Ethanol injection under ultrasound guidance to palliate unresectable parathyroid carcinoma.
BACKGROUND
Severe hypercalcemia is the leading cause of death in patients with parathyroid carcinoma. Non-curative resection and pharmacological measures may be useful for palliation in cases with recurrent and metastatic disease. Palliative treatment with intra-neoplastic ethanol injection has not been reported yet.


METHODS
Ultrasound-guided percutaneous alcohol injection in one patient with unresectable parathyroid carcinoma is reported.


RESULTS
One male patient with extensive recurrent parathyroid carcinoma suffering from severe hypercalcemia, refractory to all available medical measures has undergone two percutaneous ethanol injections. No major complications ensued and parathormone levels decreased from 2.990 pg/mL to 2.230 pg/ml after the first injection, and to 1.104 pg/mL after the second one. Calcium levels decreased from 19.8 mg/dL to 16.1 mg/dL and to 14.5 mg/dL, respectively. The patient died of metabolic hypercalcemia complications about two months later, probably due to mediastinal disease progression.


CONCLUSIONS
Ultrasound-guided percutaneous ethanol injection may be employed to palliate parathyroid carcinoma in selected cases, with a transitory decrease in PTH and calcium levels.
Montenegro
Fábio Luiz de Menezes
FL
Departamento de Cirurgia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. fabiomonte@uol.com.br
Chammas
Maria Cristina
MC
Juliano
Adriana Gonçalves
AG
Cernea
Claudio Roberto
CR
Cordeiro
Anói Castro
AC
D000431:Ethanol / Q000008:administration & dosage*; D017809:Fatal Outcome; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care / Q000379:methods*; D010282:Parathyroid Neoplasms / Q000150:complications / Q000188:drug therapy*; D018084:Ultrasonography, Interventional
D000431:Ethanol