Top

Published in:

01-05-2006

Indian Primary Hyperparathyroidism Patients with Parathyroid Carcinoma do not Differ in Clinicoinvestigative Characteristics from Those with Benign Parathyroid Pathology

Authors: Gaurav Agarwal, MS, DNB, PDC, Kaushal K. Prasad, MD, PDC, Dilip K Kar, MS, PDC, Narendra Krishnani, MD, Rakesh Pandey, MD, Saroj K. Mishra, MS, FACS

Published in: World Journal of Surgery | Issue 5/2006

Abstract

Introduction

No foolproof preoperative diagnostic indicators of parathyroid carcinoma (PC) exist in absence of nonskeletal metastases. Palpable parathyroid tumor, advanced skeletal and renal manifestations, and very high serum calcium and parathyroid hormone levels are considered strong predictors. Most of these features are common in Indian primary hyperparathyroidism (PHPT) patients although only few have PC. The aim of this study was to identify dependable clinicoinvestigative predictors of PC in Indian PHPT patients.

Materials and Methods

Clinical, biochemical, radiological, and densitometric attributes of 100 PHPT patients who underwent successful parathyroidectomy (1990–2004) were studied. Various parameters of patient groups with parathyroid adenoma (n = 84), primary hyperplasia (n = 12), and carcinoma (n = 4) were compared using ANOVA, with P value < 0.05 considered significant.

Results

Mean age of patients was 37.4 years, with no difference in the 3 groups (P = 0.92). Patients in 3 groups had comparably severe bone disease; 36 had coexistent renal disease. Two patients with PC and 27 (32%) with adenoma had palpable parathyroid tumor. None of the biochemical parameters predicted malignant pathology. Mean tumor weight (milligram) in carcinoma patients (15,080 ± 5,638.02) was significantly higher than those with adenoma (5,724 ± 1,257.9) (P = 0.002). Postoperative course and recovery in carcinoma patients were similar to those with adenoma. In follow-up (mean: 33 months), none of the adenoma patients were found to have persistent/recurrent PHPT attributable to missed PC.

Conclusion

Indian patients with parathyroid adenoma, hyperplasia, and carcinoma were not found to differ in their clinical, biochemical, and pathological characteristics except for significantly higher tumor weight in the carcinoma group.

Wang CA, Gaz RD. Natural history of parathyroid carcinoma. Diagnosis, treatment and results. Am J Surg 1985;149:522–527PubMed

Obara T, Fujimoto Y. Diagnosis and treatment of patients with parathyroid carcinoma: An update and review. World J Surg 1991;15:738–744CrossRefPubMed

DeLellis RA. Parathyroid carcinoma: an overview. Adv Anat Pathol. 2005;12(2):53–61CrossRefPubMed

Mishra SK, Agarwal G, Kar DK, et al. Unique clinical characteristics of primary hyperparathyroidism in India. Br J Surg 2001;88: 708–714CrossRefPubMed

Agarwal G, Mishra SK, Kar DK, et al. Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy. Surgery. 2002;132(6):1075–1083CrossRefPubMed

Biyabani SR, Talati J. Bone and renal stone disease in patients operated for primary hyperparathyroidism in Pakistan: is the pattern of disease different from the west? J Pak Med Assoc 1999;49(8):194–198PubMed

Fujimoto Y, Obara T, Ito Y, et al. Surgical treatment of ten cases of parathyroid carcinoma: importance of an initial en bloc tumor resection. World J Surg 1984;8(3):392–400CrossRefPubMed

Iacobone M, Lumachi F, Favia G. Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 2004;88(4):223–228CrossRefPubMed

Kebebew E. Parathyroid carcinoma. Curr Treat Options Oncol 2001;2(4):347–354PubMed

10.

Robert JH, Trombetti A, Garcia A, et al. Primary hyperparathyroidism: can parathyroid carcinoma be anticipated on clinical and biochemical grounds? Report of nine cases and review of the literature. Ann Surg Oncol 2005;12(7):526–532CrossRefPubMed

11.

Schantz A, Castleman B. Parathyroid carcinoma: a study of 70 cases. Cancer 1973;31:600–605PubMed

12.

Åkerström G, Grimelius L, Johansson H, et al. The parenchymal cell mass in normal human parathyroid glands. Acta Pathol Microbiol Scand 1981;89:367–375

13.

Grimelius L, et al. Anatomy and histopathology of human parathyroid glands. Pathol Annu 1981;16:1–24PubMed

14.

Anderson BJ, Samaan NA, Vassilopoulou-Sellin R, et al. Parathyroid carcinoma: features and difficulties in diagnosis & management. Surgery 1983;94:906–915PubMed

15.

Shane E, Bilezikian JP. Parathyroid carcinoma: a review of 62 patients. Endocr Rev 1982;3:218–226PubMedCrossRef

16.

Shortell CK, et al. Carcinoma of the parathyroid gland: A 30-year experience. Surgery 1991;110(4):704–708PubMed

17.

Fujimoto Y, Obara T. How to recognize and treat parathyroid carcinoma [Review]. Surg Clin North Am 1987;67:343–357PubMed

18.

Åkerström G. Non-Familial primary hyperparathyroidism. Semin in Surgical Oncol 1997;13:104–113CrossRef

19.

Bhansali A, Masoodi SR, et al. Primary hyperparathyroidism in north India: a description of 52 cases. Ann Saudi Med 2005;25(1):29–35PubMed

20.

