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Abramson Cancer CenterNCI CANCERLIT® Search: Parathyroid Cancer - October 2002
National Cancer Institute®
Last Modified: October 1, 2002
- Preoperative localization of parathyroid adenomas: the protagonist's view.
- Preoperative localization of parathyroid adenomas: the antagonist's view.
- Preoperative localization of parathyroid adenomas: cost-effective or just costly?
- [Patient selection criteria for single-sided or minimal invasive operative procedures in primary hyperparathyroidism (pHPT)]
- The sestamibi scan as a preoperative screening tool.
- Dose-response relationship for parathyroid adenoma after exposure to ionizing radiation in infancy.
- Using technetium 99m tetrofosmin parathyroid imaging to detect parathyroid adenoma and its relation to P-glycoprotein expression.
- Intracranial metastatic parathyroid carcinoma: case report.
- Intracranial metastatic parathyroid carcinoma: case report.
- Consistent decrease in telomere length in parathyroid tumors but alteration in telomerase activity limited to malignancies: preliminary
- Bilateral pheochromocytoma in pregnancy heralding multiple endocrine neoplasia syndrome IIA. A case report.
- [Treatment of a solitary adenoma of the parathyroid gland with ultrasound-guided percutaneous Radio-Frequency-Tissue-Ablation (RFTA)]
- [Cystic parathyroid adenoma. A rare cause of primary hyperparathyroidism]
Table of Contents
1
UI - 11951931
AU - Arkles LB
TI -
Preoperative localization of parathyroid adenomas: the protagonist's
view.
SO - Intern Med J 2002 Apr;32(4):179-82
AD - Department of Nuclear Medicine, and Peter MacCallum Cancer Institute,
Melbourne, Victoria, Australia. arkles@netspace.net.au
2
UI - 11951932
AU - Hartley L
TI -
Preoperative localization of parathyroid adenomas: the antagonist's
view.
SO - Intern Med J 2002 Apr;32(4):183-4
AD - The Princess Alexandra Hospital, Brisbane, Queensland, Australia.
hartley@orangemail.com.au
3
UI - 11951933
AU - Khafagi FA
TI -
Preoperative localization of parathyroid adenomas: cost-effective or
just costly?
SO - Intern Med J 2002 Apr;32(4):185-6
AD - Department of Nuclear Medicine & Cardiology, St Andrew's War Memorial
Hospital, Brisbane, Queensland, Australia. fkhafagi@bigpond.com
4
UI - 12058306
AU - Timm S; Hamelmann W; Luster M; Reiners C; Geling M; Thiede A; Timmermann
TI -
W
[Patient selection criteria for single-sided or minimal invasive
operative procedures in primary hyperparathyroidism (pHPT)]
SO - Zentralbl Chir 2002 May;127(5):443-7
AD - Chirurgische Universitatsklinik Wurzburg, Germany.
In 56 postoperative patients with primary hyperparathyroidism we
analysed retrospectively whether a single-sided or minimal invasive
operative procedure could have been utilized. Additionally the
sensitivity of (99m)TC-Sestamibiscintiscanning and ultrasound of the
neck region was assessed. Single gland disease was found in 49 patients,
6 patients had primary multiglandular disease and one patient revealed a
double adenoma. The overall sensitivity of
(99m)TC-Sestamibiscintiscanning and ultrasound was found to be 78 % and
53 % respectively. In 46 patients the operation would have been started
minimal invasive, in 7 of these patients a conversion to bilateral
exploration would have been necessary because of four gland hyperplasia,
double adenoma or misleading preoperative localisation. In 39 patients a
successful minimal invasive procedure would have been possible. A
primary bilateral exploration would have been necessary in 10 patients
because of either coexisting goiter or questionable localisation of the
pathological altered gland. Since sensitivity of localisation
diagnostics is low with regard to multiglandular disease, parathyroid
hormone should be monitored intraoperatively whenever minimal invasive
operative procedures are performed.
5
UI - 12356156
AU - Norton KS; Johnson LW; Griffen FD; Burke J; Kennedy S; Aultman D; Li BD;
TI -
Zibari G
The sestamibi scan as a preoperative screening tool.
SO - Am Surg 2002 Sep;68(9):812-5
AD - Louisiana State University Health Sciences Center, Shreveport, USA.
Sestamibi scan is generally recognized in the literature to play a role
in the imaging of parathyroid adenoma. Most institutions quote
sensitivities ranging from 80 to 100 per cent. There is still a question
as to whether patients need preoperative localization studies.
