Primary Paraganglioma of the Parathyroid: A Case Report and Clinicopathologic Review.

Levy MT, Braun JT, Pennant M, Thompson LDR.
Head Neck Pathol. 2010 Mar;4(1):37-43.
Paragangliomas are relatively uncommon neoplasms that arise in adrenal and extra-adrenal paraganglia of the autonomic nervous system. Parasympathetic paraganglioma develop predominantly in the head and neck. It is exceedingly uncommon to develop a primary intraparathyroid paraganglioma. There is only a single case report in the English literature. The information from the single previous case report (Medline 1960–2009) was combined with this case report. Our patient was a 69 year old woman who presented with a thyroid gland mass, with extension into the substernal space. The patient had a history of renal cell carcinoma removed 18 months before. At surgery, a thyroid lobectomy and a parathyroidectomy were performed. The parathyroid tissue showed a very well defined zellballen arrangement of paraganglion cells within the parenchyma of the parathyroid gland. The cells had ample basophilic, granular cytoplasm. The nuclei were generally round to oval with ‘salt-and-pepper’ nuclear chromatin distribution. There was a richly vascularized stroma. Mitotic figures, necrosis, invasive growth, and profound nuclear pleomorphism were absent. The neoplastic cells were strongly and diffusely immunoreactive with chromogranin, synaptophysin, CD56, and focally with cyclin-D1. The paraganglioma showed a delicate S-100 protein positive supporting sustentacular framework. Keratin, CD10, PTH, calcitonin and RCC markers were negative. The patient showed no stigmata of Multiple Endocrine Neoplasia (MEN) and has no paraganglioma in any other anatomic site. She is alive without any additional findings 12 months after surgery. Isolated paraganglioma within the parathyroid is rare, and should be separated from parathyroid adenoma, hyperplasia or metastatic disease to assure appropriate management.
PubMed ID: 20237987
Article Size: <1 MB

Parathyroid carcinoma occurring in multiple endocrine neoplasia type 1.

Kodroff KS, Lieber C, Thompson LDR.
Endocr Pract. 1999 Nov-Dec;5(6):347-349.
OBJECTIVE: To describe a patient with multiple endocrine neoplasia type I (MEN-I) in whom parathyroid carcinoma developed.
METHODS: A case report is presented, including detailed history, laboratory findings, and pathologic features.
RESULTS: A 49-year-old man with a known history of MEN-I syndrome had hypercalcemia and profoundly increased parathyroid hormone levels. Seven years earlier, he had been diagnosed with a gastrinoma, prolactinoma, and primary hyperparathyroidism. A neck exploration at that time consisted of resection of a right inferior parathyroid gland and parathyroid tissue in the thyroid gland as well as biopsies of two left-sided glands, after which microscopic examination revealed parathyroid hyperplasia and his serum calcium levels normalized. On reexploration of the neck, resection revealed pathologic findings consistent with parathyroid carcinoma.
CONCLUSION: Parathyroid carcinoma has rarely been reported in the setting of MEN-I. This case illustrates the need for near-complete resection of parathyroid tissue in the patient with MEN-I. Subtotal or total parathyroidectomy in conjunction with forearm autotransplantation should be performed, not simply to prevent recurrence of benign disease but also to prevent the potential development of carcinoma over time.
PubMed ID: n/a
Article Size: 1.5 MB

Parathyroid carcinoma.

Thompson LD.
Ear Nose Throat J. 2008 Sep; 87(9):502-504.
FIRST PARAGRAPH: Parathyroid carcinoma is rare, comprising less than 1% of all cases of primary hyperparathyroidism. Parathyroid carcinoma occurs in patients of all ages, and there is no predilection for either sex. Its clinical features are primarily attributable to the effects of hypercalcemia and excessive secretion of parathyroid hormone (PTH). Most of its symptoms–weakness, fatigue, anorexia, weight loss, and nausea–are nonspecific, but an excessively high serum calcium level (>16 mg/dl) can be associated with nephrolithiasis, renal insufficiency, and bone ‘brown tumors.’ A palpable neck mass suggests a parathyroid carcinoma. Parathyroid carcinoma is a suggested component of hyperparathyroidism-jaw tumor syndrome.
PubMed ID: 18800320
Article Size: <1 MB

Parathyroid adenoma.

