Elsevier

Endocrine Practice

Volume 15, Issue 5, July–August 2009, Pages 463-468
Endocrine Practice

Case Report
Synchronous Parathyroid Carcinoma, Parathyroid Adenoma, and Papillary Thyroid Carcinoma in a Patient with Severe and Long-Standing Hyperparathyroidism

https://doi.org/10.4158/EP09075.CRRGet rights and content

ABSTRACT

Objective

To describe a patient presenting with the rare constellation of synchronous parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma.

Methods

We summarize the clinical presentation, diagnostic work-up, surgical management, and pathologic features of our patient and review the pertinent literature.

Results

The patient was a 59-year-old man who presented with severe clinical manifestations of long-standing primary hyperparathyroidism, a serum calcium concentration of 14.4 mg/dL, and a parathyroid hormone level of 2,023 pg/mL. He was found to have a 3.4-cm parathyroid carcinoma on the left side and a 3.2-cm papillary carcinoma in the right thyroid lobe. In addition, a 917-mg parathyroid adenoma was found on the right side.

Conclusion

Synchronous parathyroid and thyroid carcinomas are extremely rare. To our knowledge, our patient is the first documented case with a parathyroid adenoma in addition to synchronous parathyroid and thyroid carcinomas. The presence of concurrent parathyroid carcinoma and parathyroid adenoma can cause diagnostic confusion and should be considered in patients presenting with severe hyperparathyroidism. Any concomitant thyroid nodules must be investigated to rule out thyroid carcinoma. (Endocr Pract. 2009;15:463-468)

Section snippets

INTRODUCTION

Primary hyperparathyroidism (HPT) is caused by parathyroid carcinoma in less than 1% of cases 1., 2.. Coexistent thyroid carcinoma in these patients is extremely rare, and to our knowledge, only 5 patients with documented synchronous parathyroid and thyroid carcinomas have been described previously in published reports 3., 4., 5., 6., 7.. Patients with parathyroid carcinoma may also have concomitant disease in other parathyroid glands, including adenoma, hyperplasia, or a second parathyroid

CASE REPORT

A 59-year-old man had been diagnosed approximately 8 years previously with primary HPT on the basis of hypercalcemia (12.6 mg/dL; reference range, 8.4 to 10.2) and an elevated serum parathyroid hormone (PTH) level (385 pg/mL; reference range, 15 to 65). Neck ultrasonography at that time showed a 3-cm mass believed to be an enlarged parathyroid gland at the posteroinferior aspect of the left thyroid lobe. He was scheduled to undergo parathyroidectomy but canceled the procedure because of

DISCUSSION

Only 5 patients with documented synchronous parathyroid and thyroid carcinomas have been described in previous reports 3., 4., 5., 6., 7.. The clinical characteristics of those patients and our current case are summarized in Table 1. Four of the patients (67%) were female, and the patients were relatively young (mean age, 55 years). In previous reports of patients with parathyroid carcinoma (not associated with thyroid carcinoma), the distribution between men and women was relatively even, and

CONCLUSION

The current report illustrates several important points that warrant emphasis. First, in patients with severe hypercalcemia, parathyroid carcinoma should be considered a possible underlying cause, and if the operative finding supports the suspicion of parathyroid carcinoma, an en bloc resection of the parathyroid tumor and the adjacent thyroid lobe should be performed. Second, although uncommon, patients with parathyroid carcinoma may have additional hyperfunctioning glands, and persistent or

DISCLOSURE

The authors have no conflicts of interest to disclose.

ACKNOWLEDGMENT

We are grateful to Drs. Yuka Sumi and Kiyoshi Itagaki for translating reference 3 into English and to Mr. Michael Cichanowski, Media Services, Beth Israel Deaconess Medical Center, for preparing Figure 5.

REFERENCES (15)

There are more references available in the full text version of this article.

Cited by (22)

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    Currently, there is no evidence that parathyroid carcinoma arises from malignant transformation of preexisting parathyroid or thyroid lesions. However, an association between parathyroid cancer and hyper-functioning parathyroid glands or thyroid cancer has previously been observed [15,21,22]. Parathyroid carcinoma may occur sporadically or as part of a genetic syndrome.

  • Pathology of the parathyroid glands

    2012, Diagnostic Histopathology
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    Multigland disease is usually hyperplasia, but ‘double’ or ‘multiple’ adenomas are also described, accounting for 1.9–15% of cases, more commonly in older patients.10 Carcinoma and adenoma can be seen in different parathyroid glands in the same patient.22 Non-functional parathyroid adenomas and carcinomas are rare.23

  • Large parathyroid tumors have an increased risk of atypia and carcinoma

    2011, American Journal of Surgery
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    The patient with the smaller parathyroid carcinoma was asymptomatic, whereas the 2 patients with the larger tumors had bone disease, 1 of them with multiple pathologic fractures. The latter patient, who also had a parathyroid adenoma and papillary thyroid carcinoma, was reported in greater detail elsewhere.5 In 2 of the patients with parathyroid carcinoma, en bloc resection of the carcinoma and the adjacent thyroid lobe was performed.

  • Multiple Metastases of Parathyroid and Papillary Thyroid Carcinoma in a Female Patient Treated with Long-Term Hemodialysis

    2023, Journal of Personalized Medicine

  • Association of Parathyroid and Differentiated Thyroid Carcinomas: A Narrative Up-To-Date Review of the Literature

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  • Parathyroid Carcinoma All-In-One, a Rare Life-Threatening Case With Multiple Systemic Manifestations: Case Report and Review of the Literature

    2022, Frontiers in Endocrinology
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Published as a Rapid Electronic Article in Press at http://www.endocrinepractice.org on June 2, 2009. DOI: 10.4158/EP09075.CRR

*

These 3 authors (listed alphabetically) contributed equally to this report.

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