Table of Contents
1
UI - 11937978
AU - Morbois-Trabut L; Saad N; Gervaise N; Legmann P; Lecomte P
TI -
[Diagnostic strategy in persistent hyperparathyroidism. Report of two
cases and review of the literature]
SO - Ann Endocrinol (Paris) 2002 Feb;63(1):18-22
AD - Clinique Medicale B, Hopital Bretonneau - CHRU de Tours, 37044 Tours
Cedex 1, France.
Ectopic adenoma is the main cause of surgery failure in the treatment of
primary hyperparathyroidism (HPT). Localization of the abnormal glands
is therefore necessary before a reoperation. We report two cases
illustrating the interest of MRI and selective venous sampling of
parathormone. In two patients with persistent hyperparathyroidism,
ultrasound and sestamibi scanning failed to localize the ectopic glands.
MRI suggested the presence of an adenoma in the mediastinum for the
first patient and inside the thyroid for the second. In both cases, the
localisation was confirmed by venous sampling and the reoperation was a
success. We review the recent literature on this topic and we propose a
diagnostic approach of persistent HPT.
2
UI - 11859206
AU - Erickson LA; Jin L; Papotti M; Lloyd RV
TI -
Oxyphil parathyroid carcinomas: a clinicopathologic and
immunohistochemical study of 10 cases.
SO - Am J Surg Pathol 2002 Mar;26(3):344-9
AD - Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
55905, USA.
Oxyphil parathyroid carcinomas are uncommon neoplasms, and the
clinicopathologic features of these tumors are largely unknown. We
evaluated the clinicopathologic features of oxyphil parathyroid
carcinomas and the expression of cytokeratin 14 (CK14), the
high-affinity glucose transporter-4 (Glut-4), as well as the cell cycle
proteins p27 and Ki67 and compared these with oxyphil parathyroid
adenomas and chief cell parathyroid adenomas and carcinomas.
Formalin-fixed, paraffin-embedded archival tissues from primary (n = 6)
and recurrent (n = 4) oxyphil carcinomas were analyzed and compared with
chief cell parathyroid carcinomas (n = 12), oxyphil parathyroid adenomas
(n = 38), and chief cell parathyroid adenomas (n = 17) by
immunohistochemistry for CK14, Glut-4, p27, and Ki67 using the
avidin-biotin peroxidase system. Patients with primary oxyphil and chief
cell carcinoma presented with high levels of serum calcium (n = 15.5 and
13.7 mg/dL, respectively). Approximately half the patients in each group
died of disease. The Ki67 labeling index was higher (4.9 vs 1.9) and the
p27 index lower (23 vs 66) in primary oxyphil carcinoma compared with
primary oxyphil adenomas. CK14 was expressed in most oxyphil adenomas
(35 of 38 cases) but not in oxyphil carcinomas (0 of 10 cases). Glut-4
was more commonly expressed in both groups of adenomas compared with
carcinomas. These results show that oxyphil parathyroid carcinomas are
functional malignancies similar to chief cell carcinomas and are
associated with hypercalcemia, recurrence, and death. Expression of CK14
is very different in oxyphil adenomas compared with carcinomas. Although
distinction between parathyroid adenomas and carcinomas can only be made
by histopathologic and clinical findings, these results suggest that
immunostaining for CK14, p27, and Ki67 may provide additional
information to help distinguish between difficult cases of parathyroid
adenomas and carcinomas. These findings also indicate that the same
histopathologic features should be used to diagnose oxyphil and chief
cell parathyroid carcinomas.
3
UI - 11157996
AU - Shane E
TI -
Clinical review 122: Parathyroid carcinoma.
SO - J Clin Endocrinol Metab 2001 Feb;86(2):485-93
AD - Department of Medicine, Columbia University College of Physicians and
Surgeons, New York, New York 10032, USA.
4
UI - 11600598
AU - Yamamoto T; Matsumura A
TI -
Comment on "Clinical review 122: Parathyroid carcinoma".
SO - J Clin Endocrinol Metab 2001 Oct;86(10):5091
5
UI - 11996789
AU - Hemmer S; Wasenius VM; Haglund C; Zhu Y; Knuutila S; Franssila K;
TI -
Joensuu H
Alterations in the suppressor gene PPP2R1B in parathyroid hyperplasias
and adenomas.
SO - Cancer Genet Cytogenet 2002 Apr 1;134(1):13-7
AD - Department of Oncology, Haartmaninkatu 4, P.O. Box 180, FIN-00029 HUS,
Helsinki, Finland.
