Case Reports in Endocrinology

Case Reports in Endocrinology / 2020 / Article

Case Report | Open Access

Volume 2020 |Article ID 2128093 | https://doi.org/10.1155/2020/2128093

César Ernesto Lam-Chung, Diana Lizbeth Rodríguez-Orihuela, Jazmín De Anda González, Armando Gamboa-Domínguez, "An Unusual Simultaneous Existence of Parathyroid Carcinoma and Papillary Thyroid Carcinoma: Case Report and Review of Literature", Case Reports in Endocrinology, vol. 2020, Article ID 2128093, 8 pages, 2020. https://doi.org/10.1155/2020/2128093

An Unusual Simultaneous Existence of Parathyroid Carcinoma and Papillary Thyroid Carcinoma: Case Report and Review of Literature

Academic Editor: J. Paul Frindik
Received04 Jan 2020
Accepted20 Feb 2020
Published31 Mar 2020

Abstract

Synchronous parathyroid and papillary thyroid carcinoma are extremely rare. To our knowledge, only 15 cases have been reported in the last four decades. We describe a 50-year-old female without significant past medical or family history and no previous trauma presented with left heel pain that prompted her to seek medical attention. Physical examination was notable for a painless nodule at the left thyroid lobe. Laboratory evaluation showed a serum calcium level of 14.3 mg/dL (8.6–10.3 mg/dL) and intact parathyroid hormone level of 1160 pg/mL (12–88 pg/mL). 99Tc-sestamibi dual-phase with single-photon emission computed tomography fused images showed increased uptake at the left-sided inferior parathyroid gland. Neck ultrasound showed a 1.4 cm heterogeneous nodule in the middle-third of the left thyroid gland and a solitary 1.9 cm vascularized and hypoechoic oval nodule that was considered likely to represent a parathyroid adenoma. Due to its clinical context (severe hypercalcemia and very high levels of PTH), parathyroid carcinoma (PC) was suspected although imaging studies were not characteristic. The patient underwent en bloc resection of the parathyroid mass and left thyroid lobe and central neck compartment dissection. Pathology analysis revealed classical papillary thyroid carcinoma of classical subtype and parathyroid carcinoma. Immunohistochemical staining was positive for cyclidin D1 and negative for parafibromin. High clinical suspicion is required for parathyroid carcinoma diagnosis in the presence of very high level of parathyroid hormone, marked hypercalcemia, and the existence of any thyroid nodule should be approached and the coexistence of other carcinomas should be considered.

1. Introduction

Less than 1% of all cancers and primary hyperparathyroidism (PHPT) can be attributed to parathyroid carcinoma (PC) [1, 2]. The vast majority of cases are sporadic, whereas the rest occur in the context of genetic syndromes such as multiple endocrine neoplasia type 1 (MEN1) or hyperparathyroidism-jaw tumor syndrome (HPT-JT) [3, 4]. It has equal frequency in both genders and usually occurs during the fifth decade of life [1, 2]. Very high serum levels of intact parathyroid hormone (iPTH) and severe hypercalcemia are the main biochemical findings and clinical manifestations are due to its excessive secretion [5, 6]. It is usually diagnosed postoperatively with histology assessment given its absence of specific clinical and biochemical features [2].

Papillary thyroid cancers (PTCs) account the majority (80–85%) of thyroid cancer cases, specifically papillary thyroid microcarcinomas (PTMs) [79]. Radiation exposure and genetics are the known risk factors for PTCs. However, only 5% of PTC cases account for familial PTC [10]. It occurs predominantly in female, and the median age at presentation is 50 years [11]. An asymptomatic thyroid mass is usually the main clinical finding, and it can be accompanied with or without cervical lymph node enlargement. However, vocal cord paralysis and tracheal compression can be present in about 20% of PTC cases, and it is manifested as hoarseness and dysphagia [12]. Biochemical tests are of limited usefulness because most patients have normal thyroid function [13].

The coexistence of thyroid and parathyroid carcinoma is extremely infrequent. Here, we describe a patient with this unusual presentation.

