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Takao Obara - One of the best experts on this subject based on the ideXlab platform.
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Parathyroid Carcinoma etiology diagnosis and treatment
World Journal of Surgery, 2009Co-Authors: Takahiro Okamoto, Takao Obara, Masatoshi Iihara, Toshihiko TsukadaAbstract:Background The goal of the present study was to make our medical practice evidence-based for patients with Parathyroid Carcinoma.
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functional Parathyroid Carcinoma long term treatment outcome and risk factor analysis
Surgery, 2007Co-Authors: Masatoshi Iihara, Takahiro Okamoto, Rumi Suzuki, Akiko Kawamata, Toshio Nishikawa, Makio Kobayashi, Takao ObaraAbstract:Background This study was conducted to evaluate the long-term outcome of surgical treatment in patients with functional Parathyroid Carcinoma and to clarify factors determining prognosis. Methods A retrospective review of 38 patients with Parathyroid Carcinoma was performed. The Ki-67 index was evaluated in 29 cases. Disease-free survival and cause-specific survival estimated using the Kaplan-Meier method were analyzed, and the median follow-up period was 119 months. Results Fifteen patients developed persistent or recurrent Parathyroid Carcinoma, and 9 patients died of the disease. Twenty-one of 41 reoperations normalized the serum calcium level for at least 6 months. Univariate and multivariate analyses showed that locoregional tumor extension at initial operation and Ki-67 index ≥5% were significant factors affecting cause-specific survival ( P = .0008, P = .05) and disease-free survival ( P = .0005, P = .005), respectively. Five of 6 patients whose tumor showed a Ki-67 index ≥10% developed recurrence within 3 years after initial operation, and 4 died of the disease. Conclusions Parathyroid Carcinomas with locoregional extension at initial surgery have potential for recurrence. Our data suggest that aggressive surgical resection of recurrent Parathyroid Carcinoma is beneficial for palliation of hypercalcemia in selected patients. Ki-67 staining may be a valuable prognostic factor for patients with Parathyroid Carcinoma, especially as tumors with indices greater than 10% are more likely to recur in the early postoperative period.
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Ultrasonographic features of Parathyroid Carcinoma.
Endocrine Journal, 2001Co-Authors: Hisato Hara, Ako Igarashi, Yukiko Yano, Tohru Yashiro, Ei Ueno, Yuji Aiyoshi, Takao ObaraAbstract:Although several authors have reported single cases illustrative of some ultrasonographic characteristic of Parathyroid Carcinoma, the value of ultrasonography for diagnosing this entity remains to be determined. The purpose of our study was to investigate the ultrasonographic features of Parathyroid Carcinoma in a large number of cases. We assessed the shape, contour, echogenicity, and depth-width (DW) ratio of 16 Parathyroid Carcinomas and 61 Parathyroid adenomas. Ultrasonography showed that Parathyroid Carcinomas tend to be large, inhomogeneous, hypoechoic masses with lobulated contours. In contrast, Parathyroid adenomas were small, homogeneous, hypoechoic masses with smooth borders. The mean (range) DW ratios for Parathyroid Carcinomas were 1.21 (0.91-2.5) and 0.64 (0.33-1.47) for adenomas; the difference was statistically significant (p
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diagnosis and treatment of patients with Parathyroid Carcinoma an update and review
World Journal of Surgery, 1991Co-Authors: Takao Obara, Yoshihide FujimotoAbstract:Parathyroid Carcinoma is a rare cause of primary hyperParathyroidism. However, to our best knowledge, at least 163 cases of functioning Parathyroid Carcinoma appeared in the English literature from 1981 to 1989. We summarize the available information obtained from the reports of those patients and compare it with previous descriptions of the disease. The etiology of Parathyroid Carcinoma is usually obscure, but the possibility of a radiation-induced malignant change in the Parathyroid gland became evident in a few patients. Clinical manifestations, including age, sex, symptoms, and biochemical findings in this review were comparable to those in previous reviews. Noninvasive localization studies such as ultrasonography may offer a diagnostic clue to Parathyroid Carcinoma. Measurement of DNA content is a useful adjunct for making the histologic diagnosis of Parathyroid Carcinoma and prediction of the clinical outcome. Since the initial operation offers the best chance for cure, preoperative suspicion and intra-operative recognition of the Parathyroid cancer are essential. The initial operation should been bloc resection of the tumor, avoiding rupture of the tumor capsule and spillage of tumor cells. As Parathyroid Carcinoma is a slow-growing but tenacious malignancy, repeated resection of local recurrent tumors or even distant metastases is effective for palliation of recurrent hypercalcemia and occasional cure. When hypercalcemia is refractory to surgical therapy or no recurrent tumor can be identified, other modalities of therapy must be considered. New drugs to control hypercalcemia by inhibiting bone resorption may hold promise in patients with recurrent Parathyroid Carcinoma.
