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Abramson Cancer CenterNCI CANCERLIT® Search: Parathyroid Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 21397988
AU - Rubello D; Piotto A; Pagetta C; Pelizzo M; Casara D
TI -
Ectopic parathyroid adenomas located at the carotid bifurcation: the
role of preoperative Tc-99m MIBI scintigraphy and the intraoperative
gamma probe procedure in surgical treatment planning.
SO - Clin Nucl Med 2001 Sep;26(9):774-6
AD - Nuclear Medicine Service 2, Regional Hospital and University of Padova,
via Giustiniani 2, 35100 Padua, Italy.
PURPOSE: The prevalence of ectopic parathyroid adenoma (PA) is
relatively low, despite some studies in which it has been reported to be
as high as 20%. Ectopic PA is a frequent cause of surgical failure, and
therefore some authors recommend preoperative imaging to localize the
condition in patients with primary hyperparathyroid (HPT) disease before
initial surgery. METHODS: Two unusual cases of primary HPT caused by an
ectopic PA located at the carotid bifurcation are reported. The patients
were examined before operation using Tc-99m MIBI scintigraphy and then
underwent radioguided surgery using the intraoperative gamma probe
technique with injection of a low dose (37 MBq; 1 mCi) of Tc-99m MIBI.
RESULTS: The first patient had a history of primary HPT and coexisting
multinodular goiter. She had undergone total thyroidectomy in another
center, but no enlarged parathyroid gland was found at bilateral neck
exploration and serum calcium and parathyroid hormone levels remained
elevated after intervention. The patient was referred to our center. A
Tc-99m MIBI scan showed a focus of abnormal tracer uptake in the
superior left laterocervical region that was thought to be a PA. The
next day she underwent radioguided surgery and an 18-mm PA located at
the left carotid bifurcation was easily removed through a 2.5-cm skin
incision. The second patient was examined in our center before surgery.
A neck ultrasound showed a multinodular goiter but no enlarged
parathyroid glands. A pertechnectate-MIBI subtraction scan revealed a
focus of abnormal Tc-99m MIBI uptake in the right superior
laterocervical region that was thought to be a PA. One week later, at
radioguided surgery, a 25-mm PA was identified at the right carotid
bifurcation and removed successfully. CONCLUSIONS: These data strongly
support the utility of preoperative imaging with Tc-99m MIBI in patients
with primary HPT before initial neck exploration with the aim of
avoiding surgical failure. Furthermore, the intraoperative gamma probe
technique seems to be useful to reduce surgical trauma and, possibly,
complications in patients with ectopic PA.
2
UI - 21415194
AU - Kacker A; Komisar A
TI -
Unilateral versus bilateral neck exploration in parathyroid surgery: an
assessment of 55 cases.
SO - Ear Nose Throat J 2001 Aug;80(8):530-2, 534
AD - Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital,
100 E. 77th St., New York, NY 10021, USA.
We retrospectively evaluated the cases of 55 patients who had undergone
surgery for primary hyperparathyroidism at our institution to determine
whether their parathyroid glands were abnormal on both sides. Thirty-six
of these patients had undergone a bilateral neck exploration, and 19 had
had a unilateral investigation. Of the 36 bilaterally explored patients,
30 had a solitary adenoma and no parathyroid pathology on the opposite
side, five patients had hyperplastic glands with more than one gland
involved, and one patient had two adenomas. In the unilaterally explored
group, all 19 patients had a solitary adenoma. There were no failures in
the way of persistent hypercalcemia in either group. Based on our
findings, we conclude that a unilateral neck exploration should be
performed during surgery for primary hyperparathyroidism whenever a
large parathyroid adenoma and a normal parathyroid gland are found on
the same side. Bilateral exploration should be reserved for patients in
whom pathology cannot be found on the initially explored side during
surgery and for patients who have obvious parathyroid hyperplasia.
3
UI - 21300307
AU - Bergwitz C; Bremer B; Soudah B; Mayr B; Brabant G
TI -
Familial isolated parathyroid adenoma in a consanguineous family.
SO - J Endocrinol Invest 2001 May;24(5):349-55
AD - Dept. of Clinical Endocrinology, Medical School of Hannover, Germany.
bergwitc@mail.nih.gov
The 23-year-old Caucasian male propositus presented with symptomatic
hypercalcemia, hypophosphatemia and normocalciuria for 2 months. His
29-year-old brother had undergone an operation for recurrent parathyroid
adenoma at age 26 and 28. No other member of the family was affected.