2. Case Presentation

A 50-year-old female without significant past medical or family history and no previous trauma presented with pain on her left heel that prompted her to seek medical attention. Initial evaluation was notable for serum concentration of calcium 14.3 mg/dL (normal range 8.6–10.3 mg/dL), alkaline phosphatase of 339.4 U/L (normal range 34–104 U/L), creatinine of 1.8 mg/dL (normal range 0.3–0.7 mg/dL), and iPTH level of 1160 pg/mL (normal range 12–88 pg/mL). Biochemical data of the patient are summarized in Table 1. Because of the concern for chronic kidney disease, a renal ultrasound was performed and showed both kidney medullary nephrocalcinosis and thinning of the renal parenchyma. Bone densitometry revealed osteoporosis at the anteroposterior spine (T score −2.7) and femoral neck (T score −2.9) and osteopenia at the total hip (T score −2.3). A presumptive diagnosis of parathyroid carcinoma (PC) was made and referred to endocrinology department for further evaluation. Physical examination revealed a hardened and painless nodule at the left thyroid lobe without vocal cord paralysis. Thyroid function test values were within the reference ranges.


Laboratory values (normal range)At admissionAt two months postoperatively

Calcemia (8.6–10.3 mg/dL)14.39.5
Ionized calcemia (4.36–5.2 mg/dL)7.064.83
Magnesium (1.9–2.7 mg/dL)2.11.94
Creatinine (0.3–0.7 mg/dL)21.77
Albumin (3.5–5.7 g/dL)3.683.24
Alkaline phosphatase (34–104 U/L)381399
PTH (12–88 pg/mL)11607.4
Phosphatemia (2.5–5 mg/dL)2.733.28
25(OH) vitamin D (30–100 ng/mL)10.143
FT4 (0.63–1.34 ng/dL)0.720.97
T3T (0.64–1.81 ng/mL)1.070.79
TSH (0.3–5 mIU/L)1.84.14

A 99mTc-sestamibi dual-phase fusion imaging with single-photon emission computed tomography/computed tomography (SPECT/CT) was performed, and a possible left-sided inferior parathyroid was identified (Figure 1(a)). Neck ultrasonography showed a 1.4 cm heterogeneous nodule and central vascularity in the middle-third of the left thyroid gland (Figures 2(a) and 2(b)). At the same area depicted by SPECT/CT, a 1.9 cm vascularized and hypoechoic oval nodule was present and considered likely to represent a parathyroid adenoma (Figure 1(b)). Due to its clinical context (severe hypercalcemia and very high levels of PTH), PC was suspected although imaging studies were not characteristic. At surgical intervention, a normal-appearing inferior parathyroid gland was identified and preserved in situ. An en bloc resection of the parathyroid mass and left thyroid lobe and central lymph node compartment dissection was performed. On the fourth postoperative day, the iPTH value was 84.6 pg/mL.

Gross examination of the surgical specimen revealed a 4.8 × 2.6 × 2.3 cm left thyroid lobe and a 2.4 × 1.8 × 1.4 cm left superior parathyroid gland. Histological examination revealed a 1.3 × 1.2 cm mass at the left thyroid lobe consistent of PTC of classical subtype (Figure 3) and PC, 2.5 cm in widest tumor dimension, with capsular and vascular space invasion (Figure 4). Immunohistochemical staining was positive for cyclidin D1 and negative for parafibromin. Ki-67 index was 2%. Six examined lymph nodes from central compartment were negative for metastasis. Her thyroid carcinoma was staged pT1bN0M0 (TNM AJCC 2018).

On the sixth postoperative day, the patient presented hypocalcemic symptoms (calcium 6.9 mg/dL) consistent with hungry bone syndrome. She received intravenous and oral calcium and vitamin D supplementation. Subsequently, she was discharged with oral calcium treatment and remained well, with the latest serum calcium level being 8.6 mg/dL (6 weeks postoperatively).