David F Schneider - One of the best experts on this subject based on the ideXlab platform.
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Parathyroid Carcinoma is it time for change
Annals of Surgical Oncology, 2015Co-Authors: David F SchneiderAbstract:Parathyroid Carcinoma is a rare etiology for primary hyperParathyroidism, but recurrence and even mortality occur much more frequently in this disease compared with its more common, benign counterparts—adenomas or hyperplasia. Asare et al. study detailing the prognostic factors for Parathyroid Carcinoma from the National Cancer Data Base (NCDB) provides useful insights into the behavior of this rare disease and changes current surgical dogma on the appropriate treatment. Analyses from large population-level cancer registries like NCDB often receive criticism from the stalwart, because they fail to capture disease-specific outcomes. Endocrine tumors like Parathyroid Carcinoma certainly fall into this category. The authors point out many of the limitations within NCDB, such as the lack of operative findings or disease-specific mortality. Recurrence would be another useful outcome for Parathyroid cancer, but this also is lacking in the NCDB. Instead, the authors chose overall survival as their primary outcome for analysis. On its surface, overall survival may seem like a poor outcome indicator for this disease. However, it may reflect the disease course for those patients who do recur. These patients will suffer the consequences of uncontrolled hypercalcemia. If disease specific mortality were recorded, how accurately would these deaths be coded? Many would probably be recorded as cardiovascular or renal causes of death when the underlying etiology is really hypercalcemia from their Parathyroid Carcinoma. Hence, overall survival may serve as a realistic outcome for Parathyroid cancer. The most striking finding from Asare et al. analysis is that nodal status did not significantly impact survival. This adds to a growing body of literature suggesting that tumor size impacts prognosis much more than lymph node status. This makes sense given that Parathyroid Carcinoma spreads by local extension and not via lymphatic channels. A similar analysis from the surveillance epidemiology and end results (SEER) dataset found that only large tumors (greater than 3 cm) were associated with lymph node involvement. Although difficult to determine from cancer registry data, this likely reflects local extension of larger tumors rather than metastases via lymphatic channels. Asare et al. also identified larger tumor size as an important prognostic factor. Currently no consensus staging system for Parathyroid Carcinoma exists. The existing framework of the American Joint Committee on Cancer (AJCC) TNM staging system typically features nodal status (‘‘N’’) in staging. More importantly, the results from this study and others like it call into question our current treatment of this disease. Surgical texts dictate an en bloc resection of the Parathyroid tumor with the ipsilateral thyroid lobe and a central compartment lymph node dissection. If lymph nodes are not important, then maybe this practice needs to change? While large population-level datasets like NCDB certainly have limitations, they compile data from many more patients than any single-institution retrospective review could potentially capture for a rare disease like Parathyroid Carcinoma. Studies, such as that of Asare et al. can indicate how to better risk stratify patients and thereby tailor surgical treatment. They also can indicate when long-standing dogma needs to change.
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is central lymph node dissection necessary for Parathyroid Carcinoma
Surgery, 2014Co-Authors: Rebecca S Sippel, Herbert Chen, David F SchneiderAbstract:Background Parathyroid Carcinoma is a rare cancer. Unlike other more common malignancies, the importance of lymph node (LN) status remains controversial. The purpose of this study was to determine the relative importance of LN metastases in disease-specific survival (DSS). Methods A retrospective review of the Surveillance, Epidemiology, and End Result database was performed on Parathyroid Carcinoma cases diagnosed between 1988 and 2010. Results We identified 405 Parathyroid Carcinoma patients. Among 114 patients with LNs examined at operation, only 12 (10.5%) had positive LNs. Sensitivity analysis found that a tumor size threshold of 3 cm best divided the cohort by DSS. Only tumors ≥3 cm and distant metastasis but not LN metastases were independent prognostic factors on multivariate analysis. When examining factors associated with LN status, only tumors ≥3 cm predicted LN metastasis. LN metastases were 7.5 times more likely in patients with tumors ≥3 cm than those with tumors Conclusion Tumors ≥3 cm were associated with LN metastases in Parathyroid Carcinoma, but positive LN status was not associated with DSS. Tumor size can potentially risk stratify patients by their risk of LN metastases.
Orlo H Clark - One of the best experts on this subject based on the ideXlab platform.
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Nonfunctioning Parathyroid Carcinoma: case report and review of literature.
