Diagnosis and treatment of liver metastases of parathyroid carcinoma

Parathyroid carcinoma: New insights

Parathyroid carcinoma (PC) is a rare malignancy, comprising 1 % of all cases of primary hyperparathyroidism (PHPT). This narrative review explores recent advances in PC management, with a focus on molecular insights, diagnostic advancements, surgical innovations, and emerging targeted therapies. Manuscripts published between 2023 and 2024 were obtained from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). The review highlights advances in biochemical markers, such as circulating tumour cells (CTCs), and imaging modalities such as 18F-FDG PET/CT and 4D-CT, which are improving diagnostic accuracy. Surgical resection remains central to localised and metastatic disease management. For patients with widespread metastatic or unresectable disease, newer targeted approaches such as tyrosine kinase inhibitors (TKIs), temozolomide, and immune checkpoint inhibitors (ICIs) may offer clinical benefit to specific patient cohorts. This review identifies future research areas to improve outcomes and recommends that patients with advanced PC continue to be managed in centres of excellence.

Microwave ablation permits an effective and safe treatment for lung metastasis of parathyroid carcinoma: A Retrospective Single-Center Study

PURPOSE

Metastatic parathyroid carcinoma (PC) is rare and hard to treat. Minimally invasive alternatives to surgery are needed. We aimed to evaluate the effectiveness and safety of microwave ablation (MWA) for lung metastases from PC.

METHODS

This retrospective study analyzed data from PC patients undergoing percutaneous MWA for lung metastases at a Chinese tertiary hospital. Primary outcomes included changes in corrected serum calcium (ΔCSC) and parathyroid hormone (ΔPTH), with influencing factors being assessed. Adverse events were also recorded.

RESULTS

Six patients received 15 MWA procedures for 21 lung metastases. Serum PTH levels decreased by 40.5 ± 21.5%, with a ΔPTH of 321.1 (240.0, 433.0) pg/mL. CSC levels dropped by 0.27 ± 0.25 mmol/L (P = 0.030), normalizing in 66.7% of MWA sessions. Ablated tumor sizes either reduced slightly or stabilized. The time to reach the lowest PTH and CSC levels was 2.0 (1.0, 7.0) days and 3.0 (1.0, 7.0) days, respectively, with effects lasting 31.5 (19.3, 133.0) days for PTH and 14.0 (14.0, 49.0) days for CSC. Fewer metastases (r = -0.539, P = 0.038; r = -0.660, P = 0.007; respectively) and a higher proportion of ablated nodules (r = 0.568, P = 0.027; r = 0.629, P = 0.012; respectively) were associated with greater PTH and CSC reductions. Common complications included mild pneumothorax and mild hemorrhage (20% each), with no adverse events in about half of the sessions.

CONCLUSION

MWA offers a safe and effective option for treating lung metastases in PC patients when surgery is not feasible.

18F-Fluorocholine-Positron Emission Tomography/Computerized Tomography (FCH PET/CT) Imaging for Detecting Abnormal Parathyroid Glands: Indication, Practice, Interpretation and Diagnostic Performance

In patients with confirmed hyperparathyroidism (HPT) scheduled for surgical treatment, the preoperatory imaging permits to optimize the operatory protocol of parathyroidectomy (PTX), in particular by selecting those patients who can benefit from minimally invasive PTX (MIPTX). The MIPTX has the merit to shorten the operative time, incision length, and to reduce the operatory risks. With preoperative localization studies, the rate of PTX failure, in particular due to nonsuspected multiglandular or ectopic disease, has been profoundly decreased. The first cases of incidental localization of abnormal parathyroid glands (PTs) on FCH PET/CTs performed for another indication were reported more than one decade ago. Since then, significant amount of data from heterogeneous series of patients consistently confirmed better diagnostic performances of FCH PET/CT (sensitivity for detection of abnormal PT 97%, range 96%-98%) in comparison with other radiopharmaceuticals, ultrasonography or 4D-CeCT in localizing hyperfunctioning parathyroid glands (HFPTGs) in case of primary HPT. Utility of FCH PET/CT in case of renal HPT has been reported in fewer series. The article discusses and summarizes the bibliographic evidence on documented indications of FCH PET/CT in patients with HPT, its safety profile, the practice of FCH PET/CT and interpretation of FCH PET/CT findings, including potential interpretation pitfalls and tips to avoid them. Our real-world experience over 12 years reinforces published evidence supporting the use of FCH PET/CT as the first-line radionuclide imaging technique in patients with all types of HPT in whom surgery is an option.