His father and mother were second-degree relatives. Laboratory studies
showed primary hyperparathyroidism (pHPT), while the remaining endocrine
studies and genetic testing for multiple endocrine neoplasia 1 and 2A
were normal. Technetium-cardiolite scintigraphy and ultrasound scans
revealed a parathyroid mass at the left lower neck. Apart from bilateral
hearing loss due to gentamicin treatment as a pre-term child, the
patient was in of good health. Signs or symptoms of other
endocrinopathies were absent. The patient was referred for
parathyroidectomy with subsequent autotransplantation of the remaining
glands into his sternocleidomastoid muscle. Histological examination
revealed an adenoma with oncocytic differentiation, similar to that seen
in his brother. The disease may follow a recessive mode of inheritance
or may be due to a dominant germ-cell mutation in one of the parents.
The presented case may ultimately help in elucidating the molecular
genetic basis of this rare form of pHPT.
4
UI - 21344950
AU - Demirkol MO; Birinci HS; Kadioglu A
TI -
Intense skeletal lesions in a patient with primary hyperparathyroid
disease.
SO - Clin Nucl Med 2001 Aug;26(8):727-8
AD - Department of Nuclear Medicine, Kosuyolu Heart and Research Hospital,
Istanbul, Turkey. onurdemirkol@hotmail.com
5
UI - 21302902
AU - Schmidt H; Kusser B; Spelsberg F
TI -
Asymptomatic hypercalcemia due to an ectopic parathyroid adenoma in an
8-year-old boy.
SO - Exp Clin Endocrinol Diabetes 2001;109(3):184-6
AD - Kinderklinik und Kinderpoliklinik im Dr. v. Haunerschen Kinderspital der
Universitat Munchen, Germany.
The diagnosis of primary hyperparathyroidism in children is often
delayed and is usually based on symptoms of hypercalcemia rather than
abnormal laboratory values alone. We report the case of an 8-year-old
boy with hypercalcemia, hypophosphatemia and mildly, but inadequately
elevated intact parathyroid hormone (iPTH) who presented without any
symptoms of hyperparathyroidism. Although imaging studies were
misleading and four normal parathyroid glands were found
intraoperatively, exploration of the thymus revealed an ectopic
parathyroid adenoma. After removal of the ectopic gland, a rapid iPTH
immunoassay proved immediate normalization of iPTH. This is the first
report of sporadic isolated primary hyperparathyroidism diagnosed in an
asymptomatic child on the basis of hypercalcemia and hypophosphatemia.
6
UI - 21301911
AU - Shaha AR; Ferlito A; Rinaldo A
TI -
Distant metastases from thyroid and parathyroid cancer.
SO - ORL J Otorhinolaryngol Relat Spec 2001 Jul-Aug;63(4):243-9
AD - Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York,
NY 10021, USA. shahaa@mskcc.org
Thyroid cancer represents a unique biological tumor where even with the
high incidence of distant metastases, the overall prognosis is not as
poor as many other human cancers. The overall long-term survival in
patients presenting initially with distant metastasis is approximately
50%. The overall incidence of distant metastases varies between 10 and
35%, depending upon the histology. The overall incidence is directly
related to various histologies - being least in papillary thyroid
carcinoma (10%) and highest in Hurthle cell tumor (33%). The incidence
of distant metastases is also very high in patients with medullary and
anaplastic thyroid cancer. The incidence of distant metastases at the
time of initial presentation in differentiated thyroid cancer is
approximately 4%. In high-risk patients - especially in patients with
extrathyroidal extension or massive nodal metastasis - the distant
metastases can be evaluated after total thyroidectomy with radioactive
iodine ablation. Pulmonary metastases are very common in young
individuals, but they are extremely well treated and the mortality from
distant metastases in this group is very low. However, distant
metastases in patients with poorly-differentiated carcinoma have a poor
prognosis. In high-risk patients, generally a total thyroidectomy should
be undertaken so that the patient can undergo radioactive iodine
dosimetry and ablation as indicated. The surveillance in patients with
thyroid cancer includes: close clinical follow-up, chest X-ray, and
radioactive iodine dosimetry. Thyroglobulin is commonly used as a
prognostic marker in patients having undergone total thyroidectomy. The
incidence of distant metastases in medullary thyroid cancer is high,
mainly to the lung and liver. Persistent hypercalcitonemia is an
indication of regional or distant metastases. A variety of diagnostic
tests are helpful, such as octreotide scanning, computed tomography
scan, magnetic resonance imaging and positron emission tomography scan.
