International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationsParathyroid carcinoma—the princess margaret hospital experience
Introduction
De Quevain reported the first case of metastatic parathyroid carcinoma in 1909 (1). The patient had a large locally invasive neck mass removed and subsequently developed lung metastases, but without clinical features of hypercalcemia. Three decades later, Armstrong described another patient suffering from severe hypercalcemia associated with parathyroid cancer (2).
Carcinoma of the parathyroid gland is a rare disease, representing only 0.5 to 4% of all patients with primary hyperparathyroidism 3, 4, 5. As with other endocrine neoplasms, diagnosing parathyroid cancer purely on histologic morphology is difficult. In 1969, Holmes et al. (6) reviewed 46 cases of parathyroid carcinoma reported in the literature. They recommended an initial radical operation for parathyroid cancer. Since then, several reviews have suggested that initial en bloc resection is the only chance for cure 3, 7, 8, 9, 10. Adjuvant chemotherapy or radiotherapy was reported to have no role in improving the outcome 3, 6, 9, 10, 11, 12, 13, 14. We, therefore, reviewed our experience with this rare disease with special emphasis on the role of postoperative radiation therapy that has been applied to patients with a high risk of microscopic residuum following surgery.
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Methods and materials
A retrospective review was conducted of all cases of parathyroid cancer referred between January 1, 1958 and December 31, 1996. We identified 10 patients with parathyroid carcinoma managed at our institution. Patients were referred because of locally invasive disease, possible microscopic residual cancer following surgery, or for metastatic disease. The surgical specimens were reviewed by experienced endocrine pathologists in Toronto. The criteria to distinguish parathyroid carcinoma from
Results
There were 5 men and 5 women with a mean age of 53 years (range, 14–72 years) (Table 2). Of these, 9 patients were hypercalcemic and presented with associated renal, gastrointestinal, or bone complications. They all received medical treatment for hypercalcemia, including rehydration. Cases No. 2 and 7 presented with osteoporosis and pathological fractures of the lower limbs and Case No. 5 (14-year-old patient) had brown tumors, complications related to calcium absorption. The 14-year-old
Discussion
Most series report an equal gender distribution or a slight female preponderance in parathyroid cancer 4, 6, 9, 17; whereas, for benign parathyroid adenomas, there is a definite female predominance (11). The female:male ratio in our series was 1:1. The age at diagnosis can range from 19 to 81 years, with the median age between the fourth and fifth decade 4, 6, 17. The mean age in our series was 53 years. This is in contrast to patients with adenomas who are generally 10 to 20 years older 4, 6,
Acknowledgements
We gratefully thank Vida Bagha for her secretarial work. Edward Chow is a recipient of the Geoffrey H. Wood Foundation fellowship fund.
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