3. Discussion

The simultaneous presence of thyroid and parathyroid carcinoma is extremely rare with only 15 documented cases [1430] in the last 41 years, and no correlation, up to date, has been discovered between these entities [31]. Comparison of the previous cases and ours are described in Table 1. The average age was 52 years (range 21–79), and the vast majority were female (80%). According to Surveillance, Epidemiology, and End Results (SEER) database, PTCs usually occur during the fourth and fifth decades of life and have a 2.5 : 1 female-to-male ratio [32], while the reported mean age for PC presentation was 44 to 45 years with an even distribution between genders [3335]. As a result, the coexistence of thyroid and parathyroid carcinoma may have an impact on the gender distribution and age presentation. Notably, the youngest patient reported had Hürthle cell thyroid carcinoma and PC [21]. Hürthle cell carcinoma is associated with poorer prognosis and higher recurrence rate in local lymph nodes [36, 37].

Almost all patients had functional PC (including our patient) as outlined in Table 2. Nonfunctional PC is much more infrequent than functional PC, and it has a decreased survival due to its absence of symptoms and perhaps to its aggressive biology [16, 39]. To our knowledge, only one case of nonfunctional PC occurring with PTM was reported [40]. Interestingly, all cases with reported PC localization including the one here reported had a preponderance for the left lower side.


ReferenceAgeGenderCalcium (mg/dL)PTH (pg/mL)Parathyroid gland size (cm)Carcinoma locationThyroid carcinomaAssociated parathyroid diseaseSurgical treatmentOutcome

Kurita et al. [38]68F12.263004.2 × 3.2 × 2.4Left lowerPapillaryNoneEn bloc resectionPostoperative normocalcemia
Christmas et al. [26]62FHypercalcemiaUnknownUnknownUnknownFollicularNoneUnknownDied from metastatic parathyroid carcinoma
Savli et al. [22]47FNormalNormalNormalUnknownPapillaryHyperplasiaTotal thyroidectomy parathyroidectomy (excision of 2 hyperplastic glands)Normocalcemia (1 year)
Bednarek-Tupikowska et al. [27]42F15.416555 cm in diameterLeft lowerFollicularNoneEn bloc resectionPersistent hypercalcemia
Schoretsanitis, 2002 [24]55F14.2>10003 × 3Left lowerPapillaryNoneEn bloc resectionNormocalcemia (6 years)
Kern et al. [28]54FUnknown4652.5 × 1.8 × 1.6Right lowerPapillary and follicularNoneRight parathyroidectomy; total thyroidectomy with local lymph node resection; corticectomy in the right superior frontal gyrusDied from intracranial metastatic parathyroid carcinoma
Lin et al. [25]38M16.53514 × 3 × 3Left lowerPapillaryTwo enlarged parathyroid glands on contralateral sideTotal thyroidectomy and left parathyroidectomyNormocalcemia (6 years)
Goldfarb et al. [16]58M14.420233.4 × 3.3 × 2.2Left lowerPapillaryContralateral parathyroid adenomaEn bloc resectionPersistent hypercalcemia after resection of parathyroid carcinoma; normocalcemia after excision of contralateral parathyroid adenoma (1 year)
Marcy et al. [17]42F14.13831.3Right lowerPapillaryNoneTotal thyroidectomy, right parathyroidectomy, and central and lateral neck dissectionNormocalcemia (14 months)
Chaychi et al. [18]79F10.4891.1 × 1.2 × 4.8Left superiorPapillaryNoneTotal thyroidectomy and left parathyroidectomyNormocalcemia (6 months)
Amoodi et al. [19]48FUnknown186>5Left lowerPapillaryNoneEn bloc resectionPersistent hypercalcemia after resection of parathyroid carcinoma; hypoparathyroidism after completion of parathyroidectomy
Zakerkish et al. [21]21M131311UnknownUnknownHürthleNoneTotal thyroidectomy and parathyroidectomyPersistent hypercalcemia and died due to its complications
Song et al. [30]45F1714554.28 × 3.09 × 2.54Left lowerPapillaryNoneLeft parathyroidectomy and left thyroid lobectomy plus left neck dissectionPersistent hypercalcemia after left parathyroidectomy; normocalcemia after left thyroid lobectomy plus left neck dissection (6 months)
Baek et al. [23]68F12.812474.2 × 3.3 × 3.1Left lowerPapillaryNoneLeft inferior parathyroidectomy and left thyroid lobectomyPostoperative normocalcemia
Kuzu et al. [29]52F11.4208UnknownUnknownPapillaryNoneRight parathyroidectomy and right thyroid lobectomyPostoperative normocalcemia
Our case50F13.911602.4 × 1.8 × 1.4Left superiorPapillaryNoneLeft inferior parathyroidectomy and left thyroid lobectomyPostoperative normocalcemia