Laparoscopy to evaluate the surface of the liver is also an important
investigation to detect distant metastases. The incidence of distant
metastases is very high in patients with anaplastic thyroid cancer, but
most of the time the outcome depends on the locoregional recurrence and
massive disease in the central compartment. The parathyroid cancer is
quite rare, less than 1%, in patients undergoing parathyroidectomy. The
diagnosis of parathyroid cancer is made by pathological features but the
most certain method of diagnosis of a malignant tumor of the parathyroid
is the identification of secondary deposits. The incidence of distant
metastasis is difficult to determine due to the rarity of this
condition, but the most common site is the lung. Patients with distant
metastasis have recurrent progressive hypercalcemia along with high
parathormone level. Copyright 2001 S. Karger AG, Basel
7
UI - 20303470
AU - Goshen O; Aviel-Ronen S; Dori S; Talmi YP
TI -
Brown tumour of hyperparathyroidism in the mandible associated with
atypical parathyroid adenoma.
SO - J Laryngol Otol 2000 Apr;114(4):302-4
AD - Department of Otolaryngology-Head and Neck Surgery, Chaim Sheba Medical
Center, Tel Hashomer, Israel.
The brown tumour of hyperparathyroidism is a localized bone tumour and
an uncommon manifestation of hyperparathyroidism. A 27-year-old woman
presented with a mandibular 8 x 10 cm solid mass diagnosed as central
giant cell granuloma. Chemical blood analysis revealed increased serum
calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124
pg/dL. The patient underwent surgery with removal of a parathyroid mass.
Histologically, this parathyroid tissue was seen to be limited by a
fibrous capsule with morphological features consistent with atypical
parathyroid adenoma. The mandibular tumour has receded and the patient
declined further procedures. This is the first case reported of brown
tumour as the primary manifestation of an atypical parathyroid adenoma,
a lesion that shares some features with parathyroid carcinoma without
the unequivocal properties of malignancy.
8
UI - 21260334
AU - Kar DK; Agarwal G; Mishra SK
TI -
Brown tumour of hyperparathyroidism in the mandible associated with
parathyroid adenoma.
SO - J Laryngol Otol 2001 Apr;115(4):352-3
9
UI - 21381198
AU - Horanyi J; Duffek L; Darvas K; Szlavik R; Pinkola K; Dabasi G; Horvath C
TI -
[New intraoperative diagnostic methods in parathyroid surgery:
intraoperative measurement of parathyroid hormone]
SO - Orv Hetil 2001 Jun 24;142(25):1327-9
AD - Altalanos Orvostudomanyi Kar, I. Sebeszeti Klinika, Semmelweis Egyetem,
Budapest.
intraoperative intact parathyroid hormone level were studied.
Preoperative samples of blood were taken from a peripheral vein before
the beginning the operation. The second sample was taken 5 minutes after
removal of parathyroid adenoma. The plasma intact parathyroid hormone
concentration was measured by quick IRMA method. The preoperative high
PTH levels reduced after excision of adenoma to the mean 18%. 33
patients had normal PTH levels after 5 minutes of removing. The total
measuring time of quick PTH assay was about 30 minutes. The QPTH assay
was a quantitative adjunct for the surgeon to ensure a successful
parathyroidectomy. When the intraoperative QPTH level is not reduced to
50%, then the exploration should be continued and the probability of
reoperation is decreased. They propose the application of the routine
intraoperative measurement of QPTH level in all parathyroidectomy.
10
UI - 21446356
AU - Cundiff JG; Portugal L; Sarne DH
TI -
Parathyroid adenoma after radioactive iodine therapy for multinodular
goiter.
SO - Am J Otolaryngol 2001 Sep-Oct;22(5):374-5
AD - University of Illinois at Chicago, College of Medicine, Chicago, IL,
USA.
The development of hyperparathyroidism after radioactive iodine (RAI)
therapy has been reported in 38 cases in the literature. However, the
development of a parathyroid adenoma after RAI therapy for a
hyperfunctioning multinodular goiter has not been reported. This report
describes the pathologic and operative finding on a patient with both
hyperthyroidism and hyperparathyroidism, which was diagnosed after
previous RAI therapy for a toxic, multinodular goiter.
11
UI - 21486638
AU - Yamamoto T; Matsumura A
TI -
Comment on "Clinical review 122: Parathyroid carcinoma".
SO - J Clin Endocrinol Metab 2001 Oct;86(10):5091
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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