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Case Reports
. 2024 May 29;14(11):1127.
doi: 10.3390/diagnostics14111127.

Coincidence or Causality: Parathyroid Carcinoma in Chronic Kidney Disease-Case Report and Literature Review

Affiliations
Case Reports

Coincidence or Causality: Parathyroid Carcinoma in Chronic Kidney Disease-Case Report and Literature Review

Stefana Catalina Bilha et al. Diagnostics (Basel). .

Abstract

Parathyroid carcinoma (PC) associated with primary hyperparathyroidism (PHPT) has been well investigated in recent years. Data regarding PC evolution in secondary hyperparathyroidism (SHPT) due to chronic kidney disease (CKD) are, however, scarce. Most features that raise the suspicion of PC in PHPT are part of the usual SHPT evolution in CKD, mirroring the natural changes undergone by the parathyroid glands. Therefore, pre-surgically establishing the malignant or benign character of the lesions is cumbersome. We present two cases of PC in end-stage renal disease, one of which was bilateral, diagnosed after total parathyroidectomy in a high-volume parathyroid surgery center. A literature review of the data was also performed. A systematic search of the PubMed/MEDLINE database until January 2024 identified 42 cases of PC associated with SHPT. Understanding the PC features in CKD might improve associated bone and mineral disease management, and reduce the risk of metastasis, parathyromatosis, or recurrence. Irradiation, prolonged immunosuppression, long dialysis vintage, and genotype may predispose to the malignant transformation of chronically stimulated parathyroids. Despite postsurgical diagnosis, favorable outcomes occurred when distant metastases were absent, even without "en bloc" resection. Further research is warranted to delineate specific diagnostic and therapeutic approaches tailored to this particular patient subpopulation.

Keywords: chronic kidney disease; parathyroid carcinoma; secondary hyperparathyroidism.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(a) 99Tc; (b) early 99mTc-methoxyisobuthylisonitrile (99mTc-MIBI); (c) delayed 99mTc-MIBI scintigraphy images of the neck: increased radiotracer uptake in the lower third of the right thyroid lobe and posterior to the left thyroid lobe, interpreted as a right inferior and a left inferior parathyroid adenoma, respectively (arrows).
Figure 2
Figure 2
Case 1: left inferior parathyroid gland, hematoxylin–eosin, ×4. (a) Vascular tumor embolism in the capsular vessels: deposits of fibrin and parathyroid cells. (b) Solid and trabecular architecture with parathyroid main and oxyphil cells.
Figure 3
Figure 3
Positron emission tomography: abdominal coronal and axial sections; heterogeneous left renal mass with calcifications, metabolically active (maximum standardized uptake value = 6.3 g/mL; arrows).
Figure 4
Figure 4
Case 2: right inferior parathyroid gland. (a) Capsular infiltration; hematoxylin–eosin, ×4 (on the left of the image); (b) acinar architecture with interstitial calcifications; hematoxylin–eosin ×4; (c) detail of vascular embolism with deposits of fibrin and parathyroid cells, hematoxylin–eosin, ×10; (d) proliferation rate Ki-67 = 5%, ×10.
Figure 5
Figure 5
(a) 99mTcMIBI whole-body scintigraphy. (b) Cervical computed tomography: absence of any signs of recurrence 3 months after surgery (arrows).

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