A common but not diagnostic features of PC include trabecular architecture of the parenchymal cells, a thick capsule, fibrous trabeculae traversing the gland, nuclear atypia, and high mitotic rates [4143]. Criteria for definitive diagnosis of PC consist of capsular and vascular invasion, adjacent tissues invasion, involvement of regional lymph nodes, and distant metastatic lesions. Because cell seeding can occur due to the rupture of capsule in the operative field, locally recurrent disease is not diagnostic. Our patient had a clear capsular and vascular invasion (Figures 2(b) and 2(c)), making the diagnosis of PC unequivocal. It has been reported that extracapsular vascular invasion correlates best with the diagnosis [33].

Risk factors for PC include history of neck irradiation, long-standing secondary hyperparathyroidism (HPT), end-stage renal disease, and hereditary HPT-jaw tumor syndrome. Additionally, mutation of parafibromin (HRPT2, also known as CDC73) and cyclin D1 (CCND1) plays an important role in the molecular pathogenesis of PC [1, 44, 45]. Our patient has no history of neck irradiation and has not underwent genetic testing.

Here, we describe a case of a PTH-secreting PC that had an appearance of parathyroid adenoma in imaging studies. It was suspected due to marked hypercalcemia and a very high iPTH and renal and bone disease. PTC was only diagnosed postoperatively with histological examination.

Radical surgery provides the best possibility of cure. However, more than 50% of the patients have persistent or recurrent disease. The main cause of morbidity and mortality is due to hypercalcemia complications [34] and less frequently to metastasis [46].

4. Conclusion

The presented case emphasizes the requirement of high clinical suspicion of parathyroid carcinoma in the presence of very high level of iPTH, marked hypercalcemia, and overt skeletal and renal involvement. The existence of any thyroid nodules should be approached and coexistence of other carcinomas should be considered. Although imaging studies assist in the localization, reliable distinction of parathyroid carcinoma from adenoma cannot be made. Radical surgery is the only effective and curative treatment and should consist of initial en bloc resection of the tumor with ipsilateral thyroidectomy and central neck dissection.

Conflicts of Interest

The authors have no conflicts of interest to declare.

Acknowledgments

The authors thank the Department of Endocrinology and Metabolism and Pathology of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

