If the definite treatment for Parathyroid Carcinoma is en Bloc resection of the tumor and areas of potential local invasion and regional metastasis, then is it necessary to take consent for this prior to surgery in patients with Parathyroid adenoma?
Inputs please
"A definitive preoperative diagnosis of parathyroid carcinoma is impossible to make; metabolic manifestations of parathyroid cancer overlap with the manifestations of parathyroid adenoma. A high index of suspicion of parathyroid carcinoma should be maintained, however, especially in patients with serum calcium levels greater than 14 mg/dL and a palpable neck mass."
Cummings Otolaryngology, 6th edition, volume 2, chapter 124, page 1954
A false diagnosis of parathyroid carcinoma was made due to fibrosis made from aggressive large needle biopsy causing fibrosis. At surgery there was extensive fibrosis but not carcinoma. We named it Parathyroid death by FNA.
If a parathyroid biopsy is needed is is essential to be gentle.
Use a #27 needle and do not use suction or jab the needle into the gland.
Enter the gland and just spin the needle 360 degrees. A drop of blood is all you need to obtain a washout for PTH. Cytology is similar to thyroid cytologic cells.
Thank you very much Dr Richard Guttler Sir for your valuable inputs.
We had a case with normal Ca and PTH. Patient was operated and is without sign of relapse.
Werner Furlan Sir, thank you very much for inputs.
Sir,
If the serum ca was normal, how was the decision taken to measure the PTH?
If serum Ca and PTH was normal, then how was Parathyroid pathology suspected (did the patient have a neck mass or osteoporosis)?
How was cytological diagnosis achieved?
Why was the decision to operate the patient? was it variant of Parathyroid adenoma (clear cell type),
Can you please enlighten us more about this interesting case.
there was a cold nodule in the left lobe of the thyroid. Fine needle aspiration was suspicious for papillary carcinoma. Histology after thyreoidectomy revealed parathyroid carcinoma - cytologic diagnosis was not correct. Preoperative Ca was normal, PTH was at the upper limit.
Not all the cases of parathyroid ca present typically with hypercalcemia. Some patient have atypical presentation with normal ca level ( these patients often present with a neck mass. Nonfunctioning parathyroid carcinomas are rare, with 32 cases reported (uptodate reference) )those patients often DX postoperativley and in such case reoperation and en bloc resection of ipsilateral lobe frequently done
Greetings
The major clinical manifestations of parathyroid carcinoma can be summarized from several small studies :
●Mean age – 44 to 54 years (equivalent incidence in men and women)
●Mean serum calcium concentration – 14.6 to 15.9 mg/dL (3.7 to 4.0 mmol/L)
●Mean serum parathyroid hormone (PTH) concentrations 5- to 10-fold higher than the upper limit of normal
●Serum calcium concentration above 14 mg/dL (3.5 mmol/L) – 65 to 75 percent
●Parathyroid crisis – 12 percent
●Neck mass – 34 to 52 percent
●Bone disease – 34 to 73 percent
●Renal disease – 32 to 70 percent
●Pancreatitis – 0 to 15 percent
●No symptoms – 2 to 7 percent
Uptodate reference
we had 2 cases of PT-Carcinoma. Both without sign of relapse until now.
- Badges
- Science method