Thompson LD.
Ear Nose Throat J. 2014 Jul;93(7):246-68.
FIRST PARAGRAPH: A parathyroid adenoma is a benign neoplasm of parathyroid parenchymal cells. There is an association with the HRPT2 gene (1q25-q31), which is associated with hyperparathyroidism-jaw tumor syndrome (an autosomal dominant disorder). Parathyroid adenoma is the single most common cause of hyperparathyroidism. It is usually seen in patients in the fourth and fifth decades of life, and women are affected more often than men by a margin of 3 or 4 to 1.
PubMed ID: 25025408
Article Size: <1 MB

Primary parathyroid hyperplasia.

Penner CR, Thompson LD.
Ear Nose Throat J. 2003 May;82(5):363.
FIRST PARAGRAPH: Parathyroid hyperplasia is classified as either primary, secondary, or tertiary. Primary parathyroid hyperplasia occurs in approximately 15% of patients with hyperparathyroidism. Most cases are sporadic, and they usually occur in patients who are middle-aged and older. Approximately 20% of all cases of primary chief-cell hyperplasia are associated with one of the multiple endocrine neoplasia syndromes. Symptoms are referable to the level and duration of serum calcium elevation, although routine biochemical testing has led to an increase in the identification of asymptomatic patients. Biochemically, ionized serum calcium levels are elevated, and serum phosphorus concentrations are lowered. Technetium-99m sestamibi imaging successfully localizes as many as 60% of hyperplastic glands, although this technique is significantly more effective in localizing adenomas and carcinomas. Therefore, at least two glands should be examined histologically to confirm the diagnosis.
PubMed ID: 12789760
Article Size: <1 MB


Thompson LD.
Ear Nose Throat J. 2005 Oct;84(10):636.
FIRST PARAGRAPH: Parathyroiditis is a rare and poorly understood condition. Chronic parathyroiditis may occur in patients with hypoparathyroidism, as well as in those with primary chief-cell hyperplasia. Most patients are asymptomatic. Antibodies to parathyroid tissue are seen in only a few cases of parathyroiditis. It is thought that parathyroiditis represents an autoimmune process similar to thyroid gland Hashimoto’s disease. The presence of seronegative cases of parathyroiditis does not rule against an autoimmune etiology, because a similar phenomenon is observed in Hashimoto’s thyroiditis. Based on this assumption, it is believed that the lymphocytic infiltration is an ongoing destructive process.
PubMed ID: 16382744
Article Size: <1 MB

Metastases to the Parathyroid Glands: A Comprehensive Literature Review of 127 Reported Cases.

Bauer JL, Toluie S, Thompson LDR.
Head Neck Pathol. 2017 Sep 5. [Epub ahead of print]
Metastases to the head and neck organs are uncommon, potentially representing the initial presentation of an occult malignancy. Single case reports and small series report metastases to the parathyroid gland, but there is no large review of the literature on secondary tumors involving the parathyroid glands. A review of the English literature between 1950 and 2017 was performed of all metastases or secondary involvement of the parathyroid glands. One hundred and twenty-seven cases of metastatic tumors were reported, although potentially significantly unrepresented in autopsy series (parathyroid glands are not routinely examined) and due to reporting bias. Women were affected more commonly than men (5.8:1; 99 vs. 17, respectively), with a mean age at presentation of 58.5 years, when reported. The most common primary sites of malignancies that metastasized to the parathyroid glands were breast carcinomas (66.9%, n = 85), melanoma (11.8%, n = 15), and lung carcinoma (5.5%, n = 7), with carcinomas representing 86.6% of metastases. Metastases were nearly always identified as part of widely metastatic disease, with only five (3.2%) cases reported as isolated metastases. Tumor-to-tumor metastases comprised 5.5% of all metastases to the parathyroid glands (metastases to parathyroid adenoma). A significant clinical finding of metastases to the parathyroid glands was the development of deranged calcium homeostasis, well beyond the 9 (7.2%) cases with primary parathyroid gland disease present. Although concurrent conditions (renal disease; bone metastases) may partially affect calcium metabolism, the onset of calcium derangement seemed to coincide with parathyroid gland metastases and not systemic disease. In summary, metastases to the parathyroid glands are uncommon, potentially under-recognized in patients who have otherwise widely metastatic tumors. Women are affected more often than men, with breast carcinomas (66.9%) and melanoma (11.8%) the most common primary tumors. Calcium homeostasis is affected, probably as a result of parathyroid gland parenchymal destruction.
PubMed ID: 28875280
Article Size: 1.1 MB