eMedicine Specialties > Oncology > Carcinomas of Endocrine Organs

Parathyroid Carcinoma: Differential Diagnoses & Workup

Author: Lawrence Kim, MD, Chief of Surgical Services, Central Arkansas Veterans Affairs Healthcare System; Director of Surgical Endocrinology, Professor, Department of Surgery, University of Arkansas for Medical Sciences
Contributor Information and Disclosures

Updated: May 4, 2009

Differential Diagnoses

Hypercalcemia
Hyperparathyroidism
Paraneoplastic Syndromes
Thyroid Nodule

Workup

Laboratory Studies

  • Laboratory workup for parathyroid carcinoma is the same as that for primary hyperparathyroidism. Simultaneous calcium and parathyroid hormone (PTH) levels should be determined.
    • Serum calcium level is usually elevated more markedly than in benign primary hyperparathyroidism.
    • Parathyroid hormone (intact): Parathyroid carcinoma should produce authentic parathyroid hormone; therefore, serum parathyroid hormone levels should be elevated, usually markedly.

Imaging Studies

  • Imaging studies may be used preoperatively to determine the location of an abnormal parathyroid gland. See Hyperparathyroidism for the rationale of whether to obtain imaging studies for this purpose. Imaging studies may also be used for staging to determine the presence of distant metastases.
  • Radiographs
    • Hand films may show subperiosteal bone resorption of the distal phalanges.
    • Skull films have a characteristic "ground glass" or "salt and pepper" appearance.
    • In severe cases, plain films reveal the classic bone finding, osteitis fibrosa cystica. It consists of bone cysts with or without pathologic fractures. These cysts are also known as brown tumors.
  • CT scanning may be helpful in detecting metastatic disease.
  • Positron emission tomography (PET) scanning may be helpful in staging. False-positive findings due to brown tumors have been reported.18

Other Tests

  • Fine-needle aspiration biopsy is not helpful in establishing a diagnosis and may be harmful by causing tumor dissemination.

Procedures

  • No preoperative test is currently available to distinguish parathyroid cancer from benign primary hyperparathyroidism reliably.
  • Diagnosis is based on the histologic appearance of the excised parathyroid gland and clinical indicators such as recurrence or metastases.

Histologic Findings

  • The parathyroid glands are usually large (2-10 g).
  • Tumors are usually encapsulated and often have fibrous septa extending into the gland.
    • The majority of tumors are fibrotic.
    • The parenchyma of the tumor usually has a predominance of chief cells. They are often larger than those typically seen in adenomas and have a bland cytologic appearance.
    • The parenchyma may appear indistinguishable from a benign adenoma.
  • The most reliable histologic finding in carcinoma is extracapsular invasion by the tumor, but this is seen in only two thirds of cases.
  • Some degree of nuclear atypia is seen commonly, and mitotic figures are usually evident.
  • Molecular or genetic markers may prove useful in distinguishing parathyroid cancer from other lesions.

Staging

  • Parathyroid cancer is sufficiently rare that no staging systems have been established.

More on Parathyroid Carcinoma

Overview: Parathyroid Carcinoma
Differential Diagnoses & Workup: Parathyroid Carcinoma
Treatment & Medication: Parathyroid Carcinoma
Follow-up: Parathyroid Carcinoma
Multimedia: Parathyroid Carcinoma
References
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References

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Further Reading

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Keywords

parathyroid cancer, parathyroid gland, parathyroid carcinoma, parathyroid malignancy, parathyroid gland malignancy, hyperparathyroidism, bone disease, high serum calcium level, renal stones, hypercalcemia

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Contributor Information and Disclosures

Author

Lawrence Kim, MD, Chief of Surgical Services, Central Arkansas Veterans Affairs Healthcare System; Director of Surgical Endocrinology, Professor, Department of Surgery, University of Arkansas for Medical Sciences
Lawrence Kim, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons, American College of Surgeons, Association for Academic Surgery, Association of VA Surgeons, International Association of Endocrine Surgeons, Society of Surgical Oncology, Society of University Surgeons, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

Medical Editor

Sanjiv S Agarwala, MD, Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Associate Professor of Cancer Biology, University of Pennsylvania
Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Head and Neck Surgery, Eastern Cooperative Oncology Group, and European Society for Medical Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Wendy Hu, MD, Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center
Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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