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Lymph Node Involvement and Surgical Approach in Parathyroid Cancer

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Abstract

Background

The best surgical approach to parathyroid cancer is disputed. Recommendations vary and are built on incoherent evidence. High rates of recurrence and death require an in-depth review of underlying findings.

Methods

This retrospective study includes 11 patients with parathyroid cancer who underwent surgery with central and/or lateral neck dissection by a single surgeon between 2005 and 2010. The diagnosis was based on histopathological criteria in all patients. Patterns of lymph node and soft tissue involvement of these and formerly reported patients were analysed based on full-text review of all published cases of parathyroid cancer.

Results

In this series only 1 of 11 patients (9.1%) manifested lymph node metastasis. In the literature, lymph node metastases have been reported in only 6.5% of 972 published patients, or in 32.1% of the 196 in whom lymph node involvement was assessed by the authors. They were, with few exceptions, localised in the central compartment. Recurrence in soft tissue is more frequent than in locoregional lymph nodes.

Conclusion

Oncological en bloc clearance of the central compartment with meticulous removal of all possibly involved soft tissues, including a systematic central lymph node resection, may improve outcomes and should be included in the routine approach to the suspicious parathyroid lesion. There is no need for a prophylactic lateral neck dissection.

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Abbreviations

PTH:

Parathyroid hormone

Ca:

Corrected serum calcium

mM/L:

Millimoles per litre

CI:

Confidence interval

RR:

Relative risk

OR:

Odds ratio

TNM:

Tumour node metastasis

References

  1. Talat N, Schulte KM (2010) Clinical presentation, staging and long-term evolution of parathyroid cancer. Ann Surg Oncol 17:2156–2174

    Article  PubMed  Google Scholar 

  2. DeLellis RA, Mazzaglia P, Mangray S (2008) Primary hyperparathyroidism: a current perspective. Arch Pathol Lab Med 132(8):1251–1262

    PubMed  Google Scholar 

  3. Wynne AG, van Heerden J, Carney JA et al (1992) Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore) 71(4):197–205

    CAS  Google Scholar 

  4. Okamoto T, Iihara M, Obara T et al (2009) Parathyroid carcinoma: etiology, diagnosis, and treatment. World J Surg 33:2343–2354

    Article  PubMed  Google Scholar 

  5. Holmes EC, Morton DL, Ketcham AS (1969) Parathyroid carcinoma: a collective review. Ann Surg 169(4):631–640

    Article  CAS  PubMed  Google Scholar 

  6. Clayman GL, Gonzalez HE, El-Naggar A et al (2004) Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer 100(5):900–905

    Article  PubMed  Google Scholar 

  7. Obara T, Okamoto T, Kanbe M et al (1997) Functioning parathyroid carcinoma: clinicopathologic features and rational treatment. Semin Surg Oncol 13(2):134–141

    Article  CAS  PubMed  Google Scholar 

  8. Rao SR, Shaha AR, Singh B et al (2002) Management of cancer of the parathyroid. Acta Otolaryngol 122(4):448–452

    Article  PubMed  Google Scholar 

  9. Koea JB, Shaw JH (1999) Parathyroid cancer: biology and management. Surg Oncol 8(3):155–165

    Article  CAS  PubMed  Google Scholar 

  10. Rodgers SE, Perrier ND (2006) Parathyroid carcinoma. Curr Opin Oncol 18(1):16–22

    Article  PubMed  Google Scholar 

  11. Kulkarni PS, Parikh PM (2004) The carcinoma of parathyroid gland. Indian J Cancer 41(2):51–59

    CAS  PubMed  Google Scholar 

  12. Fujimoto Y, Obara T (1987) How to recognize and treat parathyroid carcinoma. Surg Clin North Am 67(2):343–357

    CAS  PubMed  Google Scholar 

  13. Shane E (2001) Parathyroid carcinoma. J Clin Endocrinol Metab 86(2):485–493

    Article  CAS  PubMed  Google Scholar 

  14. Aldinger KA, Hickey RC, Ibanez ML et al (1982) Parathyroid carcinoma: a clinical study of seven cases of functioning and two cases of nonfunctioning parathyroid cancer. Cancer 49(2):388–397

    Article  CAS  PubMed  Google Scholar 

  15. Obara T, Fujimoto Y (1991) Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 15(6):738–744

    Article  CAS  PubMed  Google Scholar 

  16. Rawat N, Khetan N, Williams DW et al (2005) Parathyroid carcinoma. Br J Surg 92(11):1345–1353

    Article  CAS  PubMed  Google Scholar 

  17. Wang CA, Gaz RD (1985) Natural history of parathyroid carcinoma. Diagnosis, treatment, and results. Am J Surg 149(4):522–527

