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Kulak Burun Bogaz Ihtisas Dergisi : KBB... 2015This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing...
OBJECTIVES
This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies.
PATIENTS AND METHODS
Data of 13 patients (4 males, 9 females; mean age 49.23 years; range 27 to 63 years) who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation.
RESULTS
Mean preoperative parathyroid hormone and calcium levels were 284.36 (134-1,083 pg/mL) and 11.9 (10.7-13.5 mg/dL), respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid adenoma excision via minimally invasive parathyroidectomy were successfully carried out in 10 patients with single adenoma confirmed by sestamibi.
CONCLUSION
Technetium 99m sestamibi scintigraphy with single photon emission computed tomography and frozen section analysis may provide more meaningful information and be more advantageous compared to other preoperative localization techniques.
Topics: Adenoma; Adult; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroid Neoplasms; Parathyroidectomy; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon
PubMed: 26211860
DOI: 10.5606/kbbihtisas.2015.33678 -
Journal of Pediatric Hematology/oncology Jan 2016Parathyroid carcinoma is exceedingly rare in children. We describe a case of parathyroid cancer in a young female who was originally classified as benign and managed... (Review)
Review
CONTEXT
Parathyroid carcinoma is exceedingly rare in children. We describe a case of parathyroid cancer in a young female who was originally classified as benign and managed surgically. Upon her diagnosis with malignancy, concurrent with metastatic lung involvement, she was referred for medical and surgical palliation to control her symptomatic hypercalcemia. We briefly review published childhood cases, consider the challenges in differentiating malignant from benign hyperparathyroidism in this age group, and discuss the association of CDC73 mutations with parathyroid carcinoma.
CASE PRESENTATION
A 13-year-old African American girl with a history of parathyroid adenoma, diagnosed at 8 years of age with multiple recurrences, presented with hypercalcemia and elevated parathyroid hormone when her disease had been reclassified as malignant. Germline gene analysis revealed a heterozygous partial deletion of CDC73. The patient underwent palliative surgery for disease metastatic to her lungs. She continues with medical management of her hypercalcemia.
CONCLUSIONS
A case of pediatric parathyroid carcinoma associated with haploinsufficiency of CDC73 is discussed. We review all published cases of pediatric parathyroid carcinoma and offer diagnostic considerations for a parathyroid mass in a child.
Topics: Adenoma; Adolescent; Carcinoma; Female; Humans; Neoplasm Recurrence, Local; Parathyroid Neoplasms; Tumor Suppressor Proteins
PubMed: 26650250
DOI: 10.1097/MPH.0000000000000443 -
Surgical Innovation Feb 2022
Topics: Adenoma; Calcium; Humans; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy
PubMed: 34100329
DOI: 10.1177/15533506211026434 -
Endocrine Regulations Jan 2023Hyperparathyroidism is a prevalent disease with parathyroid adenomas being the most common cause. Surgical excision remains the standard treatment for parathyroid...
Hyperparathyroidism is a prevalent disease with parathyroid adenomas being the most common cause. Surgical excision remains the standard treatment for parathyroid adenoma. Successful preoperative localization of the parathyroid adenoma could facilitate the decision regarding the extent of surgical exploration. The aim of the current study was to assess the correlation between the preoperative values of parathyroid hormone and ionized calcium with the adenoma weight and volume in patient with primary hyperparathyroidism caused by single-gland adenoma. We did this retrospective review for all patients who were diagnosed with primary hyperparathyroidism due to a solitary parathyroid adenoma in our general surgery department over 4 years. SPSS software was used to get the correlation coefficient between the peak preoperative levels of calcium and parathyroid hormone with the parathyroid adenoma weight and volume. Ninety-nine patients were included into the study. The average age at surgery was 62.65±12.00 years. The correlation coefficient between the adenoma volume and weight with the preoperative ionized calcium level was weakly positive (r=0.329, p<0.01) and (r=0.281, p=0.019), respectively, while the correlation with the preoperative parathyroid hormone level was stronger (r=0.708, p<0.01) and (r=0.650, p<0.01), respectively. The strong positive relationship between the preoperative parathyroid hormone and calcium levels with the parathyroid adenoma size and weight can help the surgeon to predict the volume of the involved gland and avoid an unnecessary dissection.
Topics: Humans; Middle Aged; Aged; Parathyroid Glands; Calcium; Parathyroid Neoplasms; Hyperparathyroidism, Primary; Parathyroid Hormone; Parathyroidectomy; Adenoma; Retrospective Studies
PubMed: 36753663
DOI: 10.2478/enr-2023-0002 -
Annali Italiani Di Chirurgia 2022Primary Hyperparathyroidism (PHPT) is a systemic pathology caused by an excessive secretion of parathyroid hormone. Parathyroidectomy is the treatment of choice in PHPT,...
