No abstract available.
Aged ; Biological Markers/blood ; Biopsy ; Calcium/blood ; Female ; Humans ; Hyperparathyroidism/blood/diagnosis/*etiology/surgery ; Hyperplasia ; Parathyroid Glands/metabolism/*pathology/radionuclide imaging/surgery/ultrasonography ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/blood/*complications/diagnosis/surgery ; Parathyroidectomy ; Treatment Outcome ; Up-Regulation

OBJECTIVE: To investigate the clinical manifestation, diagnosis, treatment of parathyroid occupying lesions. METHOD: The clinical data of 26 patients with parathyroid occupying lesions between January 2003 and October 2012 at Dalian Central Hospital were retrospectively analyzed. RESULT: There were 2 cases of parathyroid cancer, 11 cases of parathyroid adenoma, 13 cases of parathyroid cysts in this study. All the cases,except 13 cases of cysts, are accompanied by symptoms of hyperparathyroidism. The symptoms were as follows:26 cases of neck lump, 11 cases of osteoporosis/osteitis fibrosa cystica,9 cases of urinary symptom, 8 cases of digestive symptom. Serum calciumion level and serum parathyroid hormone(PTH) level were examined qualitatively before operation. Ultrasonography, CT, MRI were used in diagnosing and locating parathyroid occupying lesion before operation. 2 cases of parathyroid cancer, 11 cases of parathyroid adenoma and 13 cases of parathyroid cysts with preoperative and postoperative diagnosis coincidence rate was 0 (0/2), 91% (10/11), 69% (9/13). All patients were treated with operation. 2 cases of parathyroid cancer survived with out recurrence during follow up for 17 months and 27 months after operation. 11 cases of parathyroid adenoma and 13 cases of parathyroid cysts were treated with operation,achieved complete remission and the outcome was no recurrence. CONCLUSION There lack of specific clinical symptoms of parathyroid occupying lesions,neck lump are common manifestations. Examination of serum calcium and PTH level together with ultrasonography, CT, MRI, 99mTc-MIBI is helpful to diagnose parathyroid occupying lesions. Parathyroid cancer preoperative diagnosis is difficult . Parathyroid occupying lesions determine the diagnosis depends on pathology. Surgery should be done as primary treatment.
Adenoma ; blood ; complications ; diagnosis ; surgery ; Adult ; Aged ; Biomarkers, Tumor ; Cysts ; blood ; diagnosis ; surgery ; Female ; Humans ; Hyperparathyroidism ; etiology ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Parathyroid Hormone ; blood ; Parathyroid Neoplasms ; blood ; complications ; diagnosis ; surgery ; Retrospective Studies

This study was conducted to review the clinical characteristics of parathyroid carcinoma (PC) and to evaluate potential preoperative predictive factors for PC in patients with primary hyperparathyroidism (PHPT). We performed a retrospective review of electronic medical records of 194 patients with pathologically confirmed PHPT in affiliated teaching hospitals of Seoul National University from January 2000 to March 2011. Adenoma was diagnosed in 171 patients, hyperplasia in 12, and carcinoma in 11. Several biochemical measurements were higher in patients with PC than in patients with benign disease, including serum total calcium (P < 0.001), intact parathyroid hormone (P = 0.003), and alkaline phosphatase (ALP) (P < 0.001). Tumors were larger in PC than in benign disease (P < 0.001). Multivariate analysis revealed that serum ALP level (P < 0.001) and tumor size were associated with PC (P = 0.03). Tumor size and serum ALP level were evaluated as preoperative predictive factors for PC using ROC analyses: a tumor size of 3.0 cm (sensitivity 90.9%, specificity 92.1%) and serum ALP level of 285 IU/L (83.3%, 97.0%) had predictive value for the diagnosis of PC in patients with PHPT. In conclusion, elevated serum ALP and a large parathyroid mass at the time of diagnosis can be helpful to predict PC in patients with PHPT.
Adenoma/complications/diagnosis/surgery ; Adult ; Aged ; Alkaline Phosphatase/blood ; Calcium/blood ; Carcinoma/complications/diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism, Primary/complications/*diagnosis ; Hyperplasia/complications/diagnosis ; Male ; Middle Aged ; Neoplasm Staging ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/complications/*diagnosis/surgery ; Predictive Value of Tests ; *Preoperative Care ; ROC Curve ; Retrospective Studies

