OBJECTIVE: To report the use of immunohistochemical staining for parafibromin, APC, and galectin-3 to evaluate the malignant potential of a resected parathyroid specimen in a patient initially presenting with primary hyperparathyroidism attributable to 4-gland hyperplasia, who subsequently developed metastatic parathyroid carcinoma. METHODS: We describe a patient with primary hyperparathyroidism who underwent a 3-gland resection of hypercellular parathyroid glands, with postoperative normalization of her serum calcium and parathyroid hormone levels. She returned 4 years later with recurrent hypercalcemia and underwent partial resection of her remaining hypercellular parathyroid gland, without improvement of her hypercalcemia. Selective venous sampling localized the source as draining into her azygos vein, and metastatic parathyroid carcinoma was ultimately diagnosed. RESULTS: Immunohistochemical staining for parafibromin, APC, and galectin-3 suggested the malignant potential of the atypical adenoma removed during the patient's original operation, which is believed to be the source of her metastatic disease. Access to this information by the treating surgeon may have prompted a more extensive en bloc resection or more vigilant follow-up that could have altered the patient's clinical course. CONCLUSION: Immunohistochemical staining for parafibromin, APC, and galectin-3 can be used to help distinguish the source of metastatic disease in patients with parathyroid carcinoma. Selective venous sampling may help localize metastatic parathyroid carcinoma when the source is otherwise not apparent.
OBJECTIVE: To report the use of immunohistochemical staining for parafibromin, APC, and galectin-3 to evaluate the malignant potential of a resected parathyroid specimen in a patient initially presenting with primary hyperparathyroidism attributable to 4-gland hyperplasia, who subsequently developed metastatic parathyroid carcinoma. METHODS: We describe a patient with primary hyperparathyroidism who underwent a 3-gland resection of hypercellular parathyroid glands, with postoperative normalization of her serum calcium and parathyroid hormone levels. She returned 4 years later with recurrent hypercalcemia and underwent partial resection of her remaining hypercellular parathyroid gland, without improvement of her hypercalcemia. Selective venous sampling localized the source as draining into her azygos vein, and metastatic parathyroid carcinoma was ultimately diagnosed. RESULTS: Immunohistochemical staining for parafibromin, APC, and galectin-3 suggested the malignant potential of the atypical adenoma removed during the patient's original operation, which is believed to be the source of her metastatic disease. Access to this information by the treating surgeon may have prompted a more extensive en bloc resection or more vigilant follow-up that could have altered the patient's clinical course. CONCLUSION: Immunohistochemical staining for parafibromin, APC, and galectin-3 can be used to help distinguish the source of metastatic disease in patients with parathyroid carcinoma. Selective venous sampling may help localize metastatic parathyroid carcinoma when the source is otherwise not apparent.
Authors: C Juhlin; C Larsson; T Yakoleva; I Leibiger; B Leibiger; A Alimov; G Weber; A Höög; A Villablanca Journal: Endocr Relat Cancer Date: 2006-06 Impact factor: 5.678
Authors: C Christofer Juhlin; Felix Haglund; Andrea Villablanca; Lars Forsberg; Kerstin Sandelin; Robert Bränström; Catharina Larsson; Anders Höög Journal: Int J Oncol Date: 2009-02 Impact factor: 5.650
Authors: Gustavo G Fernandez-Ranvier; Elham Khanafshar; David Tacha; Mariwil Wong; Electron Kebebew; Quan-Yang Duh; Orlo H Clark Journal: Cancer Date: 2009-01-15 Impact factor: 6.860
Authors: C C Juhlin; A Villablanca; K Sandelin; F Haglund; J Nordenström; L Forsberg; R Bränström; T Obara; A Arnold; C Larsson; A Höög Journal: Endocr Relat Cancer Date: 2007-06 Impact factor: 5.678
Authors: V L Cryns; A Thor; H J Xu; S X Hu; M E Wierman; A L Vickery; W F Benedict; A Arnold Journal: N Engl J Med Date: 1994-03-17 Impact factor: 91.245