1. A nationwide study on parathyroid carcinoma
- Author
-
Päivi Kekäläinen, Eliisa Löyttyniemi, Helena Leijon, Leo Niskanen, Matti Välimäki, Markku Laakso, Eeva Ryhänen, Johanna Arola, Saara Metso, Camilla Schalin-Jäntti, Otto Knutar, Mika Väisänen, Raija Ristamäki, Marjo Tamminen, Ilkka Heiskanen, Pirkko Korsoff, Petteri Ahtiainen, Eija Eloranta, Caj Haglund, Endokrinologian yksikkö, Department of Medicine, Clinicum, HUSLAB, Department of Pathology, Medicum, HYKS erva, Department of Surgery, II kirurgian klinikka, Translational Cancer Biology (TCB) Research Programme, Research Programs Unit, HUS Abdominal Center, and HUS Internal Medicine and Rehabilitation more...
- Subjects
Male ,medicine.medical_treatment ,Parathyroid hormone ,Gastroenterology ,PROGNOSTIC-FACTORS ,0302 clinical medicine ,Aged, 80 and over ,biology ,Incidence ,Incidence (epidemiology) ,High-Throughput Nucleotide Sequencing ,Hematology ,General Medicine ,Middle Aged ,Prognosis ,CANCER ,TUMORS ,3. Good health ,Parathyroid Neoplasms ,Oncology ,Parathyroid carcinoma ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Ki-67 ,Female ,PARAFIBROMIN IMMUNOREACTIVITY ,Adult ,Parathyroidectomy ,medicine.medical_specialty ,Adolescent ,Adenoma ,RETINOBLASTOMA ,3122 Cancers ,030209 endocrinology & metabolism ,DIAGNOSIS ,Young Adult ,03 medical and health sciences ,Internal medicine ,KI-67 ,Biomarkers, Tumor ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Germ-Line Mutation ,Aged ,Retrospective Studies ,business.industry ,Tumor Suppressor Proteins ,Cancer ,Retrospective cohort study ,ta3121 ,medicine.disease ,GENE ,ADENOMA ,Surgery ,biology.protein ,EXPERIENCE ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Parathyroid carcinoma (PC) is rare and diagnostically challenging. Reported outcomes are rather poor and the incidence might be increasing.We performed a nationwide study on all cases (n= 32) diagnosed in 2000-2011 in Finland, and compared clinical and histopathological characteristics and outcome to atypical parathyroid (APA; n= 28) and parathyroid adenomas (PA; n= 72). The incidence in years 1955-1999 was compared to that in 2000-2013.Preoperatively, calcium and parathyroid hormone concentrations were higher in PC compared to APA and PA (1.76, 1.56 and 1.44 mmol/l, p .001; and 989, 355 and 160 μmol/l, p .001, respectively). Calcium was ≤1.77 mmol/l for all PAs. Hospitalization (44% vs. 22% and 3%, respectively, p = .01), renal (50% vs. 48% vs. 22%, respectively, p = .01) and bone (47% vs. 15% vs. 38%, respectively p = .002) manifestations were more common. PC and APA tumors were larger than PA (p .001). Histopathological characteristics of PC compared to PA are increased mitotic activity (p= .001), chief cells (p = .003), diffuse growth pattern (p .001), higher Ki67 (p .001) and negative parafibromin (p .001). One PC (1/18) and one APA (1/16) patient had a CDC73 mutation. After 6.7 (2-13.9) years of follow-up, 9.4% of PC had residual, 21% recurrent disease and 12.5% died of disease. Overall mortality did not differ between subgroups (p = .094). Recurrent PC was characterized by vascular invasion, lymph node metastases, high mitotic activity, necrosis and negative parafibromin. Incidence increased from 1.42 (range 0.52-2.14) to 7.14 (range 3.42-10.38)/10.000.000/years; (p .001).PC associates with severe primary hyperparathyroidism and must be suspected if calcium ≥1.77 mmol/l. The prevalence of CDC73 germline mutations in PC and APA in Finland is 6%. PC has distinct histopathological characteristics and its incidence has increased over the past decades. more...
- Published
- 2017
- Full Text
- View/download PDF