References

  1. E. Shane, “Parathyroid carcinoma,” The Journal of Clinical Endocrinology & Metabolism, vol. 86, no. 2, pp. 485–493, 2001. View at: Publisher Site | Google Scholar
  2. F. Cetani, E. Pardi, and C. Marcocci, “Update on parathyroid carcinoma,” Journal of Endocrinological Investigation, vol. 39, no. 6, pp. 595–606, 2016. View at: Publisher Site | Google Scholar
  3. E. Kebebew, “Parathyroid carcinoma,” Current Treatment Options in Oncology, vol. 2, no. 4, pp. 347–354, 2001. View at: Publisher Site | Google Scholar
  4. J. M. Sharretts and W. F. Simonds, “Clinical and molecular genetics of parathyroid neoplasms,” Best Practice & Research Clinical Endocrinology & Metabolism, vol. 24, no. 3, pp. 491–502, 2010. View at: Publisher Site | Google Scholar
  5. L. Wang, D. Han, W. Chen et al., “Non-functional parathyroid carcinoma: a case report and review of the literature,” Cancer Biology & Therapy, vol. 16, no. 11, pp. 1569–1576, 2015. View at: Publisher Site | Google Scholar
  6. B. J. Wilkins and J. S. Lewis Jr., “Non-functional parathyroid carcinoma: a review of the literature and report of a case requiring extensive surgery,” Head and Neck Pathology, vol. 3, no. 2, pp. 140–149, 2009. View at: Publisher Site | Google Scholar
  7. S. Guth, U. Theune, J. Aberle, A. Galach, and C. M. Bamberger, “Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination,” European Journal of Clinical Investigation, vol. 39, no. 8, pp. 699–706, 2009. View at: Publisher Site | Google Scholar
  8. L. Dal Maso, C. Panato, S. Franceschi et al., “The impact of overdiagnosis on thyroid cancer epidemic in Italy, 1998–2012,” European journal of cancer, vol. 94, pp. 6–15, 2018. View at: Publisher Site | Google Scholar
  9. L. Davies, L. G. T. Morris, M. Haymart et al., “American Association of Clinical Edocrinologists and American College of Endocrinology Disease State Clinical Review: the increasing incidence of thyroid cancer,” Endocrine Practice, vol. 21, no. 6, pp. 686–696, 2015. View at: Publisher Site | Google Scholar
  10. M. Mileva, B. Stoilovska, A. Jovanovska et al., “Thyroid cancer detection rate and associated risk factors in patients with thyroid nodules classified as bethesda category III,” Radiology and Oncology, vol. 52, no. 4, pp. 370–376, 2018. View at: Publisher Site | Google Scholar
  11. H. Lim, S. S. Devesa, J. A. Sosa, D. Check, and C. M. Kitahara, “Trends in thyroid cancer incidence and mortality in the United States, 1974–2013,” JAMA, vol. 317, no. 13, pp. 1338–1348, 2017. View at: Publisher Site | Google Scholar
  12. F. Rahmat, A. Kumar Marutha Muthu, N. S. R. Gopal, S. Jo Han, and A. S. Yahaya, “Papillary thyroid carcinoma as a lateral neck cyst: a cystic metastatic node versus an ectopic thyroid tissue,” Case Reports in Endocrinology, vol. 2018, Article ID 5198297, 3 pages, 2018. View at: Publisher Site | Google Scholar
  13. S. Suzuki, T. I. Bogdanova, V. A. Saenko et al., “Histopathological analysis of papillary thyroid carcinoma detected during ultrasound screening examinations in Fukushima,” Cancer Science, vol. 110, no. 2, pp. 817–827, 2019. View at: Publisher Site | Google Scholar
  14. S. Tseleni-Balafouta, H. Gakiopoulou, N. Kavantzas, G. Agrogiannis, N. Givalos, and E. Patsouris, “Parathyroid proliferations,” Cancer, vol. 111, no. 2, pp. 130–136, 2007. View at: Publisher Site | Google Scholar
  15. H. Mazeh, D. Prus, and H. R. Freund, “Incidental non-functional parathyroid carcinoma identified during thyroidectomy,” Israel Medical Association Journal, vol. 10, no. 8-9, p. 659, 2008. View at: Google Scholar
  16. M. Goldfarb, P. O’Neal, J. Shih, P. Hartzband, J. Connolly, and P.-O. Hasselgren, “Synchronous parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma in a patient with severe and long-standing hyperparathyroidism,” Endocrine Practice, vol. 15, no. 5, pp. 463–468, 2009. View at: Publisher Site | Google Scholar
