Parathyroid carcinoma: twenty cases. Up to date in a high rate incidence series

S.M.M. Basso MD, F. Lumachi MD, R. Behboo MD, G. Favia MD

Endocrine Surgery Unit. Department of Surgical and Gastroenterological Sciences. University of Padova. Italy

Aim. The aim of this study was to evaluate incidence of parathyroid (PT) carcinoma in patients with primary hyperparathyroidism (HPT). Methods. Between 1980-2000, 404 patients with proved primary HPT underwent successful parathyroidectomy (PTx). There were 86 men (21.28%), 318 women (78.72%, with a median age of 61 years (range 9-79). Final pathology specimens showed 335 PT adenomas (82.92%), 49 multiglandular disease (12.13%) and 20 carcinomas (4.95%). In none of them the malignancy was diagnosed pre-operatively. Six of the patients with PT carcinoma were females (30%) and 14 males (70%). Median age was 59 years (range 30-78). The average serum calcium and s-PTH levels were significantly higher (p<0.05) than in patients with PT adenoma. Results. All patients underwent surgery and 6 patients had one or more reoperations for recurrence. Seven patients had prolonged postoperative hypocalcemia (2-10 months), while six patients had persistent HPT. Recurrence was found in eleven patients. The median disease-free period was 28 months (range 4-130) and average survival was 38 months (range 11-130). No chemotherapy was performed and only one patient underwent external-beam radiotherapy (50 Gy in 25 sessions). Three patients (15.0%) are still alive (one with recurrence). Conclusions. Parathyroid carcinoma is a rare cause of PTH-dependent hypercalcemia and its management is still debated. The history after surgical treatment seems to be variable. PT carcinoma should be suspected in patients with HPT with calcemia higher than 3.5 mmol/l and PT glands more than 3 cm in the greatest diameter. Aggressive surgical treatment seems to be useful in terms of survival.

For more information, contact

Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Novel Therapies, Part 1.