyl tyrosine PET/CT in parathyroid cancer. Clin Nucl Med, 2017, 42(6): 448-450.
15.	Qiu ZL, Wu CG, Zhu RS, et al. Unusual case of solitary functioning bone metastasis from a " parathyroid adenoma”: imagiologic diagnosis and treatment with percutaneous vertebroplasty—case report and literature review. J Clin Endocrinol Metab, 2013, 98(9): 3555-3561.
16.	Obara T, Okamoto T, Ito Y, et al. Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery, 1993, 114(6): 1040-1049.
17.	Wynne AG, van Heerden J, Carney JA, et al. Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore), 1992, 71(4): 197-205.
18.	Vetto JT, Brennan MF, Woodruf J, et al. Parathyroid carcinoma: diagnosis and clinical history. Surgery, 1993, 114(5): 882-892.
19.	Busaidy NL, Jimenez C, Habra MA, et al. Parathyroid carcinoma: a 22-year experience. Head Neck, 2004, 26(8): 716-726.
20.	Munson ND, Foote RL, Northcutt RC, et al. Parathyroid carcinoma: is there a role for adjuvant radiation therapy? Cancer, 2003, 98(11): 2378-2384.
21.	Chow E, Tsang RW, Brierley JD, et al. Parathyroid carcinoma—the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys, 1998, 41(3): 569-572.
22.	Calandra DB, Chejfec G, Foy BK, et al. Parathyroid carcinoma: biochemical and pathologic response to DTIC. Surgery, 1984, 96(6): 1132-1137.
23.	Bukowski RM, Sheeler L, Cunningham J, et al. Successful combination chemotherapy for metastatic parathyroid carcinoma. Arch Intern Med, 1984, 144(2): 399-400.
24.	Rozhinskaya L, Pigarova E, Sabanova E, et al. Diagnosis and treatment challenges of parathyroid carcinoma in a 27-year-old woman with multiple lung metastases. Endocrinol Diabetes Metab Case Rep, 2017: pii: 16-0113.
25.	Sandelin K, Tullgren O, Farnebo LO. Clinical course of metastatic parathyroid cancer. World J Surg, 1994, 18(4): 594-599.
26.	Shane E, Bilezikian JP. Parathyroid carcinoma: a review of 62 patients. Endocr Rev, 1982, 3(2): 218-226.
27.	Janneke E. Witteveen, Harm R. Haak, Job Kievit, et al Challenges and pitfalls in the management of parathyroid carcinoma: 17-year follow-up of a case and review of the literature. Horm Cancer, 2010, 1(4): 205-214.

1. Cetani F, Pardi E, Marcocci C. Update on parathyroid carcinoma. J Endocrinol Invest, 2016, 39(6): 595-606.
2. Marcocci C, Cetani F, Rubin MR, et al. Parathyroid cancer. J Bone Miner Res, 2008, 23(12): 1869-1880.
3. Fraker DL. Update on the management of parathyroid tumors. Curr Opin Oncol, 2000, 12(1): 41-48.
4. Kassahun WT, Jonas S. Focus on parathyroid carcinoma. Int J Surg, 2011, 9(1): 13-19.
5. Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985–1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer, 1999, 86(3): 538-544.
6. Iacobone M, Lumachi F, Favia G. Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol, 2004, 88(4): 223-228.
7. Shane E. Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab, 2001, 86(2): 485-493.
8. Givi B, Shah JP. Parathyroid carcinoma. Clin Oncol (R Coll Radiol), 2010, 22(6): 498-507.
9. Wang P, Xue S, Wang S, et al. Clinical characteristics and treatment outcomes of parathyroid carcinoma: A retrospective review of 234 cases. Oncol Lett, 2017, 14(6): 7276-7282.
10. Koea JB, Shaw JH. Parathyroid cancer: biology and management. Surg Oncol, 1999, 8(3): 155-165.
11. Santiago Chinchilla A, Ramos Font C, Muros de Fuentes MA, et al. False negative of the scintigraphy with ^99mTc-sestamibi in parathyroid carcinoma with associated brown tumors. Contributions of the ¹⁸F-FDG-PET/CT. Rev Esp Med Nucl, 2011, 30(3): 174-179.
12. Pasieka JL. What’s new in general surgery: endocrine surgery. J Am Coll Surg, 2004, 199(3): 437-445.
13. Evangelista L, Sorgato N, Torresan F, et al. FDG-PET/CT and parathyroid carcinoma: Review of literature and illustrative case series. World J Clin Oncol, 2011, 2(10): 348-354.
14. Hatzl M, Röper-Kelmayr JC, Fellner FA, et al. ¹⁸F-fluorocholine, ¹⁸F-FDG, and ¹⁸F-fluoroethyl tyrosine PET/CT in parathyroid cancer. Clin Nucl Med, 2017, 42(6): 448-450.
15. Qiu ZL, Wu CG, Zhu RS, et al. Unusual case of solitary functioning bone metastasis from a " parathyroid adenoma”: imagiologic diagnosis and treatment with percutaneous vertebroplasty—case report and literature review. J Clin Endocrinol Metab, 2013, 98(9): 3555-3561.
16. Obara T, Okamoto T, Ito Y, et al. Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery, 1993, 114(6): 1040-1049.
17. Wynne AG, van Heerden J, Carney JA, et al. Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore), 1992, 71(4): 197-205.
18. Vetto JT, Brennan MF, Woodruf J, et al. Parathyroid carcinoma: diagnosis and clinical history. Surgery, 1993, 114(5): 882-892.
19. Busaidy NL, Jimenez C, Habra MA, et al. Parathyroid carcinoma: a 22-year experience. Head Neck, 2004, 26(8): 716-726.
20. Munson ND, Foote RL, Northcutt RC, et al. Parathyroid carcinoma: is there a role for adjuvant radiation therapy? Cancer, 2003, 98(11): 2378-2384.
21. Chow E, Tsang RW, Brierley JD, et al. Parathyroid carcinoma—the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys, 1998, 41(3): 569-572.
22. Calandra DB, Chejfec G, Foy BK, et al. Parathyroid carcinoma: biochemical and pathologic response to DTIC. Surgery, 1984, 96(6): 1132-1137.
23. Bukowski RM, Sheeler L, Cunningham J, et al. Successful combination chemotherapy for metastatic parathyroid carcinoma. Arch Intern Med, 1984, 144(2): 399-400.
24. Rozhinskaya L, Pigarova E, Sabanova E, et al. Diagnosis and treatment challenges of parathyroid carcinoma in a 27-year-old woman with multiple lung metastases. Endocrinol Diabetes Metab Case Rep, 2017: pii: 16-0113.
25. Sandelin K, Tullgren O, Farnebo LO. Clinical course of metastatic parathyroid cancer. World J Surg, 1994, 18(4): 594-599.
26. Shane E, Bilezikian JP. Parathyroid carcinoma: a review of 62 patients. Endocr Rev, 1982, 3(2): 218-226.
27. Janneke E. Witteveen, Harm R. Haak, Job Kievit, et al Challenges and pitfalls in the management of parathyroid carcinoma: 17-year follow-up of a case and review of the literature. Horm Cancer, 2010, 1(4): 205-214.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Refractory recurrent metastatic parathyroid carcinoma: MDT of a case and literatures review

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