Kapur MM, Agrawal MS, Gupta A, et al. Clinical and biochemical features of primary hyperparathyroidism. Indian J Med Res 1985;81:607–612PubMed

21.

Harinarayan CV, Gupta N, Kochupillai N. Vitamin D status in primary hyperparathyroidism in India. Clin Endocrinol 1995;43:351–358

22.

Ingemansson SG, Hugosson CH, Woodhouse NJY. Vitamin D deficiency and hyperparathyroidism with severe bone disease. World J Surg 1988;12:517–521CrossRefPubMed

23.

Chan SP, Hew FL, Jayaram G, et al. A case report of primary hyperparathyroidism with severe bony involvement and nephrolithiasis. Ann Acad Med Singapore 2001;30(1):66–70PubMed

24.

Velazquez D, et al. Clinical characteristics and course of severe hypercalcemia caused by primary hyperparathyroidism in surgically treated patients. Rev Invest Clin 2000;52(6):618–426PubMed

25.

Deshmukh RG, Alsagoff SA, Krishnan S, et al. Primary hyperparathyroidism presenting with pathological fracture. J R Coll Surg Edinb. 1998;43(6):424–427PubMed

26.

Bandeira F, Caldas G, Freese E, et al. Relationship between serum vitamin d status and clinical manifestations of primary hyperparathyroidism. Endocr Pract 2002;8(4):266–270PubMed

27.

Sawa TE, Safar SB. Pathological fracture: a common presentation of primary hyperparathyroidism in Iraq. Eur J Surg 1996;162(10):777–781PubMed

28.

Lopez JM, Sapunar J, Campusano C, et al. Changes in the clinical presentation of primary hyperparathyroidism. Analysis of 84 cases (Spanish). Rev Med Chil 1993;121(3):265–272PubMed

29.

Kleeman CR, Norris K, Coburn JW. Is the clinical expression of primary hyperparathyroidism a function of long-term vitamin D status of the patient? [Review]. Mineral Electrolyte Metab 1987;13:305–310

30.

Awumey EM, Mitra DA, Hollis BW, et al. Vitamin D metabolism is altered in Asian Indians in the Southern United States: A clinical research center study. J Clin Endocrinol Metab 1998;83(1):169–173CrossRefPubMed

31.

Kameyama K, Takami H. Proposal for the histological classification of parathyroid carcinoma. Endocr Pathol 2005;16(1):49–52CrossRefPubMed

32.

Wallfelt C, Ljunghall S, Bergström R, et al. Clinical characteristics and surgical treatment of sporadic primary hyperparathyroidism with emphasis on chief cell hyperplasia. Surgery 1990;107:13–19PubMed

33.

Åkerström G, Rudberg C, Grimelius L, et al. Histologic parathyroid abnormalities in autopsy series. Human Pathol 1986;17:520–527

34.

van Heerden JA, Weiland LH, ReMine WH, et al. Cancer of the parathyroid glands. Arch Surg 1979;114:475–480PubMed

35.

Prasad KK, Agarwal G, Krishnani N. Water-clear cell adenoma of the parathyroid gland: a rare entity. Indian J Pathol Microbiol 2004;47(1):39–40PubMed

36.

Prasad KK, Agarwal G, Mishra SK, et al. Oxyphilic cell adenoma of parathyroid resulting in primary hyperparathyroidism and Osteitis fibrosa cystica. Indian J Pathol Microbiol 2006. (In Press)

37.

Erickson LA, et al. Oxyphil parathyroid carcinoma: clinicopathologic & immunohistochemical study of 10 cases. Am J Surg Pathol 2002;26(3):344–349CrossRefPubMed

38.

Harness JK, et al. Multiple adenomas of the parathyroids: do they exist? Arch Surg 1979;114:468–474PubMed

39.

Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 1992;16(4):724–731CrossRefPubMed

Title: Indian Primary Hyperparathyroidism Patients with Parathyroid Carcinoma do not Differ in Clinicoinvestigative Characteristics from Those with Benign Parathyroid Pathology
Authors: Gaurav Agarwal, MS, DNB, PDC
Kaushal K. Prasad, MD, PDC
Dilip K Kar, MS, PDC
Narendra Krishnani, MD
Rakesh Pandey, MD
Saroj K. Mishra, MS, FACS
Publication date: 01-05-2006
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 5/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-005-0366-5

At a glance: The STEP trials

Springer Medicine

Indian Primary Hyperparathyroidism Patients with Parathyroid Carcinoma do not Differ in Clinicoinvestigative Characteristics from Those with Benign Parathyroid Pathology

Abstract

Introduction

Materials and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2006

Does Familial Non-Medullary Thyroid Cancer Adversely Affect Survival?

Endoscopic Lateral Approach Thyroid Lobectomy: Safe Evolution from Endoscopic Parathyroidectomy

Desmoplastic Stromal Reaction in Medullary Thyroid Cancer—An Intraoperative “Marker” for Lymph Node Metastases

Abdominal Visceral Lesions in von Hippel-Lindau Disease: Incidence and Clinical Behavior of Pancreatic and Adrenal Lesions at a Single Center

Classical and Follicular Variant of Papillary Thyroid Carcinoma: A Comparative Study on Clinicopathologic Features and Long-term Outcome

Diagnostic and Prognostic Value of Cell-cycle Regulatory Genes in Malignant Thyroid Neoplasms