  17. P.-Y. Marcy, J. Thariat, A. Sudaka, and G. Poissonnet, “Synchronous parathyroid and papillary thyroid carcinomas,” Thyroid, vol. 19, no. 10, pp. 1131–1133, 2009. View at: Publisher Site | Google Scholar
  18. L. Chaychi, K. Belbruno, A. Golding, and V. Memoli, “Unusual manifestation of parathyroid carcinoma in the setting of papillary thyroid cancer,” Endocrine Practice, vol. 16, no. 4, pp. 664–668, 2010. View at: Publisher Site | Google Scholar
  19. H. A. Amoodi, F. M. Makki, S. Mark Taylor, M. J. Bullock, R. D. Hart, and J. R. Trites, “Synchronous thyroid/parathyroid carcinomas,” Journal of Otolaryngology—Head & Neck Surgery, vol. 39, no. 5, pp. E42–E47, 201. View at: Google Scholar
  20. S. Basceken, V. Genc, S. Ersoz, Y. Sevim, S. Celik, and I. Bayram, “Is local resection sufficient for parathyroid carcinoma?” Clinics, vol. 70, no. 4, pp. 247–249, 2015. View at: Publisher Site | Google Scholar
  21. M. Zakerkish, E. Rajaei, M. Dargahi, and M. Bahadoram, “A rare constellation of Hürthle cell thyroid carcinoma and parathyroid carcinoma,” Journal of Clinical and Diagnostic Research, vol. 9, no. 12, 2015. View at: Publisher Site | Google Scholar
  22. H. Savli, A. Sevinc, R. Sari, S. Ozen, S. Buyukberber, and E. Ertas, “Occult parathyroid carcinoma in a patient with papillary thyroid carcinoma and Hashimoto’s thyroiditis,” Journal of Endocrinological Investigation, vol. 24, no. 1, pp. 42–44, 2001. View at: Publisher Site | Google Scholar
  23. C.-O. Baek, K. H. Kim, and S. K. Song, “Synchronous parathyroid carcinoma and papillary thyroid carcinoma in a patient with long-standing schizophrenia,” The Korean Journal of Internal Medicine, vol. 32, no. 6, pp. 1104–1107, 2017. View at: Publisher Site | Google Scholar
  24. G. Schoretsanitis, J. Melissas, M. Kafousi, N. Karkavitsas, and D. D. Tsiftsis, “Synchronous parathyroid and papillary thyroid carcinoma: a case report,” American Journal of Otolaryngology, vol. 23, no. 6, pp. 382–385, 2002. View at: Publisher Site | Google Scholar
  25. S.-D. Lin, S.-T. Tu, S.-R. Hsu, J. H.-M. Chang, K.-T. Yang, and L.-H. Yang, “Synchronous parathyroid and papillary thyroid carcinoma,” Journal of the Chinese Medical Association, vol. 68, no. 2, pp. 87–91, 2005. View at: Publisher Site | Google Scholar
  26. T. J. Christmas, C. R. Chapple, J. G. Noble, E. J. G. Milroy, and A. G. A. Cowie, “Hyperparathyroidism after neck irradiation,” British Journal of Surgery, vol. 75, no. 9, pp. 873-874, 1988. View at: Publisher Site | Google Scholar
  27. G. Bednarek-Tupikowska, T. Tolloczko, W. Tupikowski et al., “Coexistence of parathyroid carcinoma and non-medullary carcinoma of the thyroid,” Medical Science Monitor, vol. 7, no. 3, pp. 448–456, 2001. View at: Google Scholar
  28. M. Kern, G. Lee, P. Robbins, M. Bynevelt, and P. Watson, “Intracranial metastatic parathyroid carcinoma,” Journal of Neurosurgery, vol. 101, no. 6, pp. 1065–1069, 2004. View at: Publisher Site | Google Scholar
  29. F. Kuzu, A. Cinkaya, M. Ekici, H. Kodaz, and A. Deger, “Synchronous parathyroid carcinoma and multifocal papillary thyroid carcinoma: a case report,” Eurasian Journal of Medicine and Oncology, vol. 1, no. 1, pp. 49–52, 2017. View at: Google Scholar
  30. C. Song, J. Wang, X. Cai, and L. Gao, “Synchronous parathyroid carcinoma and papillary thyroid carcinoma : a case study and review of literature,” International Journal of Clinical and Experimental Pathology, vol. 9, no. 1, pp. 302–309, 2016. View at: Google Scholar
  31. A. Campennì, S. Giovinazzo, S. A. Pignata et al., “Association of parathyroid carcinoma and thyroid disorders: a clinical review,” Endocrine, vol. 56, no. 1, pp. 19–26, 2017. View at: Publisher Site | Google Scholar
