Metachronous primary hyperparathyroidism due to a parathyroid adenoma and a subsequent carcinoma: report of a case

An extremely rare case of metachronous primary hyperparathyroidism (PHP) due to a parathyroid adenoma and subsequent carcinoma with local lymphatic spread is presented herein. A 55-year-old woman was operated on for a parathyroid adenoma in the right inferior gland. Thirteen years after the first operation, she was again hospitalized for hypercalcemia and the presence of a hard mass in the right anterior neck region. Exploratory surgery and a histological examination of the resected tumor provided evidence of a parathyroid neoplasm in the right superior gland but the malignancy was equivocal. Postoperatively, her serum parathyroid hormone (PTH) level remained at 1.5-fold the upper limit of the normal range, and hypercalcemia again gradually developed. The results of higher positive rates by Ki-67 immunohistochemical staining and an aneuploid pattern by a flow cytometric analysis of the second neoplasm were consistent with a histological diagnosis of carcinoma, and she therefore underwent further surgery. A radical neck dissection revealed two lymph node metastases which were both successfully removed. The postoperative serum PTH and calcium levels then returned to within the normal ranges. These findings indicate the usefulness of Ki-67 immunohistochemical staining and a flow cytometric analysis for differentiating malignant lesions from benign parathyroid lesions, and the importance of surgically treating cases limited to local regions without distant metastasis.

Esophageal schwannoma

A 56-year-old woman was seen with an abnormal shadow on chest radiogram. Evaluation revealed an esophageal tumor, which was resected. The tumor was found in the muscular layers of the esophagus; esophageal schwannoma was diagnosed by light microscopic and immunohistochemical studies. There was no relationship between the tumor and vagus nerve. The tumor demonstrated partially invasive growth, and mitotic figures were occasionally observed.

[An unresectable gastric cancer radically resectable following UFT, ADM, MMC therapy]

A 58-year-old woman who was inoperable because of S3 (pancreas and colon) and P1 at the initial operation was treated with UFT, ADM and MMC at a dosage of 242.7 g, 418 mg and 166 mg, respectively. After the chemotherapy (2 years and 6 months from initial operation), a second look operation revealed that a tumor was localized in the submucosal layer and there were no lymph node metastases. Thus, it could be resected radically. Until now, various methods of chemotherapy for unresectable gastric cancer have been reported, and many cases of CR contained fluoropyrimidine derivates. In the case under study, combination chemotherapy containing UFT was performed with good results.