INTRODUCTION
Primary Hyperparathyroidism (PHPT) is a systemic pathology caused by an excessive secretion of parathyroid hormone. Parathyroidectomy is the treatment of choice in PHPT, and the success of surgery is based on precise localization of the abnormal parathyroid gland. Preoperative diagnosis makes use of imaging techniques and functional examinations, however these are insufficient in some cases for the precise location of the pathological gland. Therefore the need arises for an intraoperative localization technique.
MATERIALS AND METHODS
We have retrospectively analyzed 20 consecutive patients with PHPT undergoing parathyroidectomy from April 2019 to September 2021, and divided them in two groups, in base of the use of Indocyanine Green (ICG) fluorescence during the surgery.
RESULTS
Of the twenty patients considered in the two groups, all received a preoperative ultrasound evaluation, while second level examinations were reserved for the more difficult cases, with small volume parathyroid adenomas. In the group where the fluorescence method was employed, fluorescence was especially useful in doubtful cases, allowing easier identification of the parathyroid adenoma and consequently a reduction of time and operatory risks. In two procedures using Indocyanine green, a fluorescence signal was weak.
CONCLUSIONS
ICG represents a convenient and safe way to detect parathyroid adenomas. We found that ICG fluorescence was very useful in all patients with non-localizing preoperative imaging studies. However further investigation is needed, to demonstrate how ICGfluorescence could be a useful localization method during parathyroid surgery.
KEY WORDS
Endocrine surgery, Indocyanine green, Parathyroid surgery.
Topics: Humans; Parathyroidectomy; Parathyroid Neoplasms; Hyperparathyroidism, Primary; Indocyanine Green; Fluorescein Angiography; Retrospective Studies; Parathyroid Glands
PubMed: 36617270
DOI: No ID Found -
Annals of Diagnostic Pathology Jun 2022Computer-aided examination of digital tissue images has attracted attention in recent years. Application in the field of parathyroid pathology has not been studied...
BACKGROUND
Computer-aided examination of digital tissue images has attracted attention in recent years. Application in the field of parathyroid pathology has not been studied previously. It holds a potential to assist in the examination of parathyroid gland adenoma or hyperplasia.
OBJECTIVES
To explore parathyroid cell detection of slide images by digital tissue analysis and compare the results to standard human processing.
METHODS
47 incisional biopsies of healthy appearing parathyroid glands were evaluated for their cellularity level. First, by the standard examination using microscopy by three independent pathologists. We compared the mean cellularity grading of the pathologists to the output of a computerized cell detection software.
RESULTS
A disagreement was found between the standard human cellularity grading and the digital analysis output. However, the digital analysis reaches a 94% specificity and 48% sensitivity to predict high cellularity (>60% parenchymal cells).
CONCLUSIONS
Digital analysis of parathyroid tissue can be used as a tool for hypercellularity elimination, therefore assisting in the diagnosis of parathyroid cell hyperplasia. Additional studies using more advanced algorithms are necessary for further precision enhancement.
Topics: Adenoma; Humans; Hyperplasia; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy
PubMed: 35299079
DOI: 10.1016/j.anndiagpath.2022.151907 -
JPMA. the Journal of the Pakistan... Aug 2019To assess indications, role of preoperative localization, intra-operative details and post operative recovery of patients who underwent parathyroidectomy. Data of adult...
To assess indications, role of preoperative localization, intra-operative details and post operative recovery of patients who underwent parathyroidectomy. Data of adult patients diagnosed with parathyroid adenoma with primary hyperparathyroidism from January 2006 to September 2016 was retrieved from medical records. Demographics, preoperative investigations, operative details and follow up were studied. Seventeen patients diagnosed with primary hyperparathyroidism (PHPT) due to parathyroid adenoma, were managed by parathyroidectomy by skin collar incision. Median age was 46 (IQR 35 - 57). Median duration of surgery was 80min (IQR of 15-120 min) and median blood loss was 15ml. Thyroid nodules were observed in three patients, which were managed by thyroid lobectomy. Preoperative Sestamibi scan localized adenoma in 14 patients (frequency 82%). Intraoperative methylene blue and endoscopic ultrasound were not used. Parathormone (PTH) and calcium level were decreased in all post operative patients except one and no recurrence was seen on follow up. Parathyroid adenomas can be successfully localized with a pre-operative Sestamibi scan. Surgery remains the mainstay of treatment.
