Clinicopathological Phenotype of Parathyroid Carcinoma. Therapeutic and Prognostic Aftermaths

Parathyroid carcinomas (PC) are rare and “devastating” causesof hyperparathyroidism (HP), frequently discovered fortuitously,with not always doubtless pathological confirmation, anddissociate post-therapeutic outcomes and prognosis even afterwell-performed surgery. We herein report four PT neoplasms,three of them proving to be authentic PCs, and one anatypical parathyroid adenoma. There were three females andone male, aged 32-49 (mean 44) years. In three circumstancesPC was associated with primary HP and in one case the tumorhad developed on a CKD-BMD (renal HP) background. Allpatients presented marked clinical and biochemicalphenomena related to hypercalcemia with greater intensity ofrenal, bone, neuromuscular and psychological signs and symptomsto which in one observation specific uremic manifestationswere added. Preoperative and intraoperative diagnosis wassuspected only in two cases (one of them being in fact anatypical PT adenoma), but in the other two it was establishedby paraffin section on histological evidence of peremptorystigma of malignancy. Our little experience underlines the wideand protean range of the origins, clinical aspects, course andprognosis of PC, which adds to the difficulties of pre- and intraoperativediagnosis. Awareness of this lesion must be permanentto detect its presence in any unusual eventuality, imposinga radical en bloc resection at the initial operation, assuring thebest chance of cure.

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