Preoperative localization can potentially result in less invasive
surgery, shorter operative times, decreased hospital stays, and
decreased need for re-exploration. Our hypothesis is that the sestamibi
scan is a sensitive predictor of parathyroid adenomas. The objectives of
this study are to determine the sensitivity of sestamibi scan in
detecting parathyroid adenoma, and to determine whether either
parathyroid hormone (PTH) level or calcium level is an independent
predictor of a positive scan. One hundred patients were retrospectively
reviewed at Louisiana State University Health Sciences Center-Shreveport
and Louisiana State University Health Sciences Center-Monroe from March
scan. This scan was performed using the dual-phase technique in which
the parathyroid glands are visualized after washout of tracer from the
thyroid. The scan was followed by either a unilateral or bilateral neck
dissection. There were 82 female patients and 18 male patients who
ranged in age from 23 to 78 years. The median weight of glands with a
positive scan was 795 mg. The median weight of glands with a negative
scan was 480 mg. This difference was statistically significant (P <
0.04). Overall there were 107 adenomas. Of these 93 had positive scans
and 14 had negative scans. This results in a sensitivity of 87 per cent.
There were 67 glands that weighed at least 500 mg. Of these 67 glands 61
had positive scans and six had negative scans. This resulted in a
sensitivity of 91 per cent. There were 40 glands that weighed less than
500 mg. Of these 40 glands 32 had positive scans and eight had negative
scans. This resulted in a sensitivity of 80 per cent. Using multiple
linear regression analysis calcium level correlated with the weight of
the gland (P < 0.01). Calcium level also correlated with the PTH level
(P < 0.01). However, neither the PTH level nor the calcium level
correlated with a positive sestamibi scan. Sestamibi scan is a sensitive
predictor for parathyroid adenoma greater than 500 mg (91% sensitivity).
Even in smaller glands (<500 mg) 80 per cent sensitivity was
demonstrated. Although the calcium level correlates with the PTH level
neither PTH level nor calcium level is predictive of a positive
sestamibi scan.
6
UI - 12236809
AU - Holmberg E; Wallgren A; Holm LE; Lundell M; Karlsson P
TI -
Dose-response relationship for parathyroid adenoma after exposure to
ionizing radiation in infancy.
SO - Radiat Res 2002 Oct;158(4):418-23
AD - The Oncological Centre, Sahlgrenska University Hospital, S-413 45
Goteborg, Sweden. erik.holmberg@oc.gu.se
Several authors have suggested that there is an excess risk of
hyperparathyroidism, adenomas or hyperplasia after exposure to ionizing
radiation. There is still, however, some uncertainty about this
association, because these diseases are often asymptomatic and escape
clinical detection if not specially searched for. This study is based on
a pooled Swedish cohort of 27,925 persons with skin hemangiomas. The
majority received radiation treatment in infancy between 1920 and 1965
in Stockholm and Gothenburg. The mean age at treatment was 6 months and
the median thyroid dose was 0.20 Gy (range 0-28.5 Gy). Record linkage
with the Swedish Cancer Register for the period 1958-1997 gave 43 cases
of parathyroid adenoma in the cohort. Analyses of excess relative risk
(ERR) models were performed using Poisson regression methods. Clinical
records were scrutinized to determine if the childhood radiation
exposure was known (biased cases) at the time of diagnosis. Seven of the
cases of parathyroid adenoma were classified as biased cases. The
standardized incidence ratio (SIR) was 2.10 (95% confidence interval
1.52-2.82) when all cases were included and 1.76 (95% CI 1.23-2.43) with
the biased cases excluded. A linear dose-response model with
stratification for sex fitted the data best. The ERR per gray was 3.84
(95% CI 1.56-8.99) with all cases and 1.56 (95% CI 0.36-4.45) with the
biased cases excluded. There was a significant difference in the ERR per
gray between the two subcohorts, probably because of different
diagnostic activity in the regions. Our findings confirm that there is a
dose-response relationship for radiation-induced parathyroid adenomas.
7
UI - 12324759
AU - Wu HS; Liu YC; Kao A; Wang JJ; Ho ST
TI -
Using technetium 99m tetrofosmin parathyroid imaging to detect
parathyroid adenoma and its relation to P-glycoprotein expression.
SO - Surgery 2002 Sep;132(3):456-60
AD - Department of Surgery, Show-Chwan Memorial Hospital, Changhua, Taiwan.
