Efficacy of surufatinib in the treatment of advanced parathyroid carcinoma: A case report

Abstract

Parathyroid cancer is an extremely rare form of neuroendocrine malignancy. Apart from surgery, the effectiveness of chemotherapy and radiotherapy is limited, and the efficacy of targeted drugs remains unclear. In this study, we demonstrate the therapeutic effectiveness and adverse reaction of the targeted drug surufatinib in treating a case of parathyroid cancer, and concurrently review the recent advancements in the treatment of parathyroid cancer. The patient, a 55-year-old male, underwent his first surgery for a "right cervical mass" in May 2011. Postoperative pathology indicated an atypical adenoma of the parathyroid gland. In August 2016, the patient underwent a second surgery for recurrence of the right cervical tumor, with a pathological diagnosis of parathyroid cancer based on clinical history. In November 2017, the patient underwent a third surgery for recurrence of the right cervical tumor. In December 2017, the patient underwent adjuvant external radiation therapy. In August 2022, the patient developed spinal and lung metastases and underwent spinal surgery. Subsequently, the patient received three rounds of chemotherapy on October 5, 2022, October 28, 2022, and November 18, 2022, but the tumor showed slight enlargement. In January 2023, the patient began treatment with surufatinib. After two cycles of treatment, the tumor showed regression. Given the scarcity of systemic treatment options for parathyroid cancer, the targeted drug surufatinib may offer a promising potential treatment option.

Keywords: Neuroendocrine tumor; Parathyroid carcinoma; Rare tumor; Targeting drug; Treatment.

Fig. 1

Parathyroid carcinoma: histological features (hematoxylin-eosin staining). A: The tumor capsule is clear and intact (arrows). Original magnification × 100. B: The tumor shows prominent fibrous bands (arrows). The neoplastic chief cells of the parathyroid glands were arranged in nests and active proliferation. The cytoplasm is transparent, the nucleus is enlarged, and nuclear division can be seen. original magnification × 400.

Fig. 2

Pulmonary metastasis originating from parathyroid carcinoma. A: In August 2022, lung metastases occurred. B: After three cycles of chemotherapy in December 2022, the volume of lung metastases slightly increased. C: After two courses of Surufatinib treatment in March 2022, lung metastases slightly regressed. D: In August 2022, a rib metastases was found. E: After three cycles of chemotherapy in December 2022, the volume of rib metastases slightly increased. F: After two courses of Surufatinib treatment in March 2022, the rib metastases slightly regressed.

Fig. 3

Bone metastases originating from parathyroid carcinoma: histological features (hematoxylin-eosin staining). Bone (arrows) destruction, Partial cytoplasm of tumor cells (Triangel) is transparent, part of the cytoplasm is eosinophilic, and the nuclear atypia can be seen. original magnification × 200.