Deletion of chromosome 11q23 is a common alteration in parathyroid
adenomas and hyperplasias. A new potential suppressor gene PPP2R1B
encoding the beta isoform of the A subunit of the serine/threorine
protein phosphatase 2A was recently identified and localized to
chromosome 11q23. We performed polymerase chain reaction-based
single-strand conformation polymorphism and direct sequencing on six
parathyroid hyperplasias and 12 adenomas to evaluate the role of PPP2R1B
in the pathogenesis of parathyroid lesions. A previously identified
germline G-A transition (GGC-GAC) in codon 90, changing glycine (Gly) to
aspartic acid (Asp), was detected in one adenoma. Both the common Gly
allele and the variant Asp allele were detected by direct sequencing in
the patient's somatic cells. We conclude mutations of PPP2R1B are not
frequent in parathyroid lesions, and that other genes located at 11q23
may be more closely associated with pathogenesis of parathyroid
hyperplasia and adenoma.
6
UI - 11914930
AU - Hubbard JG; Sebag F; Maweja S; Henry JF
TI -
Primary hyperparathyroidism in MEN 1--how radical should surgery be?
SO - Langenbecks Arch Surg 2002 Mar;386(8):553-7
AD - Department of Endocrine Surgery, University Hospital La Timone,
Boulevard Jean Moulin, 13385 Marseilles Cedex 5, France.
Primary hyperparathyroidism is the most common manifestation of MEN 1
syndrome. The management of these patients is complex due to the
underlying disease process, which predisposes patients to persistent and
recurrent disease. The surgical treatment of patients with MEN 1 and
hyperparathyroidism can therefore be considered to be palliative in
nature. The basic principles of surgery include (1) obtaining and
maintaining normocalcaemia for the longest time possible, avoiding
persistent/recurrent hypercalcaemia, (2) avoiding surgically induced
hypocalcaemia, and (3) facilitating future surgery for recurrent
disease. Two approaches have been described as the best practice for
patients with hyperparathyroidism in MEN 1: subtotal parathyroidectomy,
leaving a remnant of no more than 60 mg in the neck, and total
parathyroidectomy with immediate autotransplantation of 10-20 1 mm(3)
pieces of parathyroid tissue. Both approaches should be combined with
efforts to exclude supernumerary glands and ectopic parathyroid tissue
by including resection of fatty tissue from the central neck compartment
and thymectomy in all patients. Cryopreservation of parathyroid tissue
should be performed whenever facilities are available. In patients with
persistent or recurrent disease, an attempt to obtain total elimination
of cervical parathyroid tissue is justified, combined with
cryopreservation of parathyroid tissue. As radical as surgery is for
hyperparathyroidism in MEN 1, the surgeon must take steps to avoid
permanent hypoparathyroidism, which in young patients may be worse than
the disease itself.
7
UI - 10069658
AU - Li-Fern H; Rajasoorya C
TI -
The elevated serum alkaline phosphatase--the chase that led to two
endocrinopathies and one possible unifying diagnosis.
SO - Eur J Endocrinol 1999 Feb;140(2):143-7
AD - Department of Medicine, Alexandra Hospital, Singapore.
A 39-year-old Chinese man with hypertension being evaluated for elevated
serum alkaline phosphatase (SAP) levels was found to have an incidental
right adrenal mass. The radiological features were characteristic of a
large adrenal myelolipoma. This mass was resected and the diagnosis
confirmed pathologically. His blood pressure normalised after removal of
the myelolipoma, suggesting that the frequently observed association
between myelolipomas and hypertension may not be entirely coincidental.
Persistent elevation of the SAP levels and the discovery of
hypercalcaemia after surgery led to further investigations which
confirmed primary hyperparathyroidism due to a parathyroid adenoma. The
patient's serum biochemistry normalised after removal of the adenoma.
The association of adrenal myelolipoma with primary hyperparathyroidism
has been reported in the literature only once previously. Although
unconfirmed by genetic studies this association may possibly represent
an unusual variation of the multiple endocrine neoplasia type 1
syndrome.
8
UI - 11980300
AU - Monneuse O; Causeret S; Lifante JC; Berger N; Lapras V; Peix JL
TI -
[Primary juvenile hyperparathyroidism. Report of 24 cases]
SO - Ann Chir 2002 Apr;127(4):276-80
AD - Service de chirurgie, hopital de l'Antiquaille, 69321 Lyon, France.
AIM OF THE STUDY: Primary hyperparathyroidism usually affects elderly
patients. Juvenile primary hyperparathyroidism is rare, and raises
diagnostic and prognostic problems. The aim of this retrospective study
on 24 patients is to establish clinical, histological, and therapeutic
features of juvenile primary hyperparathyroidism. PATIENTS AND METHODS:
From 1986 to 2001, 673 patients were treated for primary
hyperparathyroidism in our department. Twenty four patients were younger
than 30 years old (3.5%). There were 14 women and 10 men. Mean age was
23 year (14-30). Clinical manifestations, pathologics findings and
postoperative results were studied. RESULTS: Sixteen patients presented
a sporadic form of primary hyperparathyroidism with a single adenoma.