    Article  CAS  PubMed  Google Scholar 

  18. Anderson BJ, Samaan NA, Vassilopoulou-Sellin R et al (1983) Parathyroid carcinoma: features and difficulties in diagnosis and management. Surgery 94(6):906–915

    CAS  PubMed  Google Scholar 

  19. Sandelin K, Auer G, Bondeson L et al (1992) Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16(4):724–731

    Article  CAS  PubMed  Google Scholar 

  20. Levin KE, Galante M, Clark OH (1987) Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 101(6):649–660

    CAS  PubMed  Google Scholar 

  21. Iihara M, Okamoto T, Suzuki R et al (2007) Functional parathyroid carcinoma: long-term treatment outcome and risk factor analysis. Surgery 142(6):936–943, discussion 943 e1

    Article  PubMed  Google Scholar 

  22. Cohn K, Silverman M, Corrado J et al (1985) Parathyroid carcinoma: the Lahey Clinic experience. Surgery 98(6):1095–1100

    CAS  PubMed  Google Scholar 

  23. Jarman WT, Myers RT, Marshall RB (1978) Carcinoma of the parathyroid. Arch Surg 113(2):123–125

    CAS  PubMed  Google Scholar 

  24. Fujimoto Y, Obara T, Ito Y et al (1986) Localization and surgical resection of metastatic parathyroid carcinoma. World J Surg 10(4):539–547

    Article  CAS  PubMed  Google Scholar 

  25. Flye MW, Brennan MF (1981) Surgical resection of metastatic parathyroid carcinoma. Ann Surg 193(4):425–435

    Article  CAS  PubMed  Google Scholar 

  26. Masson EA, MacFarlane IA, Bodmer CW et al (1993) Parathyroid carcinoma presenting with a brown tumour of the mandible in a young man. Br J Oral Maxillofac Surg 31(2):117–119

    Article  CAS  PubMed  Google Scholar 

  27. Kirkby-Bott J, Lewis P, Harmer CL et al (2005) One stage treatment of parathyroid cancer. Eur J Surg Oncol 31(1):78–83

    Article  CAS  PubMed  Google Scholar 

  28. Cheah WK, Rauff A, Lee KO et al (2005) Parathyroid carcinoma: a case series. Ann Acad Med Singapore 34(7):443–446

    CAS  PubMed  Google Scholar 

  29. Munson ND, Foote RL, Northcutt RC et al (2003) Parathyroid carcinoma: is there a role for adjuvant radiation therapy? Cancer 98(11):2378–2384

    Article  PubMed  Google Scholar 

  30. Chow E, Tsang RW, Brierley JD et al (1998) Parathyroid carcinoma—the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys 41(3):569–572

    Article  CAS  PubMed  Google Scholar 

  31. Ou HY, Hung CJ, Hsu WH et al (2003) Variability of clinical presentations in three cases of parathyroid carcinoma. J Formos Med Assoc 102(4):266–269

    PubMed  Google Scholar 

  32. Bhansali A, Kataria RN, Dutta P et al (2002) Parathyroid carcinoma: difficult management options. Indian J Cancer 39(3):119–122

    CAS  PubMed  Google Scholar 

  33. Busaidy NL, Jimenez C, Habra MA et al (2004) Parathyroid carcinoma: a 22-year experience. Head Neck 26(8):716–726

    Article  PubMed  Google Scholar 

  34. Fujimoto Y, Obara T, Ito Y et al (1984) Surgical treatment of ten cases of parathyroid carcinoma: importance of an initial en bloc tumor resection. World J Surg 8(3):392–400

    Article  CAS  PubMed  Google Scholar 

  35. Kameyama K, DeLellis RA, Lloyd RV et al (2002) Parathyroid carcinomas: can clinical outcomes for parathyroid carcinomas be determined by histologic evaluation alone? Endocr Pathol 13(2):135–139

    Article  PubMed  Google Scholar 

  36. Aso Y, Sato A, Tayama K et al (1996) Parathyroid carcinoma with metastatic calcification identified by technetium-99 m methylene diphosphonate scintigraphy. Intern Med 35(5):392–395

    Article  CAS  PubMed  Google Scholar 

  37. McKeown PP, McGarity WC, Sewell CW (1984) Carcinoma of the parathyroid-gland—is it over-diagnosed?—a report of 3 cases. Am J Surg 147(2):292–298

    Article  CAS  PubMed  Google Scholar 

  38. Au WY (1975) Calcitonin treatment of hypercalcemia due to parathyroid carcinoma. Synergistic effect of prednisone on long-term treatment of hypercalcemia. Arch Intern Med 135(12):1594–1597

