A nationwide study on parathyroid carcinoma

Authors

  • Eeva M. Ryhänen The Division of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • Helena Leijon Department of Pathology, Huslab and University of Helsinki, Helsinki, Finland
  • Saara Metso Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
  • Eija Eloranta Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
  • Pirkko Korsoff Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland
  • Petteri Ahtiainen Department of Internal Medicine, Central Finland Central Hospital, Jyväskylä, Finland
  • Päivi Kekäläinen Department of Internal Medicine, North Carelia Central Hospital, Joensuu, Finland
  • Marjo Tamminen Department of Internal Medicine, Kymenlaakso Central Hospital, Kotka, Finland
  • Raija Ristamäki Department of Oncology, Turku University Hospital, Turku, Finland
  • Otto Knutar Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland
  • Eliisa Löyttyniemi Department of Biostatistics, University of Turku, Turku, Finland
  • Leo Niskanen The Division of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • Mika Väisänen Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
  • Ilkka Heiskanen Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
  • Matti J. Välimäki The Division of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • Markku Laakso Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Finland
  • Caj Haglund Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland;  Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
  • Johanna Arola Department of Pathology, Huslab and University of Helsinki, Helsinki, Finland
  • Camilla Schalin-Jäntti The Division of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

DOI:

https://doi.org/10.1080/0284186X.2017.1306103

Abstract

Background: Parathyroid carcinoma (PC) is rare and diagnostically challenging. Reported outcomes are rather poor and the incidence might be increasing.

Material and methods: We performed a nationwide study on all cases (n= 32) diagnosed in 2000–2011 in Finland, and compared clinical and histopathological characteristics and outcome to atypical parathyroid (APA; n= 28) and parathyroid adenomas (PA; n= 72). The incidence in years 1955–1999 was compared to that in 2000–2013.

Results: Preoperatively, calcium and parathyroid hormone concentrations were higher in PC compared to APA and PA (1.76, 1.56 and 1.44 mmol/l, p < .001; and 989, 355 and 160 μmol/l, p < .001, respectively). Calcium was ≤1.77 mmol/l for all PAs. Hospitalization (44% vs. 22% and 3%, respectively, p = .01), renal (50% vs. 48% vs. 22%, respectively, p = .01) and bone (47% vs. 15% vs. 38%, respectively p = .002) manifestations were more common. PC and APA tumors were larger than PA (p < .001). Histopathological characteristics of PC compared to PA are increased mitotic activity (p= .001), chief cells (p = .003), diffuse growth pattern (p < .001), higher Ki67 (p< .001) and negative parafibromin (p < .001). One PC (1/18) and one APA (1/16) patient had a CDC73 mutation. After 6.7 (2–13.9) years of follow-up, 9.4% of PC had residual, 21% recurrent disease and 12.5% died of disease. Overall mortality did not differ between subgroups (p = .094). Recurrent PC was characterized by vascular invasion, lymph node metastases, high mitotic activity, necrosis and negative parafibromin. Incidence increased from 1.42 (range 0.52–2.14) to 7.14 (range 3.42–10.38)/10.000.000/years; (p < .001).

Conclusions: PC associates with severe primary hyperparathyroidism and must be suspected if calcium ≥1.77 mmol/l. The prevalence of CDC73 germline mutations in PC and APA in Finland is 6%. PC has distinct histopathological characteristics and its incidence has increased over the past decades.

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Published

2017-07-03

How to Cite

Ryhänen, E. M., Leijon, H., Metso, S., Eloranta, E., Korsoff, P., Ahtiainen, P., … Schalin-Jäntti, C. (2017). A nationwide study on parathyroid carcinoma. Acta Oncologica, 56(7), 991–1003. https://doi.org/10.1080/0284186X.2017.1306103

Issue

Vol. 56 No. 7 (2017): Acta Oncologica

Section

Articles