Premium
ES22P
PARAFIBROMIN IMMUNOHISTOCHEMISTRY ENABLES THE LATE DIAGNOSIS OF PARATHYROID CANCER
Author(s) -
Suliburk J. W.,
Sidhu S. B.,
Sywak M. S.,
Delbridge L. W.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04916_22.x
Subject(s) - medicine , parathyroid carcinoma , primary hyperparathyroidism , malignancy , hypercalcaemia , parathyroidectomy , cancer , parathyroid adenoma , parathyroid neoplasm , hyperparathyroidism , urology , pathology , calcium , parathyroid hormone
Background: Until recently the diagnosis of parathyroid cancer has been based upon difficult to interpret criteria and traditional indicators of malignancy such as mitotic activity and cellular atypia are unreliable. It is estimated that up to 50% of parathyroid carcinomas with biologically malignant behaviour may be considered benign. The aim of this study was to examine the impact of parafibromin immunohistochemistry (PI) on achieving a late diagnosis of parathyroid cancer. Methods: This is a case series with data obtained from the University of Sydney Endocrine Surgical Unit database. PI was performed on the cases identified. Results: Three patients were identified where an initial diagnosis of parathyroid adenoma had been made but where subsequent PI enabled a late diagnosis of parathyroid carcinoma. The mean age and sex distribution of the three patients at initial diagnosis was 38.3 years, M : F 2:1 (range 29–57); mean delay in diagnosis was 22 years (range 7–30). There were no statistically significant differences in patient age, sex distribution, serum calcium, and tumour weight between the three patients in the series and all other patients who have undergone parathyroidectomy for primary hyperparathyroidism. At follow‐up, one patient appears cured with a normal serum calcium, one has permanent hypoparathyroidism, and one has persistent hypercalcaemia with control of serum calcium by Cinacalcet therapy. Conclusions: Diagnosis of parathyroid cancer may well be missed due to lack of clear histological criteria. PI in selected cases of parathyroid tumours will enable the accurate diagnosis of parathyroid carcinoma.