  32. http://seer.cancer.gov/statfacts/html/thyro.html.
  33. C. E. Quinn, J. Healy, A. H. Lebastchi et al., “Modern experience with aggressive parathyroid tumors in a high-volume New England referral center,” Journal of the American College of Surgeons, vol. 220, no. 6, pp. 1054–1062, 2015. View at: Publisher Site | Google Scholar
  34. T. Obara and Y. Fujimoto, “Diagnosis and treatment of patients with parathyroid carcinoma: an update and review,” World Journal of Surgery, vol. 15, no. 6, pp. 738–744, 1991. View at: Publisher Site | Google Scholar
  35. E. Shane and J. P. Bilezikian, “Parathyroid carcinoma: a review of 62 patients,” Endocrine Reviews, vol. 3, no. 2, pp. 218–226, 1982. View at: Publisher Site | Google Scholar
  36. Y. Kushchayeva, Q.-Y. Duh, E. Kebebew, A. D’Avanzo, and O. H. Clark, “Comparison of clinical characteristics at diagnosis and during follow-up in 118 patients with hurthle cell or follicular thyroid cancer,” The American Journal of Surgery, vol. 195, no. 4, pp. 457–462, 2008. View at: Publisher Site | Google Scholar
  37. S. K. G. Grebe and I. D. Hay, “Follicular thyroid cancer,” Endocrinology and Metabolism Clinics of North America, vol. 24, no. 4, pp. 761–801, 1995. View at: Publisher Site | Google Scholar
  38. S. Kurita, S. Mihashi, M. Hirano, T. Nakashima, and A. Tanimura, “Hyperfunctioning parathyroid carcinoma combined with papillary carcinoma of the thyroid gland—report of a case (author’s transl),” Nihon Gan Chiryo Gakkai Shi, vol. 14, no. 7, pp. 1127–1135, 1979. View at: Google Scholar
  39. J. B. Koea and J. H. F. Shaw, “Parathyroid cancer: biology and management,” Surgical Oncology, vol. 8, no. 3, pp. 155–165, 1999. View at: Publisher Site | Google Scholar
  40. K. Dikmen, H. Bostanci, H. Gobut et al., “Nonfunctional double parathyroid carcinoma with incidental thyroid micropapillary carcinoma: a rare case,” The Pan African Medical Journal, vol. 27, p. 241, 2017. View at: Publisher Site | Google Scholar
  41. G. G. Fernandez-Ranvier, E. Khanafshar, K. Jensen et al., “Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis?” Cancer, vol. 110, no. 2, pp. 255–264, 2007. View at: Publisher Site | Google Scholar
  42. A. Schantz and B. Castleman, “Parathyroid carcinom: a study of 70 cases,” Cancer, vol. 31, no. 3, pp. 600–605, 1973. View at: Google Scholar
  43. B. Givi and J. P. Shah, “Parathyroid carcinoma,” Clinical Oncology, vol. 22, no. 6, pp. 498–507, 2010. View at: Publisher Site | Google Scholar
  44. A. Arnold, “Genetic basis of endocrine disease 5: molecular genetics of parathyroid gland neoplasia,” Journal of Clinical Endocrinology & Metabolism, vol. 77, no. 5, pp. 1108–1112, 1993. View at: Publisher Site | Google Scholar
  45. T. M. Shattuck, S. Välimäki, T. Obara et al., “Somatic and germ-line mutations of theHRPT2Gene in sporadic parathyroid carcinoma,” New England Journal of Medicine, vol. 349, no. 18, pp. 1722–1729, 2003. View at: Publisher Site | Google Scholar
  46. A. Campennì, R. M. Ruggeri, A. Sindoni et al., “Parathyroid carcinoma presenting as normocalcemic hyperparathyroidism,” Journal of Bone and Mineral Metabolism, vol. 30, no. 3, pp. 367–372, 2012. View at: Publisher Site | Google Scholar

Copyright © 2020 César Ernesto Lam-Chung et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


More related articles

284 Views | 228 Downloads | 0 Citations
 PDF Download Citation Citation
 Download other formatsMore
 Order printed copiesOrder

Related articles

We are committed to sharing findings related to COVID-19 as quickly as possible. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Review articles are excluded from this waiver policy. Sign up here as a reviewer to help fast-track new submissions.