    Article  CAS  PubMed  Google Scholar 

  39. Vetto JT, Brennan MF, Woodruf J et al (1993) Parathyroid carcinoma: diagnosis and clinical history. Surgery 114(5):882–892

    CAS  PubMed  Google Scholar 

  40. Black BK (1954) Carcinoma of the parathyroid. Ann Surg 139(3):355–363

    Article  CAS  PubMed  Google Scholar 

  41. Saunders KB, Richardson J (1970) Carcinoma of the parathyroid. Proc R Soc Med 63(5):453–454

    CAS  PubMed  Google Scholar 

  42. Sandelin K, Thompson NW, Bondeson L (1991) Metastatic parathyroid carcinoma: dilemmas in management. Surgery 110(6):978–986 discussion 986-988

    CAS  PubMed  Google Scholar 

  43. Barnes AD (1984) The changing face of parathyroid surgery. Ann R Coll Surg Engl 66(2):77–80

    CAS  PubMed  Google Scholar 

  44. Ehrlich A, McDonald J, Zitani A Jr (1961) Carcinoma of the parathyroid with hyperparathyroidism and metastases. JAMA 176:453–455

    CAS  PubMed  Google Scholar 

  45. de Papp AE, Kinder B, LiVolsi V et al (1994) Parathyroid carcinoma arising from parathyroid hyperplasia: autoinfarction following intravenous treatment with pamidronate. Am J Med 97(4):399–400

    Article  PubMed  Google Scholar 

  46. de la Garza S, de la Flores Garza E, Hernandez Batres F (1985) Functional parathyroid carcinoma cytology, histology, and ultrastructure of a case. Diagn Cytopathol 1(3):232–235

    Article  PubMed  Google Scholar 

  47. Solorzano CC, Carneiro-Pla DM, Lew JI et al (2007) Intra-operative parathyroid hormone monitoring in patients with parathyroid cancer. Ann Surg Oncol 14(11):3216–3222

    Article  CAS  PubMed  Google Scholar 

  48. Neumann DR, Esselstyn CB, Kim EY (1996) Recurrent postoperative parathyroid carcinoma: FDG-PET and sestamibi-SPECT findings. J Nucl Med 37(12):2000–2001

    CAS  PubMed  Google Scholar 

  49. Dotzenrath C, Goretzki PE, Sarbia M et al (2001) Parathyroid carcinoma: problems in diagnosis and the need for radical surgery even in recurrent disease. Eur J Surg Oncol 27(4):383–389

    Article  CAS  PubMed  Google Scholar 

  50. Ito Y, Iwase H, Tanaka H et al (2001) Metachronous primary hyperparathyroidism due to a parathyroid adenoma and a subsequent carcinoma: report of a case. Surg Today 31(10):895–898

    Article  CAS  PubMed  Google Scholar 

  51. Obara T, Okamoto T, Ito Y et al (1993) Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 114(6):1040–1048, discussion 1048-1049

    CAS  PubMed  Google Scholar 

  52. Davies DR, Dent CE, Ives DR (1973) Successful removal of single metastasis in recurrent parathyroid carcinoma. Br Med J 1(5850):397–398

    Article  CAS  PubMed  Google Scholar 

  53. Weinstein RS (1991) Parathyroid carcinoma associated with polycythemia vera. Bone 12(4):237–239

    Article  CAS  PubMed  Google Scholar 

  54. Rufener JB, Cohen JI (2003) Metachronous spread of parathyroid carcinoma to a retropharyngeal lymph node. Head Neck 25(11):968–971

    Article  PubMed  Google Scholar 

  55. Pollack S, Goldin RR, Cohen M (1961) Parathyroid carcinoma. A report of two cases and a review of the literature. Arch Intern Med 108:583–587

    CAS  PubMed  Google Scholar 

  56. Caley JP, Jones EE, Collins DH (1962) Fatal recurrence of parathyroid carcinoma after seven years. J Clin Pathol 15:438–445

    Article  CAS  PubMed  Google Scholar 

  57. Placzkowski K, Christian R, Chen H (2007) Radioguided parathyroidectomy for recurrent parathyroid cancer. Clin Nucl Med 32(5):358–360

    Article  PubMed  Google Scholar 

  58. Qvist N, Krøll L, Ladefoged C et al (1986) Parathyroid carcinoma: a case with recurrence treated with extensive vascular surgery to the neck. Eur J Surg Oncol 12(2):187–191

    CAS  PubMed  Google Scholar 

  59. Sheehan JJ, Hill AD, Walsh MF et al (2001) Parathyroid carcinoma: diagnosis and management. Eur J Surg Oncol 27(3):321–324