Endocrine Practice, 2007Co-Authors: Gustavo G. Fernandez-ranvier, Elham Khanafshar, Kristin C Jensen, Electron Kebebew, Jeanne M. Quivey, Christine M. Glastonbury, Orlo H ClarkAbstract:OBJECTIVE: To report a case of nonfunctioning Parathyroid Carcinoma that was incidentally found during a thyroidectomy for multinodular goiter. METHODS: We present a case report, detailing the clinical course and histologic findings in a patient with a nonfunctional Parathyroid Carcinoma. The related literature is also reviewed. RESULTS: A 67-year-old woman presented with a 30-year history of a multinodular goiter that was symptomatic. A total thyroidectomy was performed. Histologic examination revealed not only a multinodular thyroid but also a mass in the left lobe, which was diagnostic of a Parathyroid Carcinoma. Serum calcium and Parathyroid hormone levels were normal postoperatively. Eleven months after the initial operation, a suprasternal mass developed, and she underwent neck reexploration and subtotal resection of an invasive recurrent nonfunctioning Parathyroid Carcinoma. The serum Parathyroid hormone and calcium levels were normal before and after the operation. Postoperatively, the patient underwent radiation therapy. Twenty-three months after the initial operation, a computed tomographic scan of the chest revealed an interval increase in size of a nodule in the left lower lobe of the lung, and 30 months after her initial operation, she underwent resection of an isolated, 1-cm (greatest diameter), metastatic Parathyroid Carcinoma in the left lower lobe of the lung. The patient is currently doing well without evidence of recurrent disease. CONCLUSION: Nonfunctioning Parathyroid Carcinomas are difficult to diagnose and to treat. Recurrent disease after operation is common, and radiation therapy may help stabilize tumor growth. Patients with nonfunctioning Parathyroid Carcinomas appear to have a poorer prognosis than do those with functioning Parathyroid cancers.
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Parathyroid Carcinoma atypical Parathyroid adenoma or parathyromatosis
Cancer, 2007Co-Authors: Gustavo G Fernandezranvier, Elham Khanafshar, Kristin C Jensen, Rasa Zarnegar, Electron Kebebew, Orlo H ClarkAbstract:BACKGROUND. Parathyroid Carcinoma, atypical Parathyroid adenoma, and parathyromatosis can be differentiated relatively easily from typical Parathyroid adenomas, but distinguishing them from each other is more difficult. METHODS. A retrospective study of 28 consecutive patients with Parathyroid Carcinoma, 7 patients with atypical Parathyroid adenoma, and 13 patients with parathyromatosis who were treated at the University of California at San Francisco Medical Center between 1966 and 2005 was performed. Patient demographics and clinical characteristics, indication for surgery, intraoperative findings, histopathologic characteristics, disease recurrence or persistence, site of invasion/metastases, and survival were compared in the 3 groups. RESULTS. Parathyroid Carcinoma (19 of 28 patients) and atypical adenoma (4 of 7 patients) were significantly more common in men, whereas parathyromatosis was more common in women (10 of 13 patients) (P = .02). A palpable neck mass and hoarseness were almost exclusively present in patients with Parathyroid Carcinoma. Prior to the first Parathyroid surgery, patients with Parathyroid Carcinoma were found to have higher blood calcium levels (≥14 mg/dL in 16 of 26 patients [62%]), whereas only 1 of 6 patients with atypical adenoma (17%) and no patients with parathyromatosis were found to have profound hypercalcemia (P < .01). Intraoperatively, patients with Parathyroid Carcinoma and atypical adenoma presented with single lesions, whereas patients with parathyromatosis had multiple small lesions. Histopathologic findings were well defined in Parathyroid Carcinoma, but some findings overlapped in the 3 tumors studied. CONCLUSIONS. Patients with Parathyroid Carcinoma often differ from those with atypical Parathyroid adenoma or parathyromatosis at the time of presentation because patients with Parathyroid Carcinoma have more profound hypercalcemia as well as invasive tumors. However, at times it is difficult to distinguish between these conditions both clinically and by final histologic examination. Cancer 2007. © 2007 American Cancer Society.