Clinical manifestations were renal symptoms in 11 cases and acute
hypercalcemia syndrome in 2 cases. Seven patients had a NEM I syndrome:
parathyroid lesions were 6 hyperplasia and one adenoma. A 27 years old
woman presented a recurrent familial isolated hyperparathyroidism. She
was operated on 10 years before and at reoperation parathyroid carcinoma
was found. Nineteen patients were cured after a post operative follow up
ranging from 3 to 168 months. One patient had an asymptomatic
hypercalcemia recurrence. Two patients presented permanent
hypoparathyroidism treated with calcitriol and calcium. CONCLUSION:
Sporadic forms represent majority of cases of juvenile
hyperparathyroidism. Renal manifestations are usual. Nevertheless,
multiple endocrine neoplasia type 1 has to be evocated.
9
UI - 11836555
AU - Ikeda S; Ishizaki Y; Shimizu Y; Fujimori M; Ojima Y; Okajima M; Sugino
TI -
K; Asahara T
Immunohistochemistry of cyclin D1 and beta-catenin, and mutational
analysis of exon 3 of beta-catenin gene in parathyroid adenomas.
SO - Int J Oncol 2002 Mar;20(3):463-6
AD - Second Department of Surgery, Hiroshima University Faculty of Medicine,
Hiroshima 734-8551, Japan. sikeda@hiroshima-u.ac.jp
Parathyroid adenomas are benign uniglandular tumors and are the most
common cause of primary hyperparathyroidism. Several genetic changes in
parathyroid tumors, including inactivation of tumor suppressor genes,
activation of oncogenes and loss of heterozygosity at several
chromosomal loci, have been reported. In this study, we analyzed the
status of cyclin D1 and beta-catenin in 24 cases of parathyroid adenoma.
Immunohistochemistry of cyclin D1 showed positive staining in 9 (37.5%)
of the 24 parathyroid adenomas. The status of beta-catenin, which has
recently been identified as a regulator of cyclin D1 transcription, was
examined by direct sequencing of exon 3 of the beta-catenin gene and
immunohistochemistry of beta-catenin protein, but neither mutation nor
accumulation of beta-catenin was detected in any of the cases. These
results indicate that cyclin D1 is frequently accumulated in parathyroid
adenomas, independently of dysfunction in the Wnt signaling pathway.
10
UI - 11981213
AU - Nichol PF; Starling JR; Mack E; Klovning JJ; Becker BN; Chen H
TI -
Long-term follow-up of patients with tertiary hyperparathyroidism
treated by resection of a single or double adenoma.
SO - Ann Surg 2002 May;235(5):673-8; discussion 678-80
AD - Department of Surgery, University of Wisconsin Medical School, Madison,
Wisconsin 53792, USA.
OBJECTIVE: To determine whether patients with tertiary
hyperparathyroidism due to single- or two-gland disease undergoing
limited resection have similar long-term outcomes compared with patients
with hyperplasia undergoing subtotal or total parathyroidectomy. SUMMARY
BACKGROUND DATA: Tertiary hyperparathyroidism occurs in less than 2% of
patients after renal transplantation. Approximately 30% of these cases
are caused by one or two hyperfunctioning glands. Nevertheless, the
standard operation for this disease has been subtotal or total
parathyroidectomy with autotransplantation. METHODS: Seventy-one
patients underwent surgery for tertiary hyperparathyroidism. At the time
of surgery, 19 patients who had a single or double adenoma underwent
limited resection of the enlarged glands only (adenoma group). The
remaining 52 patients with three- or four-gland hyperplasia had subtotal
or total parathyroidectomy with implantation (hyper group). Long-term
cure rates between the two groups were compared. RESULTS: In the adenoma
group, 7 patients had a single adenoma and 12 underwent resection of a
double adenoma. In the hyper group, 49 patients had subtotal and 3 had
total parathyroidectomies. After surgery, 70 of 71 patients (99%) were
cured of their hypercalcemia. The incidence of postoperative transient
hypocalcemia was significantly higher in the hyper group (27% vs. 5%).
No patients in either group had permanent hypocalcemia requiring
long-term supplementation. With up to 16 years of follow-up, there have
been no recurrences in the adenoma group, whereas three patients (6%) in
the hyper group have had recurrent or persistent hyperparathyroidism.
CONCLUSIONS: Patients with tertiary hyperparathyroidism who underwent
limited resection of a single or double adenoma only had equivalent
long-term cure rates compared with patients undergoing more extensive
resections. Therefore, the authors recommend in patients with tertiary
hyperparathyroidism and enlargement of only one or two parathyroid
glands that the resection be limited to these abnormal glands only.
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