Parathyroid Cancer: Comparison with Benign Hyperparathyroidism
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: The preoperative diagnosis of parathyroid cancer (PC) is challenging. The purpose of this study was to identify the differences between PC and benign primary hyperparathyroidism. Methods: The medical records of 85 hyperparathyroidism patients that underwent surgery between 2001 and 2017 were retrospectively reviewed. Results: Seven of the 85 were diagnosed with PC. Mean age was 53.0±13.0 years and 66 (77.6%) were women. Follow-up duration was 52.9±44.4 months. Tumors were larger (3.50±1.26 cm vs. 2.10±0.84 cm, P=0.002), and intact parathyroid hormone (iPTH) (1,142.8±524.5 pg/mL vs. 461.2±513.5 pg/mL, P=0.002) and alkaline phosphatase (ALP) (398.6±493.6 U/L vs. 166.7±181.1 U/L, P=0.01) levels were higher in cancer patients than in benign primary hyperparathyroidism. Intraoperatively, adhesion to surrounding soft tissue or the thyroid gland was detected more frequently in cancer (85.7% vs. 12.8%, P<0.001). Two patients experienced recurrences and one of them died from PC. Conclusion: PC patients had larger tumors size, and higher serum iPTH and ALP levels. Intraoperative detection of adhesion to surrounding soft tissue/thyroid importantly raised suspicion of PC. Surgeons operating for hyperparathyroidism should be prepared to perform an appropriate en bloc resection initially upon suspicion of PC.
Abstract
Purpose: The preoperative diagnosis of parathyroid cancer (PC) is challenging. The purpose of this study was to identify the differences between PC and benign primary hyperparathyroidism. Methods: The medical records of 85 hyperparathyroidism patients that underwent surgery between 2001 and 2017 were retrospectively reviewed. Results: Seven of the 85 were diagnosed with PC. Mean age was 53.0±13.0 years and 66 (77.6%) were women. Follow-up duration was 52.9±44.4 months. Tumors were larger (3.50±1.26 cm vs. 2.10±0.84 cm, P=0.002), and intact parathyroid hormone (iPTH) (1,142.8±524.5 pg/mL vs. 461.2±513.5 pg/mL, P=0.002) and alkaline phosphatase (ALP) (398.6±493.6 U/L vs. 166.7±181.1 U/L, P=0.01) levels were higher in cancer patients than in benign primary hyperparathyroidism. Intraoperatively, adhesion to surrounding soft tissue or the thyroid gland was detected more frequently in cancer (85.7% vs. 12.8%, P<0.001). Two patients experienced recurrences and one of them died from PC. Conclusion: PC patients had larger tumors size, and higher serum iPTH and ALP levels. Intraoperative detection of adhesion to surrounding soft tissue/thyroid importantly raised suspicion of PC. Surgeons operating for hyperparathyroidism should be prepared to perform an appropriate en bloc resection initially upon suspicion of PC.
참고문헌 (30)
- Townsend CM Jr, "Sabiston Textbook of Surgery: the Biological Basis of Modern Surgical Practice" (2017), Elsevier Saunders
- Annual Report of Cancer Statistics in Korea in 2015, "Korea Central Cancer Registry", Korea Central Cancer Registry, ~ (2017)
- Lloyd RV, "World Health Organization; International Agency for Research on Cancer. WHO Classification of Tumours of Endocrine Organs" (2017), International Agency for Research on Cancer
- Al-Kurd A, "Parathyroid carcinoma", Surg Oncol, 23, pp.107~114 (2014)
- Owen RP, "Parathyroid carcinoma : a review", Head Neck, 33, pp.429~436 (2011)
- Talat N, "Clinical presentation, staging and long-term evolution of parathyroid cancer", Ann Surg Oncol, 17, pp.2156~2174 (2010)
- Schulte KM, "Oncologic resection achieving R0 margins improves disease-free survival in parathyroid cancer", Ann Surg Oncol, 21, pp.1891~1897 (2014)
- Givi B, "Parathyroid carcinoma", Clin Oncol(R Coll Radiol), 22, pp.498~507 (2010)
- Ricci G, "Parathyroid carcinoma : the importance of high clinical suspicion for a correct management", Int J Surg Oncol, 2012, pp.649148~ (2012)
- Shane E, "Clinical review 122 : parathyroid carcinoma", J Clin Endocrinol Metab, 86, pp.485~493 (2001)
- Kassahun WT, "Focus on parathyroid carcinoma", Int J Surg, 9, pp.13~19 (2011)
- Duan K, "Parathyroid carcinoma : diagnosis and clinical implications", Turk Patoloji Derg, 31(Suppl 1), pp.80~97 (2015)
- Kim BS, "Parathyroid carcinoma in tertiary hyperparathyroidism", Asian J Surg, 39, pp.255~259 (2016)
- Takada D, "The use of cinacalcet hinders the diagnosis of parathyroid carcinoma in a chronic dialysis patient : a case report", BMC Nephrol, 18, pp.315~ (2017)
- Bossola M, "Parathyroid carcinoma in a chronic hemodialysis patient : case report and review of the literature", Tumori, 91, pp.558~562 (2005)
- Falvo L, "Bilateral synchronous parathyroid carcinoma in a patient on long-term hemodialysis : presentation of a rare clinical case and review literature", Int Surg, 90, pp.18~22 (2005)
- Zivaljevic V, "Parathyroid cancer in a hemodialysis patient : a case report", Tumori, 88, pp.430~432 (2002)
- Bondeson L, "Histopathological variables and DNA cytometry in parathyroid carcinoma", Am J Surg Pathol, 17, pp.820~829 (1993)
- Snover DC, "Mitotic activity in benign parathyroid disease", Am J Clin Pathol, 75, pp.345~347 (1981)
- Ippolito G, "Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenoma", Br J Surg, 94, pp.566~570 (2007)
- DeLellis RA, "Parathyroid tumors and related disorders", Mod Pathol, 24(Suppl 2), pp.S78~S93 (2011)
- Stojadinovic A, "Parathyroid neoplasms: clinical, histopathological, and tissue microarray-based molecular analysis", Hum Pathol, 34, pp.54~64 (2003)
- Fernandez-Ranvier GG, "Defining a molecular phenotype for benign and malignant parathyroid tumors", Cancer, 115, pp.334~344 (2009)
- 백조옥, "Synchronous parathyroid carcinoma and papillary thyroid carcinoma in a patient with long-standing schizophrenia", The Korean Journal of Internal Medicine, 32(6), pp.1104~1107 (2017), 대한내과학회[DOI]
- Chaychi L, "Unusual manifestation of parathyroid carcinoma in the setting of papillary thyroid cancer", Endocr Pract, 16, pp.664~668 (2010)
- Savli H, "Occult parathyroid carcinoma in a patient with papillary thyroid carcinoma and Hashimoto's thyroiditis", J Endocrinol Invest, 24, pp.42~44 (2001)
- 김종규, "The prevalence of primary hyperparathyroidism in Korea: a population-based analysis from patient medical records", Annals of Surgical Treatment and Research, 94(5), pp.235~239 (2018), 대한외과학회
- Wermers RA, "Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease", J Bone Miner Res, 21, pp.171~177 (2006)
- Adami S, "Epidemiology of primary hyperparathyroidism in Europe", J Bone Miner Res, 17(Suppl 2), pp.N18~N23 (2002)
- Yu N, "Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK", Clin Endocrinol(Oxf), 71, pp.485~493 (2009)