Parathyroid carcinoma arising from four-gland hyperplasia.
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.


CONCLUSIONS
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.
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Rondi M
RM
Kauffmann
C Christofer
CC
Juhlin
Laurel E
LE
Fohn
James T
JT
Broome
John E
JE
Phay
D025601:Adenomatous Polyposis Coli Protein / Q000378:metabolism; D005260:Female; D037502:Galectin 3 / Q000378:metabolism; D006801:Humans; D006965:Hyperplasia / Q000378:metabolism / Q000503:physiopathology*; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D025521:Tumor Suppressor Proteins / Q000378:metabolism
C555337:APC protein, human; D025601:Adenomatous Polyposis Coli Protein; C454900:CDC73 protein, human; D037502:Galectin 3; D025521:Tumor Suppressor Proteins
Am J Clin Pathol. 2006 Jul;126(1):59-66
16753595
J Clin Endocrinol Metab. 2001 Feb;86(2):485-93
11157996
Endocr Relat Cancer. 2006 Jun;13(2):509-23
16728578
Am J Surg Pathol. 1993 Aug;17(8):820-9
8338192
Am J Surg. 1985 Apr;149(4):522-7
3985291
Cancer. 2009 Jan 15;115(2):334-44
19107770
Am J Surg Pathol. 2006 Sep;30(9):1140-9
16931959
Endocr Relat Cancer. 2007 Jun;14(2):501-12
17639063
Int J Oncol. 2009 Feb;34(2):481-92
19148484
N Engl J Med. 1994 Mar 17;330(11):757-61
7906387
Curr Opin Oncol. 2006 Jan;18(1):16-22
16357559
Cancer Res. 1996 Feb 1;56(3):599-605
8564978
Surgery. 1990 Dec;108(6):1006-12; discussion 1012-3
2123361
Histopathology. 2006 May;48(6):629-43
16681678
Clin Cancer Res. 2004 Oct 1;10(19):6629-37
15475453
Ann Surg. 1981 Apr;193(4):425-35
7212805
Cancer Treat Res. 1997;89:183-92
9204193
Ear Nose Throat J. 2002 Jun;81(6):395-8, 400-1
12092283
Surgery. 1985 Dec;98(6):1095-100
4071385