BACKGROUND: The purpose of this study was to retrospectively evaluate
technetium 99m tetrofosmin (Tc-TF) uptake in parathyroid adenomas and
compare the results with their expression of multidrug
resistance-mediated 170-kDa P-glycoprotein (Pgp). METHODS: Twenty
patients with larger parathyroid adenomas (> 1.5 g) and the other 40
patients with smaller parathyroid adenomas (0.5-1.5 g) underwent early
and delayed (10-minute and 2-hour) Tc-TF parathyroid imaging before
operation. In this retrospective study, immunohistochemical analyses
were performed on multiple nonconsecutive sections of the 40 parathyroid
adenomas and 40 normal control specimens (20 normal parathyroid glands
and 20 normal thyroid specimens) to detect Pgp expression. RESULTS: The
Tc-TF parathyroid image accurately localized 17 larger and 16 smaller
parathyroid adenomas, but not the remaining 3 larger and 4 smaller
adenomas. The 17 larger and 16 smaller parathyroid adenomas with
significant Tc-TF uptake on the delayed 2-hour parathyroid images
revealed negative Pgp expression, but the 3 larger and 4 smaller
adenomas without significant Tc-TF uptake, as well as 20 normal
parathyroid glands and 20 normal thyroid specimens, revealed positive
Pgp expression. CONCLUSIONS: Not only the size of parathyroid adenomas,
but Pgp expression also limited the sensitivity of Tc-TF parathyroid
image to localize parathyroid adenomas before the operation.
8
UI - 11322456
AU - Tyler D 3rd; Mandybur G; Dhillon G; Fratkin J
TI -
Intracranial metastatic parathyroid carcinoma: case report.
SO - Neurosurgery 2001 Apr;48(4):937-9; discussion 939-40
AD - Department of Neurosurgery, University of Mississippi, Jackson, USA.
OBJECTIVE AND IMPORTANCE: Parathyroid carcinoma is a rare entity, and
fewer than 200 cases have been described. It is a slowly progressive
disease characterized by frequent recurrences and local metastases. Most
patients with parathyroid carcinoma die from metabolic complications of
hyperparathyroidism. Five-year survival rates range from 25 to 50%.
Functional parathyroid carcinoma is a rare cause of hyperparathyroidism
that affects only 0.32 to 5% of all patients who undergo surgery for
hypercalcemia. A review of the literature revealed only one other
reported case of metastatic intracranial parathyroid carcinoma, in a
patient who experienced local recurrence and metastatic disease when she
was diagnosed with an intracranial lesion. CLINICAL PRESENTATION: We
report the case of a 44-year-old African-American man with recent-onset,
right lower-extremity weakness and hypercalcemia 4 years after he
underwent a parathyroidectomy for parathyroid carcinoma. At
presentation, his parathyroid level was 467 pg/ml, and his serum calcium
level was 15.2 mg/dl. Imaging studies revealed an isolated enhancing
left mesial frontoparietal mass. A systemic Cardiolite study
demonstrated a single focus of radiotracer uptake in this region. No
abnormal uptake was demonstrated in the neck or elsewhere. INTERVENTION:
The patient underwent a frameless stereotactic interventional magnetic
resonance imaging-guided resection via a parasagittal interhemispheric
approach. Pathological findings were consistent with parathyroid
carcinoma. After resection, his right lower-extremity weakness and
secondary hyperparathyroidism resolved. CONCLUSION: The typical natural
history of parathyroid carcinoma concludes with death from complications
of hyperparathyroidism. This case report supports aggressive surgical
management to eliminate all parathyroid hormone-secreting malignant
tissue and prevent metabolic complications. In this patient,
intraoperative magnetic resonance imaging was helpful to ensure complete
resection.
9
UI - 11859834
AU - Yamamoto T; Matsumura A; Nose T
TI -
Intracranial metastatic parathyroid carcinoma: case report.
SO - Neurosurgery 2001 Dec;49(6):1487
10
UI - 12209236
AU - Kammori M; Nakamura K; Kanauchi H; Obara T; Kawahara M; Mimura Y;
TI -
Kaminishi M; Takubo K
Consistent decrease in telomere length in parathyroid tumors but
alteration in telomerase activity limited to malignancies: preliminary
report.
