Skip to main content
Erschienen in: Langenbeck's Archives of Surgery 5/2005

01.09.2005 | Original Article

Results of iterative surgery for persistent and recurrent parathyroid carcinoma

verfasst von: Maurizio Iacobone, Cesare Ruffolo, Franco Lumachi, Gennaro Favia

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 5/2005

Einloggen, um Zugang zu erhalten

Abstract

Background and aims

Parathyroid carcinoma (PC) is a rare cause of primary hyperparathyroidism. Surgery is the only effective treatment; re-operations are often required, because recurrences occur in most of the cases. The aim of this retrospective study was to analyse the rate of biochemical cure, clinical relief, sensitivity of localizing studies and morbidity after re-operations.

Patients and methods

From January 1980 to December 2000, 19 patients underwent surgery for PC. PC persisted or recurred in all cases. Fourteen re-operations were performed in six patients.

Results

Twelve re-operations at loco-regional site and two pulmonary metastasectomies were performed. Iterative surgery achieved a symptomatic relief in 86% of cases and a transient biochemical remission only in one patient, but significantly reduced parathormone and calcemia. The sensitivity of scintigraphy, CT and ultrasonography was 86, 79 and 100%, respectively.

Conclusion

When recurrences occur, complete cure of PC is unlikely, despite re-operations. Iterative surgery is associated with some morbidity and never achieves a definitive cure, but provides significant clinical and biochemical palliation. Localizing studies are mandatory but do not detect all recurrences.
Literatur
1.
Zurück zum Zitat Obara T, Okamoto T, Ho Y, Yamashita T, Kawano M, Nishi T, Tani M, Sato K, Demura H, Fujimoto Y (1993) Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 114:1040–1048PubMed Obara T, Okamoto T, Ho Y, Yamashita T, Kawano M, Nishi T, Tani M, Sato K, Demura H, Fujimoto Y (1993) Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 114:1040–1048PubMed
2.
Zurück zum Zitat Fujimoto Y, Obara T (1987) How to recognize and treat parathyroid carcinoma. Surg Clin North Am 67:343–357PubMed Fujimoto Y, Obara T (1987) How to recognize and treat parathyroid carcinoma. Surg Clin North Am 67:343–357PubMed
3.
Zurück zum Zitat Obara T, Fujimoto Y (1991) Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 15:738–744PubMed Obara T, Fujimoto Y (1991) Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 15:738–744PubMed
4.
Zurück zum Zitat Obara T, Okamoto T, Kanbe M, Iihara M (1997) Functioning parathyroid carcinoma: clinicopathologic features and rational treatment. Sem Surg Oncol 13:134–141CrossRef Obara T, Okamoto T, Kanbe M, Iihara M (1997) Functioning parathyroid carcinoma: clinicopathologic features and rational treatment. Sem Surg Oncol 13:134–141CrossRef
5.
Zurück zum Zitat Akerstrom G, Juhlin C, Johansson H (1994) Parathyroid carcinoma. In: Akerstrom G (ed) Current controversies in parathyroid operations and reoperations. Landes Company, Austin TX, pp 201–218 Akerstrom G, Juhlin C, Johansson H (1994) Parathyroid carcinoma. In: Akerstrom G (ed) Current controversies in parathyroid operations and reoperations. Landes Company, Austin TX, pp 201–218
6.
Zurück zum Zitat Shane E (2001) Parathyroid carcinoma. J Clin Endocrinol Metab 86:485–493PubMed Shane E (2001) Parathyroid carcinoma. J Clin Endocrinol Metab 86:485–493PubMed
7.
Zurück zum Zitat Sandelin K, Auer G, Bondeson L, Grimelius L, Farnebo LO (1992) Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16:724–731PubMed Sandelin K, Auer G, Bondeson L, Grimelius L, Farnebo LO (1992) Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16:724–731PubMed
8.
9.
Zurück zum Zitat Vetto JT, Brennan MF, Woodruff J, Burt M (1993) Parathyroid carcinoma: diagnosis and clinical history. Surgery 114:882–892PubMed Vetto JT, Brennan MF, Woodruff J, Burt M (1993) Parathyroid carcinoma: diagnosis and clinical history. Surgery 114:882–892PubMed
10.
Zurück zum Zitat Wynne AG, van Heerden J, Carney JA, Fitzpatrick LA (1992) Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine 71:197–205PubMed Wynne AG, van Heerden J, Carney JA, Fitzpatrick LA (1992) Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine 71:197–205PubMed
11.
Zurück zum Zitat Levin K, Galante M, Clark OH (1987) Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 101:647–660 Levin K, Galante M, Clark OH (1987) Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 101:647–660
12.
Zurück zum Zitat Wang C, Gaz RD (1985) Natural history of parathyroid carcinoma. Am J Surg 149:522–527PubMed Wang C, Gaz RD (1985) Natural history of parathyroid carcinoma. Am J Surg 149:522–527PubMed
13.
Zurück zum Zitat Kebebew E, Arici C, Duh QY, Clark OH (2001) Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg 136:878–885PubMed Kebebew E, Arici C, Duh QY, Clark OH (2001) Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg 136:878–885PubMed
14.
Zurück zum Zitat Schantz A, Castleman B (1973) Parathyroid carcinoma: a study of 70 cases. Cancer 31:600–605PubMed Schantz A, Castleman B (1973) Parathyroid carcinoma: a study of 70 cases. Cancer 31:600–605PubMed
