Chondrosarcoma in association with primary hyperparathyroidism

Primary hyperparathyroidism and sarcoma: A case report and literature review

ABSTRACT

The relationship between primary hyperparathyroidism (PHPT) and bone sarcoma is debatable, especially after wider use of teriparatide treatment, concerns have intensified on the issue. Extensive search in English literature revealed 10 cases reported having PHPT and sarcomas. Besides, three cases of bone sarcoma occurring after teriparatide treatment had been reported. Hereby, we report a 51-year-old woman with a prolonged history of PHPT. She was diagnosed with chondrosarcoma 9 years after refusal and lack of treatment for PHPT. She was cured surgically for both chondrosarcoma and parathyroid adenoma at 1-year interval. So far, large cohorts did not show an increase in the incidence of bone sarcomas in PHPT. Several case observations, including the current one, as well as data from in vitro and rat studies, pointed out prolonged parathormone exposure, may be a risk for bone sarcomas. Under these circumstances, a safer attitude on individual basis would be the prevention of prolonged parathormone exposures.

Undifferentiated Pleomorphic Sarcoma and Hyperparathyroidism in an Adolescent Male: A Case Report and Review of Hyperparathyroidism-associated Sarcomas

The association between hyperparathyroidism and sarcoma is extremely rare with other reported cases describing the development of osteosarcoma and chondrosarcomas in middle-aged adults. This case describes an adolescent male with hyperparathyroidism and a pathologic fracture of a biopsy-proven brown tumor in the distal right femur. The fracture healed but later developed an undifferentiated pleomorphic sarcoma of the bone at the site of the known brown tumor. Although in vitro and in vivo studies have demonstrated the risks of elevated parathyroid hormone with development of sarcomas, there is limited evidence of a human association. The effects of elevated parathyroid hormone on the skeletally immature bone in the setting of sarcoma formation are currently not well understood without current description of adolescent hyperparathyroidism-associated sarcomas. This case highlights a sarcoma originating at a pathologically proven brown tumor within an adolescent male, discusses the association of sarcoma with hyperparathyroidism, and reviews the other nine reported cases in the literature.

Parathyroid carcinosarcoma: a rare form of parathyroid carcinoma with normal parathyroid hormone levels

Parathyroid carcinosarcoma was first described by Nacamuli et al in 2002. We present the second case of this rare disease. This rare carcinosarmoca presented as a parathyroid carcinoma with uncharacteristically normal parathyroid hormone levels. The patient is a 57-year-old woman with long-standing right-sided vocal cord paralysis presented with a progressive 3 × 2 × 3 cm mass in the right neck. She had previously undergone a total thyroidectomy revealing benign pathology. Parathyroid hormone and calcium blood levels were within normal limits. The mass was removed with negative surgical margins. Histopathology and immunohistochemical analysis showed a biphasic pattern, with positive for chromogranin and vimentin, consistent with carcinoma and sarcoma. The disease in our patient, as in the previously reported case, has shown systemic progression despite aggressive surgical resection and adjuvant therapy.

Initial experience with teriparatide in the United States

Teriparatide has been commercially available in the United States (US) for over 3 years. This summary spans the early experience with this therapy. As of December 31, 2005, over 235 000 patients had filled a prescription for teriparatide world-wide. Data collected from July to December 2004, from 15,000 retail pharmacies in the US, indicated that the mean age of patients was 67.5 years, and more recent data collected from January through October 2005 indicated that 90% of patients were female. According to market research conducted with prescribing physicians from February through March of 2005, it is estimated that over 80% of patients receiving prescriptions for teriparatide had already experienced one or more prior fractures. Since teriparatide is administered subcutaneously, it is important that patients receive training on the use of the teriparatide injection device (i.e., the pen device). Educational programs are available for those who have been prescribed teriparatide therapy. Patients may also contact a customer care program regarding a variety of topics, including pen device use. Based on patient feedback, design changes have been implemented in the pen device to facilitate optimal use. Updates have also been made to the prescribing information to reflect the post-marketing surveillance experience. Adverse experiences reported to date have been consistent with the current product label and with cumulative teriparatide clinical trial experience. As of December 31, 2005 no reports of pathology-confirmed osteosarcoma have been received for individuals who have been treated with teriparatide, either with the commercially available drug or in clinical trials. We are unaware of any reports of osteosarcoma in association with other preparations of teriparatide, or other peptides of parathyroid hormone, either in the setting of clinical trials or from marketed drug experience.