title: Primary hyperparathyroidism and osteosarcoma: examination of a large cohort identifies three cases of fibroblastic osteosarcoma.
abstract: To study a possible relationship between hyperparathyroidism and osteosarcoma, we reviewed 1234 osteosarcoma patients. In this cohort, only three patients had a diagnosis of both hyperparathyroidism and fibroblastic osteosarcoma. These results indicate that hyperparathyroidism is not more prevalent in patients with osteosarcoma than in the general population. However, the presence of hyperparathyroidism may modify the histologic and cytologic features of osteosarcoma.
  
  
  BACKGROUND
  The finding of osteosarcoma in rats receiving human PTH(1-34) raised the question of whether hyperparathyroidism might be a risk factor for development of osteosarcoma in humans.
  
  
  METHODS
  To study a possible relationship between hyperparathyroidism and osteosarcoma, we reviewed the medical records of 1234 osteosarcoma patients seen at The M.D. Anderson Cancer Center since 1948. Our study focused on clinical, biochemical, radiologic, and histopathologic findings indicative of primary hyperparathyroidism and the features of osteosarcoma.
  
  
  RESULTS
  Of the 1234 cases reviewed, 3 patients had a diagnosis of both primary hyperparathyroidism and osteosarcoma. In two cases, hyperparathyroidism preceded the osteosarcoma, and in one case, both conditions were diagnosed at the same time. In two cases with concomitant hyperparathyroidism and osteosarcoma, features of osteitis fibrocystica were identified. The third patient was treated for hyperparathyroidism 3 years before osteosarcoma was diagnosed. All three patients had histologic features of fibroblastic osteosarcoma, a type that accounts for no more than 20% of osteosarcomas. To assess whether the prevalence of hyperparathyroidism was greater than expected in the normal population, we compared the age- and sex-specific prevalence in our cohort to a population of healthy individuals in Tromso, Norway. This analysis showed no significant differences between the two populations, despite the fact that a higher prevalence of hyperparathyroidism (6.9% versus 1.6%) was noted in the 60- to 69-year-old female osteosarcoma age group.
  
  
  CONCLUSIONS
  Our results indicate that hyperparathyroidism is not more prevalent in affected individuals with osteosarcoma than in the general population. The finding of fibroblastic osteosarcoma in all three patients raises the question of whether coexistent hyperparathyroidism may modify the cytologic and histologic features of the malignancy.
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Camilo
authors.initials: C
authors.lastname: Jimenez
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
authors.forename: Hyung-Woo
authors.initials: HW
authors.lastname: Kim
authors.forename: Fozia
authors.initials: F
authors.lastname: Al-Sagier
authors.forename: Donald A
authors.initials: DA
authors.lastname: Berry
authors.forename: Adel K
authors.initials: AK
authors.lastname: El-Naggar
authors.forename: Shreyaskumar
authors.initials: S
authors.lastname: Patel
authors.forename: Rena
authors.initials: R
authors.lastname: Vassilopoulou-Sellin
authors.forename: Robert F
authors.initials: RF
authors.lastname: Gagel
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000368:Aged; D001859:Bone Neoplasms / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000473:pathology / Q000628:therapy; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009664:Norway; D010000:Osteitis / Q000175:diagnosis / Q000473:pathology; D012516:Osteosarcoma / Q000150:complications / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D015995:Prevalence; D012307:Risk Factors