15.
Zurück zum Zitat Shattuck TM, Valimaki S, Obara T, Gaz RD, Clark OH, Shoback D, Wierman ME, Tojo K, Robbins CM, Carpten JD, Farnebo LO, Larsson C, Arnold A (2003) Somatic and germ-line mutations of the HRPT2 gene in sporadic parathyroid carcinoma. N Engl J Med 349:1722–1729CrossRefPubMed Shattuck TM, Valimaki S, Obara T, Gaz RD, Clark OH, Shoback D, Wierman ME, Tojo K, Robbins CM, Carpten JD, Farnebo LO, Larsson C, Arnold A (2003) Somatic and germ-line mutations of the HRPT2 gene in sporadic parathyroid carcinoma. N Engl J Med 349:1722–1729CrossRefPubMed
16.
17.
Zurück zum Zitat Dotzenrath C, Goretzki PE, Sarbia M, Cupisti K, Feldkamp J, Roher HD (2001) Parathyroid carcinoma: problems in diagnosis and the need for radical surgery even in recurrent disease. Eur J Surg Oncol 27:383–389 Dotzenrath C, Goretzki PE, Sarbia M, Cupisti K, Feldkamp J, Roher HD (2001) Parathyroid carcinoma: problems in diagnosis and the need for radical surgery even in recurrent disease. Eur J Surg Oncol 27:383–389
18.
Zurück zum Zitat Shortell C, Andrus CH, Phillips CE, Schwatz S (1991) Carcinoma of the parathyroid glands: a 30 year experience. Surgery 110:704–708PubMed Shortell C, Andrus CH, Phillips CE, Schwatz S (1991) Carcinoma of the parathyroid glands: a 30 year experience. Surgery 110:704–708PubMed
19.
Zurück zum Zitat Flye MW, Brennan MF (1981) Surgical resection of metastatic parathyroid carcinoma. Ann Surg 193:425–435PubMed Flye MW, Brennan MF (1981) Surgical resection of metastatic parathyroid carcinoma. Ann Surg 193:425–435PubMed
20.
Zurück zum Zitat Fujimoto Y, Obara T, Ito Y, Kodama T, Nobori M, Ebihara S (1986) Localization and surgical resection of metastatic parathyroid carcinoma. World J Surg 10:539–547CrossRefPubMed Fujimoto Y, Obara T, Ito Y, Kodama T, Nobori M, Ebihara S (1986) Localization and surgical resection of metastatic parathyroid carcinoma. World J Surg 10:539–547CrossRefPubMed
21.
Zurück zum Zitat Quiros RM, Alef MJ, Wilhelm SM, Djuricin G, Loviscek K, Prinz RA (2003) Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomy. Surgery 134:675–681CrossRefPubMed Quiros RM, Alef MJ, Wilhelm SM, Djuricin G, Loviscek K, Prinz RA (2003) Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomy. Surgery 134:675–681CrossRefPubMed
22.
Zurück zum Zitat Arslan N, Rydzewski B (2002) Detection of a recurrent parathyroid carcinoma with FDG positron emission tomography. Clin Nucl Med 27:221–222CrossRefPubMed Arslan N, Rydzewski B (2002) Detection of a recurrent parathyroid carcinoma with FDG positron emission tomography. Clin Nucl Med 27:221–222CrossRefPubMed
23.
Zurück zum Zitat Rasmuson T, Kristoffersson A, Boquist L (2000) Positive effect of radiotherapy and surgery on hormonally active pulmonary metastases of primary parathyroid carcinoma. Eur J Endocrinol 143:749–754 Rasmuson T, Kristoffersson A, Boquist L (2000) Positive effect of radiotherapy and surgery on hormonally active pulmonary metastases of primary parathyroid carcinoma. Eur J Endocrinol 143:749–754
24.
Zurück zum Zitat Collins MT, Skarulis MC, Bilezikian JP, Silverberg SJ, Spiegel AM, Marx SJ (1998) Treatment of hypercalcemia secondary to parathyroid carcinoma with a novel calcimimetic agent. J Clin Endocrinol Metab 83:1083–1088CrossRefPubMed Collins MT, Skarulis MC, Bilezikian JP, Silverberg SJ, Spiegel AM, Marx SJ (1998) Treatment of hypercalcemia secondary to parathyroid carcinoma with a novel calcimimetic agent. J Clin Endocrinol Metab 83:1083–1088CrossRefPubMed
25.
Zurück zum Zitat Bradwell AR, Harvey TC (1999) Control of hypercalcaemia of parathyroid carcinoma by immunization. Lancet 353:370–373CrossRefPubMed Bradwell AR, Harvey TC (1999) Control of hypercalcaemia of parathyroid carcinoma by immunization. Lancet 353:370–373CrossRefPubMed
26.
Zurück zum Zitat Sandelin K, Thompson NW, Bondeson L (1991) Metastatic parathyroid carcinoma: dilemmas in management. Surgery 110:978–988PubMed Sandelin K, Thompson NW, Bondeson L (1991) Metastatic parathyroid carcinoma: dilemmas in management. Surgery 110:978–988PubMed
27.
Zurück zum Zitat Hundahl SA, Fleming ID, Fremgen AM, Menck HR (1999) Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985–1995: a National Cancer Data Base Report. Cancer 86:538–544 Hundahl SA, Fleming ID, Fremgen AM, Menck HR (1999) Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985–1995: a National Cancer Data Base Report. Cancer 86:538–544
28.
Zurück zum Zitat Iacobone M, Lumachi F, Favia G (2004) Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 88:223–228CrossRefPubMed Iacobone M, Lumachi F, Favia G (2004) Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 88:223–228CrossRefPubMed
Metadaten
Titel
Results of iterative surgery for persistent and recurrent parathyroid carcinoma
verfasst von
Maurizio Iacobone
Cesare Ruffolo
Franco Lumachi
Gennaro Favia
Publikationsdatum
01.09.2005
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 5/2005
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-005-0555-6

Weitere Artikel der Ausgabe 5/2005

Langenbeck's Archives of Surgery 5/2005 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.