Parathyroid carcinoma—An experience of the enigma over 10 years

• Main Authors: Supreet Singh Nayyar, Shivakumar Thiagarajan, Devendra Chaukar, Sarbani Ghosh Laskar, Asawari Patil, Abhishek Mahajan, Snehal Shah
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Endocrinology and Metabolism
• Subjects: brown tumors; castleman's criteria; parathormone; parathyroid carcinoma; pimary hyperparathyroidism
• Online Access: http://www.ijem.in/article.asp?issn=2230-8210;year=2020;volume=24;issue=2;spage=137;epage=142;aulast=Nayyar

Introduction: Parathyroid carcinoma (PC) is an uncommon clinical entity. Identification and appropriate treatment of PC remains a challenge. In this study, we explore clinico-radiological features suggestive of PC, the utility of Castleman's histopathological criteria for the diagnosis of PC and discuss the MD-Anderson prognostic stratification system for PC. Methods: Retrospective analysis (case series) of patients who were treated at our tertiary oncology institution between January 2009 and December 2018 with an eventual diagnosis of PC. Results: The study group comprised 15 patients. The most common presentation was related to the musculoskeletal system (n = 9, 60%). In one of the cases, ultrasound features were recorded to be suspicious of PC. The highest histopathological correlation with PC was found with capsular and vascular invasion (n = 12, 80%). The primary tumor was found in inferior parathyroid glands in most cases (n = 12, 80%). The average tumor size was 2.47 cm. Six patients (40%) received adjuvant radiotherapy (RT). Three patients (20%) developed recurrence, all having distant metastasis. Overall survival (OS) at 3 years was 92.31% and disease-free survival (DFS) of 76.61%. Conclusion: The presence of certain features on ultrasonography might suggest PC preoperatively. Among Castleman's criteria, capsular invasion and vascular invasion had a maximum association with PC in our series. At present, there is no evidence to routinely give adjuvant RT to all patients with PC.