SO - World J Surg 2002 Sep;26(9):1083-7
AD - Department of Surgery, Endocrine and Metabolic Unit, The University of
Tokyo, 3-28-6 Mejirodai, Bunkyo-ku, Tokyo 112-8688, Japan.
kanmori-dis@umin.ac.jp
Telomerase is known to be activated and telomere length altered in
various types of malignant and benign tumors, but whether this is also
the case for parathyroid lesions has hitherto been unclear. We therefore
investigated telomerase activity and telomere length in 3 parathyroid
metastatic cancers, 6 adenomas, 2 cases of parathyroid hyperplasia, and
16 samples of normal parathyroid tissue. Telomerase activity, assayed by
the telomeric repeat amplification protocol, was detected in all of the
parathyroid cancers (100%), in none of the 8 parathyroid benign lesions,
and in only 1 of the 16 normal parathyroid samples (8.3%). Telomere
length, determined by the terminal restriction fragment assay, was
reduced in the tumor tissues with a mean telomere length of 8.23 +/-
0.86 kbp compared with the 12.61 +/- 0.81 kbp for the 16 age-matched
subjects (p = 0.002). The results indicate that telomerase activity and
telomere length may reflect the biologic behavior of individual
parathyroid lesions.
11
UI - 11354841
AU - Tewari KS; Steiger RM; Lam ML; Rutgers JK; Berkson RA; DiSaia PJ
TI -
Bilateral pheochromocytoma in pregnancy heralding multiple endocrine
neoplasia syndrome IIA. A case report.
SO - J Reprod Med 2001 Apr;46(4):385-8
AD - Divisions of Gynecologic Oncology and Maternal-Fetal Medicine and
Department of Obstetrics and Gynecology, University of California,
Irvine, Medical Center, Orange, 101 The City Drive, Orange, CA 92868,
USA.
BACKGROUND: Multiple endocrine neoplasia syndrome type IIA (MEN IIA) has
rarely been encountered in pregnancy. CASE: A 22-year-old, nulliparous
woman developed bilateral pheochromocytomas during pregnancy. This
finding aroused suspicion for MEN IIA, and close endocrinologic
follow-up was arranged. Four years later, hyperparathyroidism developed,
and the diagnosis was established. The patient underwent prophylactic
total thyroidectomy with parathyroid exploration. CONCLUSION: This was
the first case of MEN IIA in pregnancy in which the diagnosis was
established prior to the development of medullary thyroid cancer,
thereby allowing prophylactic thyroidectomy. The presence of bilateral
neoplastic disease in young patients may be indicative of a hereditary
predisposition to malignancy.
12
UI - 12168145
AU - Hansler J; Harsch IA; Strobel D; Hahn EG; Becker D
TI -
[Treatment of a solitary adenoma of the parathyroid gland with
ultrasound-guided percutaneous Radio-Frequency-Tissue-Ablation (RFTA)]
SO - Ultraschall Med 2002 Jun;23(3):202-6
AD - Medizinische Klinik I mit Poliklinik der Friedrich-Alexander-Universitat
Erlangen-Nurnberg. johannes.haensler@med1.imed.uni-erlangen.de
Radio-Frequency-Tissue-Ablation (RFTA) for the treatment of primary and
secondary tumours of the liver has been used for several years, but this
minimally invasive treatment is not limited to the liver. A patient
suffering from symptomatic postmenopausal osteoporosis, additionally
having primary hyperparathyroidism since 1995, refused a surgical
resection of the adenoma of the parathyroid gland. Sonographically a 16
mm hypoechoic tumour dorsal of the right upper pole of the thyroid gland
was detected. Osteodensitometry: severe osteoporosis of the lumbar spine
(88 % of the norm for this age group). Blood check: Elevation of serum
calcium level (3.1mmol/l) and serum parathormone level 274 pg/dl (N:
10-50). A percutaneous ultrasound guided RFTA of the adenoma of the
thyroid gland was carried out. After RFTA the serum parathormone levels
and the serum calcium levels dropped back to normal. The patient was
followed-up for one year. For the first time a sufficient therapy for
osteoporosis comprising calcium, etidronate and cholecalciferol could be
carried out. The osteodensitometry carried out one year after treatment
showed an increase in bone density. For the treatment of symptomatic
primary hyperparathyroidism RFTA can be a therapeutic alternative for
patients with contraindications for surgery.
13
UI - 12362873
AU - Sall M; Kissmeyer-Nielsen P; Kiil J
TI -
[Cystic parathyroid adenoma. A rare cause of primary
hyperparathyroidism]
SO - Ugeskr Laeger 2002 Sep 9;164(37):4291-2
AD - Viborg Sygehus, organkirurgisk afdeling. sall@dadlnet.dk
Two cases of primary hyperparathyroidism associated with parathyroid
cysts were identified by an elevated plasma Ca++ level. The diagnosis
was established preoperatively by the presence of high quantities of PTH
in the cyst fluid in one of the patients. Cysts in the neck or superior
mediastinum should raise suspicion of primary hyperparathyroidism.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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