Topics: Adenoma; Adult; Calcium; Female; Humans; Hyperparathyroidism, Primary; Iodine Radioisotopes; Length of Stay; Male; Middle Aged; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Ultrasonography, Doppler, Color
PubMed: 31431781
DOI: No ID Found -
Medicina 2023Hyperparathyroidism-induced hypercalcemic crisis (HIHC) is an unusual state of marked progressive primary hyperparathyroidism (PHPT). Patients have severe hypercalcemia...
Hyperparathyroidism-induced hypercalcemic crisis (HIHC) is an unusual state of marked progressive primary hyperparathyroidism (PHPT). Patients have severe hypercalcemia and may have severe symptoms such as kidney failure, acute pancreatitis, and mental changes. PHPT is due to the presence of a single gland adenoma/ disease in 80 to 85%; parathyroid carcinoma is reported in <1%. Among patients with adenoma, atypical parathyroid tumor can be found infrequently. Parathyroidectomy is the only curative approach for PHPT. In this report we present three cases of HIHC due to giant parathyroid adenomas (GPAs), one of them with histopathological characteristics of an atypical parathyroid tumor, with satisfactory evolution after parathyroidectomy.
Topics: Humans; Hypercalcemia; Parathyroid Neoplasms; Hyperparathyroidism, Primary; Acute Disease; Pancreatitis; Adenoma
PubMed: 37870339
DOI: No ID Found -
Langenbeck's Archives of Surgery Mar 2022Giant parathyroid adenoma (GPA) can present with severe biochemical derangement similar to the clinical presentation of parathyroid carcinoma (PC). This study aims to...
PURPOSE
Giant parathyroid adenoma (GPA) can present with severe biochemical derangement similar to the clinical presentation of parathyroid carcinoma (PC). This study aims to present the current evidence on surgical management of GPAs in primary hyperparathyroidism.
METHODS
A systematic review of the literature on GPAs was conducted following the PRISMA guidelines. Data on clinical, biochemical, preoperative diagnostic, and surgical methods were analysed.
RESULTS
Sixty-one eligible studies were included reporting on 65 GPAs in eutopic, ectopic mediastinal, and intrathyroidal locations (61.5%, 30.8%, and 7.7%, respectively). A palpable neck mass was present in 58% of GPAs. A total of 90% of patients had symptoms including fatigue, skeletal pain, pathological fracture, nausea, and abdominal pain. Ninety percent of patients had significant hypercalcaemia (mean 3.51 mmol/L; range: 2.59-5.74 mmol/L) and hyperparathyroidism with PTH levels on average 14 times above the upper limit of the normal reference. There was no correlation between the reported GPA size and PTH nor between GPA weight and PTH (p = 0.892 and p = 0.363, respectively). Twenty-four percent had a concurrent thyroidectomy for suspicious features, intrathyroidal location of GPA, or large goitre. Immunohistochemistry such as Ki-67, parafibromin, and galectin-3 was used in 18.5% of cases with equivocal histology. Ninety-five percent of GPAs were benign with 5% reported as atypical adenomas.
CONCLUSION
The reported data on GPAs are sparse and heterogeneous. In GPAs with suspicious features for malignancy, en bloc resection with concurrent thyroidectomy may be considered. In the presence of equivocal histological features, ancillary immunohistochemistry is advocated to differentiate GPAs from atypical adenomas and PCs.
Topics: Adenoma; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Parathyroid Hormone; Parathyroid Neoplasms
PubMed: 35039921
DOI: 10.1007/s00423-021-02406-3 -
Water Clear Cell Adenoma of the Parathyroid Gland: A Forgotten Cause of Primary Hyperparathyroidism.International Journal of Surgical... Aug 2017Water clear cell adenoma of the parathyroid gland is a rare neoplasm composed of large clear cells with foamy cytoplasm and mild nuclear pleomorphism, compressing the... (Review)
Review
Water clear cell adenoma of the parathyroid gland is a rare neoplasm composed of large clear cells with foamy cytoplasm and mild nuclear pleomorphism, compressing the residual nonneoplastic parathyroid tissue. The differential diagnosis includes a variety of neoplasms with clear cell features. In this article, we provide an overview of the entity with a historical perspective, in order to help pathologists in distinguishing it from other neoplasms in their daily practice.
Topics: Adenoma; Carcinoma, Renal Cell; Cytoplasm; Diagnosis, Differential; Humans; Hyperparathyroidism, Primary; Microscopy, Electron; Parathyroid Glands; Parathyroid Neoplasms; Rare Diseases; Salivary Gland Neoplasms
PubMed: 28382826
DOI: 10.1177/1066896917701577