A young woman with severe vitamin D deficiency presented with proximal muscle weakness, fragility fracture and pseudoarthrosis. On evaluation, she was found to have hypercalcaemia, a single parathyroid adenoma and an undetectable 25-hydroxyvitamin D level. She received parenteral cholecalciferol and subsequently underwent curative parathyroidectomy. Postoperatively, she had hungry bone syndrome, which she gradually recovered from with calcium and calcitriol replacement. Notably, her calcium levels were in the lower limit of normal range and associated with elevated alkaline phosphatase levels at postoperative Day 14. Follow-up for the next four years showed that the patient had remarkable symptomatic and radiological improvements. In this report, we discuss the pathophysiological interactions between vitamin D deficiency and associated primary hyperparathyroidism.
Adenoma ; diagnosis ; diagnostic imaging ; surgery ; Adult ; Female ; Follow-Up Studies ; Fractures, Spontaneous ; diagnostic imaging ; etiology ; surgery ; Humans ; Hyperparathyroidism, Primary ; complications ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Muscle Weakness ; diagnosis ; etiology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Parathyroidectomy ; methods ; Pseudarthrosis ; diagnostic imaging ; etiology ; physiopathology ; Radiography ; Severity of Illness Index ; Singapore ; Treatment Outcome ; Vitamin D Deficiency ; complications ; diagnosis

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.
Calcium ; blood ; Female ; Humans ; Hypercalcemia ; etiology ; Hyperparathyroidism ; diagnosis ; Hypocalcemia ; drug therapy ; etiology ; Mediastinal Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Middle Aged ; Parathyroid Glands ; pathology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Postoperative Complications ; Technetium Tc 99m Sestamibi ; pharmacology ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo study the clinicopathologic characteristics of parathyroid carcinoma (PTC).

METHODSEleven cases of PTC encountered during the period from 1994 to 2012 were enrolled into the study. Forty cases of parathyroid adenoma (PA) were also retrieved for comparison. The clinical manifestations, laboratory results and pathologic features were analyzed, with literature review.

RESULTSThe main clinical manifestations of PTC included neck mass (11/11), hypercalcemia (11/11) and hyperparathyroidism (11/11). Most patients also had osteoporosis (10/11). In contrast, PA often manifested as hypercalcemia (40/40) and hyperparathyroidism (40/40). Histologic examination of PTC showed that the tumor cells contained clear to eosinophilic cytoplasm and separated by dense bands of fibrosis. The tumor mass was surrounded by thick fibrous capsule. Foci of capsular invasion and vascular permeation were identified at the tumor periphery in all cases. Cellular atypia was not conspicuous but mitotic figures and coagulative necrosis were easily identified. On the other hand, PA were composed of tumor cells with clear to eosinophilic cytoplasm, forming glands, trabeculae or nests. Most of them (35/40) had intact fibrous capsule. Mitotic figures were rarely encountered and tumor necrosis was absent. Immunohistochemical study showed that the tumor cells in PTC were positive for CK19 (11/11), chromogranin A (9/11), synaptophysin (7/11) and parathyroid hormone (11/11). They were negative for thyroglobulin, TTF-1 and calcitonin. The Ki-67 index was less than 10% (range = 2% to 9%). In contrast, the tumor cells in PA were positive (40/40) for CK19, chromogranin A, synaptophysin and parathyroid hormone. They were negative for thyroglobulin, TTF-1 and calcitonin. The Ki-67 index was less than 3%. Follow up-data were available in 9 cases of PTC (duration of follow up = 11 months to 224 months) and 7 of the patients were still alive. Follow up of all PA cases showed no evidence of recurrence.

CONCLUSIONSPTC is a rare malignant endocrine tumor presenting as neck mass. Histologic features suggestive of malignant behavior include presence of coagulative tumor necrosis and capsular/vascular invasion. It needs to be distinguished from other entities such as parathyroid adenoma, papillary thyroid carcinoma and medullary thyroid carcinoma.

Adenoma ; metabolism ; pathology ; Adult ; Carcinoma ; metabolism ; pathology ; Carcinoma, Neuroendocrine ; Carcinoma, Papillary ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Hypercalcemia ; etiology ; Hyperparathyroidism ; etiology ; Immunohistochemistry ; Keratin-19 ; metabolism ; Male ; Middle Aged ; Osteoporosis ; etiology ; Parathyroid Hormone ; metabolism ; Parathyroid Neoplasms ; complications ; metabolism ; pathology ; surgery ; Synaptophysin ; metabolism ; Thyroid Neoplasms ; metabolism ; pathology