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localization and reoperation results for persistent and recurrent Parathyroid Carcinoma
Archives of Surgery, 2001Co-Authors: Electron Kebebew, Cumhur Arici, Orlo H ClarkAbstract:Hypothesis: Reoperation is safe and benefits patients with persistent and recurrent Parathyroid Carcinoma. Design: Retrospective study. The mean follow-up time was 8.1 years (median, 7 years; range, 1-23 years). Setting: A university tertiary referral center. Patients: Eighteen patients treated for Parathyroid Carcinoma from 1966 to 1999. Results: The mean serum calcium level was 13.7 mg/dL (3.43 mmol/L), and the Parathyroid hormone (PTH) level was 1.6 to 20 times the upper limit of normal. Fourteen of 18 patients had persistent or recurrent Parathyroid Carcinoma and underwent 54 reoperations (28 at our institution). Mean time to recurrence was 4.8 years (range, 1-20 years). Symptoms of hyperParathyroidism were relieved in 86% of patients who had reoperation (P<.05). Reoperation for Parathyroid Carcinoma (25 locoregional and 3 distant) significantly reduced and normalized the serum calcium and PTH levels in 75% and 62% of the cases, respectively (P<.001). The preoperative serum calcium level was a significant predictor of postreoperative normalization of the serum calcium level but not extent of initial resection, PTH level, time to recurrence, concordance of localization studies, or patient age and sex (P<.01). Surgical complications consisted of 5 unilateral and 1 bilateral permanent recurrent laryngeal nerve palsies (2 intentionally resected en bloc), 1 transient hypoParathyroidism, 1 wound seroma, and 1 tracheoesophageal fistula. The sensitivity rates of sestamibi scan (n = 14), magnetic resonance imaging (n=15), computed tomographic scan (n=6), ultrasound (n= 13), and selective venous catheterization with PTH measurement (n = 6) were 79%, 93%, 67%, 69%, and 83%, respectively. Conclusions: Recurrence is common in patients with Parathyroid Carcinoma. Patients with this disease should have frequent, lifelong follow-up to ensure early detection of recurrence. Although reoperation for persistent or recurrent Parathyroid Carcinoma provides significant symptomatic relief and normalizes serum calcium and PTH levels in most patients, it is associated with some morbidity. Localizing studies of Parathyroid Carcinoma are helpful but do not detect all tumor foci.
W F Ng - One of the best experts on this subject based on the ideXlab platform.
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use of denosumab in Parathyroid Carcinoma with refractory hypercalcemia
QJM: An International Journal of Medicine, 2015Co-Authors: Chin Voon Tong, Zeti Azura Mohamed Hussein, Mohd N Noor, Mariam Mohamad, W F NgAbstract:### Learning Point for Physicians This case illustrates the difficulties in treating hypercalcemia caused by Parathyroid Carcinoma. However, there are various choices of treatment and in recalcitrant cases, denosumab should be considered as a therapeutic option. It is important to know the vitamin D status of the patient and to monitor for hypocalcemia post treatment. Parathyroid Carcinoma is rare; accounting for ∼1% of all the causes of primary hyperParathyroidism.1 When the tumor is no longer amenable for surgery, medical therapy to control the hypercalcemia becomes the main focus of management. Unfortunately, Parathyroid Carcinoma mediated hypercalcemia is often severe and more resistant to medical therapy. We report a case of Parathyroid Carcinoma with refractory hypercalcemia treated with denosumab. A 26-year-old lady with recurrent Parathyroid Carcinoma initially presented in April 2012 with symptoms of hypercalcemia, a serum calcium of 4.0 mmol/l with …
Robert F Gagel - One of the best experts on this subject based on the ideXlab platform.
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Parathyroid Carcinoma a 22 year experience
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2004Co-Authors: Naifa L Busaidy, Camilo Jimenez, Mouhammed Amir Habra, Pamela N Schultz, Adel K Elnaggar, Gary L Clayman, Joshua A Asper, Eduardo M Diaz, Douglas B Evans, Robert F GagelAbstract:Purpose. Because Parathyroid Carcinoma is rare, clear consensus is not available regarding the optimal management of patients with this condition. Treatment strategies generally derive from clinical and anecdotal experiences. We report our experience with this entity. Methods. We included all patients with Parathyroid Carcinoma seen at The University of Texas M. D. Anderson Cancer Center since January 1, 1980. The medical records and pathology specimens were reviewed and verified in all cases. Results. Since 1980, 27 patients (16 men and 11 women) registered at M. D. Anderson Cancer Center with Parathyroid Carcinoma and a minimum follow-up of 2 years. The age at initial diagnosis (mean ± SD) was 46.7 ± 15.3 years. All patients were seen with hypercalcemia (mean calcium, 13.4 ± 1.5 mg/dL). Eighteen patients had locally invasive disease, eight had localized disease, and one had distant metastasis. Parathyroid cancer was treated with complete surgical excision with curative intent in 18 patients. In the other nine patients, who had clinical and/or radiographic evidence of soft tissue extension, the tumor was treated by comprehensive “en bloc” soft tissue resection. Of six patients who received adjuvant radiotherapy after initial surgery, only one had a local relapse. In contrast, of 20 patients who did not receive adjuvant radiotherapy, 10 had a local relapse, excluding the one patient who had distant metastases. The 5-year survival was 85%, and the 10-year survival was 77%. Five patients died of Parathyroid Carcinoma; all deaths were hypercalcemia related. Conclusions. Parathyroid Carcinoma can be an indolent disease with morbidity and mortality related to hypercalcemia. Adjuvant radiotherapy may improve local control and limit the occurrence of local relapse. A comprehensive multidisciplinary approach with surgery, radiation therapy, and medical treatment for hypercalcemia is needed to optimize patient outcome. © 2004 Wiley Periodicals, Inc. Head Neck26: 716–726, 2004
