Nonfunctional parathyroid cancer − a case report

Czech version

Authors: E. Šplíchalová ¹; R. Holý ¹; E. Traboulsi ²; A. Zadražilová ³; J. Astl ¹
Authors‘ workplace: Klinika otorhinolaryngologie a maxilofaciální chirurgie 3. lékařské fakulty Univerzity Karlovy a Ústřední vojenská, nemocnice, Praha ¹; Oddělení patologie, Ústřední vojenská nemocnice, Praha ²; Endokrinologie, Medicon, a. s. ³
Published in: Rozhl. Chir., 2021, roč. 100, č. 3, s. 133-137.
Category: Case Report
doi: https://doi.org/10.33699/PIS.2021.100.3.133–137

Overview

Introduction: Parathyroid cancer is a rare endocrine malignancy. These tumors are typically functional, causing severe hypercalcemia due to primary hyperparathyroidism. Nonfunctional parathyroid cancer with normal serum calcium and parathyroid hormone levels is extremely rare. The disease is usually indolent but progressive with a tendency to metastasize. It is very difficult to diagnose this malignancy. The definitive diagnosis is made by histopathological examination. Radical surgery with ipsilateral lobectomy and en bloc neck dissection is considered to be the most appropriate therapeutic approach. There is no evidence of efficiency of adjuvant cancer therapy and its indication has not been defined. Disease recurrence is common.

Case report: We report the case of a 26-year-old female patient who underwent left hemithyroidectomy for growth progression of a hypoechoic lesion behind the left thyroid lobe detected by ultrasonography. Preoperative cytology and imaging assessments were not suspicious for malignancy. Serum parathyroid hormone and calcium levels were normal. The diagnosis of nonfunctional parathyroid carcinoma was determined based on histopathological examination. No further surgery or adjuvant therapy was indicated. No signs of recurrence or generalization have been observed at 36 months after the surgery.

Conclusion: Nonfunctional parathyroid cancer is extremely rare. In many cases, the diagnosis is made in advanced stages of the disease. No formal classification or treatment protocol has been established so far. A new staging system has been proposed in the 8th edition of AJCC/UICC. Early detection, radical surgery and close follow-up are crucial aspects to affect the mortality and morbidity of patients with this type of malignancy.

Keywords:

parathyroid cancer − nonfunctional parathyroid cancer − case report

Sources

Machado NN, Wilhelm SM. Parathyroid cancer: A review. Cancers (Basel) 2019;11(11):1676. Published 2019 Oct 28. doi:10.3390/cancers11111676.
Wilkins BJ, Lewis JS Jr. Non-functional parathyroid carcinoma: a review of the literature and report of a case requiring extensive surgery. Head Neck Pathol. 2009;3(2):140−149. doi:10.1007/s12105-009-0115-4.
Marcocci C, Cetani F, Rubin MR, et al. Parathyroid carcinoma. J Bone Miner Res. 2008;23(12):1869−1880. doi:10.1359/jbmr.081018.
Shane E. Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab. 2001;86(2):485−493. doi:10.1210/jcem.86.2.7207.
Cetani F, Frustaci G, Torregrossa L, et al. A nonfunctioning parathyroid carcinoma misdiagnosed as a follicular thyroid nodule. World J Surg Oncol. 2015;13:270. Published 2015 Sep 8. doi:10.1186/s12957-015-0672-9.
Ireland JP, Fleming SJ, Levison DA, et al. Parathyroid carcinoma associated with chronic renal failure and previous radiotherapy to the neck. J Clin Pathol. 1985;38(10):1114−1118. doi:10.1136/jcp.38.10.1114.
Berland Y, Olmer M, Lebreuil G, Grisoli J. Parathyroid carcinoma, adenoma and hyperplasia in a case of chronic renal insufficiency on dialysis. Clin Nephrol. 1982;18(3):154−158.
Marx SJ, Simonds WF, Agarwal SK, et al. Hyperparathyroidism in hereditary syndromes: special expressions and special managements. J Bone Miner Res. 2002;17 Suppl 2:N37−N43.
Wang L, Han D, Chen W, et al. Non-functional parathyroid carcinoma: a case report and review of the literature. Cancer Biol Ther. 2015;16(11):1569−1576. doi:10.1080/15384047.2015.1070989.
Suganuma N, Iwasaki H, Shimizu S, et al. Non-functioning parathyroid carcinoma: a case report. Surg Case Rep. 2017;3(1):81. doi:10.1186/s40792-017-0357-4.
Bartoňová L, Campr V, Chmelová R, et al. Nefunkční karcinom parathyroidey v terénu parathyreomatózy. Kazuistika. Cesk Patol. 2018;54(1):37−42.
Heo I, Park S, Jung CW, et al. Fine needle aspiration cytology of parathyroid lesions. Korean J Pathol. 2013;47(5):466−471. doi:10.4132/KoreanJPathol.2013.47.5.466.
Adámek S, Krásná L. Karcinom příštitných tělísek. In: Krška Z, Hoskovec D, Petruželka L, et al. Chirurgická onkologie. 1. vyd. Praha, Grada Publishing 2014: 337−340.
Chang YJ, Mittal V, Remine S, et al. Correlation between clinical and histological findings in parathyroid tumors suspicious for carcinoma. Am Surg. 2006;72(5):419−426.
Akirov A, Asa SL, Larouche V, et al. The clinicopathological spectrum of parathyroid carcinoma. Front Endocrinol (Lausanne). 2019;10:731. Published 2019 Oct 23. doi:10.3389/fendo.2019.00731.