    Article  CAS  PubMed  Google Scholar 

  60. Dubost C, Jehanno C, Lavergne A et al (1984) Successful resection of intrathoracic metastases from two patients with parathyroid carcinoma. World J Surg 8(4):547–551

    Article  CAS  PubMed  Google Scholar 

  61. Hundahl SA, Fleming ID, Fremgen AM et al (1999) Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86(3):538–544

    Article  CAS  PubMed  Google Scholar 

  62. Kebebew E, Arici C, Duh QY et al (2001) Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg 136(8):878–885

    Article  CAS  PubMed  Google Scholar 

  63. Cordeiro AC, Montenegro FL, Kulcsar MA et al (1998) Parathyroid carcinoma. Am J Surg 175(1):52–55

    Article  CAS  PubMed  Google Scholar 

  64. Ippolito G, Palazzo FF, Sebag F et al (2007) Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenoma. Br J Surg 94(5):566–570

    Article  CAS  PubMed  Google Scholar 

  65. Fernandez-Ranvier GG, Khanafshar E, Jensen K et al (2007) Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis? Cancer 110(2):255–264

    Article  PubMed  Google Scholar 

  66. Lee PK, Jarosek SL, Virnig BA et al (2007) Trends in the incidence and treatment of parathyroid cancer in the United States. Cancer 109(9):1736–1741

    Article  PubMed  Google Scholar 

  67. Agarwal G, Prasad KK, Kar DK et al (2006) Indian primary hyperparathyroidism patients with parathyroid carcinoma do not differ in clinicoinvestigative characteristics from those with benign parathyroid pathology. World J Surg 30(5):732–742

    Article  PubMed  Google Scholar 

  68. Robbins KT, Shaha AR, Medina JE et al (2008) Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 134(5):536–538

    Article  PubMed  Google Scholar 

  69. Iacobone M, Lumachi F, Favia G (2004) Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 88(4):223–228

    Article  PubMed  Google Scholar 

  70. Robert JH, Trombetti A, Garcia A et al (2005) Primary hyperparathyroidism: can parathyroid carcinoma be anticipated on clinical and biochemical grounds? Report of nine cases and review of the literature. Ann Surg Oncol 12(7):526–532

    Article  PubMed  Google Scholar 

  71. Sadowski BM, Snyder SK, Lairmore TC (2009) Routine bilateral central lymph node clearance for papillary thyroid cancer. Surgery 146(4):696–703, discussion 703–705

    Article  PubMed  Google Scholar 

  72. Alvarado R, Sywak MS, Delbridge L et al (2009) Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery 145(5):514–518

    Article  PubMed  Google Scholar 

  73. Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95(1):14–21

    CAS  PubMed  Google Scholar 

  74. Wang C (1976) The anatomic basis of parathyroid surgery. Ann Surg 183(3):271–275

    Article  CAS  PubMed  Google Scholar 

  75. Dixon E, McKinnon JG, Pasieka JL (2000) Feasibility of sentinel lymph node biopsy and lymphatic map** in nodular thyroid neoplasms. World J Surg 24(11):1396–1401

    Article  CAS  PubMed  Google Scholar 

  76. Nobori M, Saiki S, Tanaka N et al (1994) Blood supply of the parathyroid gland from the superior thyroid artery. Surgery 115(4):417–423

    CAS  PubMed  Google Scholar 

  77. Machens A, Holzhausen HJ, Dralle H (2004) Skip metastases in thyroid cancer lea** the central lymph node compartment. Arch Surg 139(1):43–45

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrine Surgery, King’s College Hospital, King’s Health Partners, Denmark Hill, London, SE5 9RS, UK

    Klaus-Martin Schulte & Nadia Talat

  2. Department of Clinical Chemistry, King’s College Hospital, King’s Health Partners, London, SE5 9RS, UK

    Caje Moniz

  3. Department of Pathology, King’s College Hospital, King’s Health Partners, London, SE5 9RS, UK

    Salvador Diaz-Cano

  4. Department of Endocrinology, University Hospital Lewisham, Lewisham, London, SE13 6HL, UK

    John Miell

  5. Department of Surgery, Princess Royal University Hospital Bromley, Or**ton, Kent, BR6 8ND, UK

    Prakash Sinha

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  1. Klaus-Martin Schulte
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Correspondence to Klaus-Martin Schulte.

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Schulte, KM., Talat, N., Miell, J. et al. Lymph Node Involvement and Surgical Approach in Parathyroid Cancer. World J Surg 34, 2611–2620 (2010). https://doi.org/10.1007/s00268-010-0722-y

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