Advances in the management of parathyroid carcinoma

Parathyroid carcinoma (PCA) is a rare malignancy accounting for approximately 1% of all patients with primary hyperparathyroidism. It is characterised by excessive parathyroid hormone (PTH) production. This manuscript reviews recent advances in the management of parathyroid carcinoma, focusing on molecular insights, diagnostic modalities, surgical innovations, adjuvant therapies, and emerging targeted treatments. Recently published manuscripts (between 2022 and 2023) were obtained from Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica (Embase), Cochrane Central Register of Controlled Trials (CENTRAL), and European Union Drug Regulating Authorities Clinical Trials (EudraCT). These were assessed for their relevance in terms of the diagnosis and management of patients with PCA. This manuscript explores the role of genetic profiling and presents case studies illustrating successful management strategies. The manuscript also discusses the ongoing challenges in the management of parathyroid carcinoma, suggesting future research directions and potential therapeutic avenues.

Endocrinology application of molecular imaging: current role of PET/CT

BACKGROUND

In recent years, nuclear medicine imaging methods have proven to be of paramount importance in a wide variety of diseases, particularly in oncology, where they are crucial for assessing the extent of disease when conventional methods fall short. Moreover, nuclear imaging modalities are able to better characterize lesions using target agents related to specific pathways (e.g. glucose metabolism, cellular proliferation, amino acid transport, lipid metabolism, specific receptor ligands). The clinical presentation of endocrine diseases encompasses a broad spectrum of sign and symptoms. Moreover, endocrine tumors show varying degrees of aggressiveness from well differentiated and indolent to highly aggressive cancers, respectively.

RATIONALE

With the application of new medicinal radio-compounds and increasingly advanced tomographic imaging technology, the utility of Positron Emission Tomography/Computed Tomography (PET/CT) in the field of endocrine diseases is expanding.

AIM

This review aims to analyze and summarize the primary indications of PET/CT, providing a practical approach for clinicians. A comprehensive literature search on PubMed was conducted to provide an updated overview of the available evidence regarding the use of PET/CT in endocrinology. Within this review, we will discuss the applications of PET/CT, compare different radiopharmaceuticals and highlight the uptake mechanism, excluding neuroendocrine carcinomas from discussion.

CONCLUSIONS

PET/CT is a valuable tool in diagnosing and managing endocrine disorders due to its capacity to furnish both functional and anatomical information, facilitate early lesion detection, guide treatment decisions, and monitor treatment response. Its non-invasive nature and precision make it an integral component of modern endocrine healthcare. This review aims to provide physicians with a clear perspective on the role of PET/CT imaging, discussing its emerging opportunities and appropriateness of use in endocrinological diseases.

Giant functional parathyroid carcinoma: a case report and literature review

Background

Parathyroid carcinoma is an infrequent neoplasm of the endocrine system, constituting roughly 0.5% to 5% of cases of primary hyperparathyroidism. The diagnosis of this condition presents a unique challenge for healthcare professionals.

Case report

We present a case of a 77-year-old female patient who presented with a longstanding right-sided neck tumor. The Positron emission tomography-computed tomography (PET-CT) scan detected a substantial tumor situated at the inferior border of the thyroid gland. A surgical procedure was conducted, resulting in the total excision of the tumor. The diagnosis of parathyroid carcinoma was confirmed through pathological investigation. At the six-month follow-up, the patient exhibited favorable post-operative outcomes with no evidence of recurrence.

Conclusion

The primary approaches for managing parathyroid carcinoma involve precise diagnosis and surgical removal. This case report provides confirmation that the implementation of rigorous treatment measures can yield a substantial improvement in the prognosis.