Carcinoma da Paratiróide
Resumo
O carcinoma da paratiroide (CP) é um tumor endócrino muito raro, correspondendo a menos de 1% dos casos de hiperparatiroidismo primário (HPT-P). Tal como em muitos outros tumores, a sua etiologia é desconhecida, contudo foram descobertas recentemente mutações no gene HRPT2/CDC73 que desempenham um papel fundamental na patogénese desta neoplasia. O CP é habitualmente uma doença esporádica mas pode ocorrer no contexto de síndromes genéticos e em doentes com hiperparatiroidismo secundário. O seu diagnóstico é um desafio, tanto clinica como histologicamente devido à ausência de características que permitam distinguir precocemente doença benigna de maligna. O tratamento com melhor potencial curativo é a resseção cirúrgica em bloco do tumor primário, com margens livres de doença pelo que o seu sucesso depende da suspeição pré ou intra-operatória do carcinoma. O CP tem um curso clínico prolongado com múltiplas recorrências, a maioria das quais ocorrem localmente, pelo que os doentes devem ser monitorizados para o resto da vida. Dado o valor limitado das terapias adjuvantes, o tratamento recomendado nos casos de recorrência e metástases é sempre que possível a resseção cirúrgica.
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Referências
1. Cetani F, Pardi E, Marcocci C. Update on parathyroid carcinoma. Journal of endocrinological investigation. 2016;39(6):595-606.
2. Betea D, Potorac I, Beckers A. Parathyroid carcinoma: Challenges in diagnosis and treatment. Annales d'endocrinologie. 2015;76(2):169-77.
3. Do Cao C, Aubert S, Trinel C, Odou MF, Bayaram M, Patey M. Parathyroid carcinoma: Diagnostic criteria, classification, evaluation. Annales d'endocrinologie. 2015;76(2):165-8.
4. Duan K, Mete O. Parathyroid Carcinoma: Diagnosis and Clinical Implications. Turk patoloji dergisi. 2015;31 Suppl 1:80-97.
5. Alperstein A, Bhayani R. Parathyroid carcinoma, a rare cause of primary hyperparathyroidism. BMJ case reports. 2014;2014.
6. Sharretts JM, Kebebew E, Simonds WF. Parathyroid cancer. Seminars in oncology. 2010;37(6):580-90.
7. Wei CH, Harari A. Parathyroid carcinoma: update and guidelines for management. Current treatment options in oncology. 2012;13(1):11-23.
8. Kassahun WT, Jonas S. Focus on parathyroid carcinoma. International journal of surgery. 2011;9(1):13-9.
9. Selvan B, Paul MJ, Seshadri MS, Thomas N, Paul T, Abraham D, et al. High index of clinical suspicion with optimal surgical techniques and adjuvant radiotherapy is critical to reduce locoregional disease progression in parathyroid carcinoma. American journal of clinical oncology. 2013;36(1):64-9.
10. DeLellis RA. Parathyroid tumors and related disorders. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. 2011;24 Suppl 2:S78-93.
11. Kasaian K, Wiseman SM, Thiessen N, Mungall KL, Corbett RD, Qian JQ, et al. Complete genomic landscape of a recurring sporadic parathyroid carcinoma. The Journal of pathology. 2013;230(3):249-60.
12. Diaconescu MR, Glod M, Costea I, Grigorovici M, Diaconescu S. Clinicopathological phenotype of parathyroid carcinoma: therapeutic and prognostic aftermaths. Chirurgia. 2015;110(1):66-71.
13. Duan K, Gomez Hernandez K, Mete O. Clinicopathological correlates of hyperparathyroidism. Journal of clinical pathology. 2015;68(10):771-87.
14. Adam MA, Untch BR, Olson JA, Jr. Parathyroid carcinoma: current understanding and new insights into gene expression and intraoperative parathyroid hormone kinetics. The oncologist. 2010;15(1):61-72.
15. Rafferty A, England J. Current management of parathyroid tumours. British journal of hospital medicine. 2013;74(1):24-9.
16. Svedlund J, Auren M, Sundstrom M, Dralle H, Akerstrom G, Bjorklund P, et al. Aberrant WNT/beta-catenin signaling in parathyroid carcinoma. Molecular cancer. 2010;9:294.
17. Barazeghi E, Gill AJ, Sidhu S, Norlen O, Dina R, Palazzo FF, et al. 5-Hydroxymethylcytosine discriminates between parathyroid adenoma and carcinoma. Clinical epigenetics. 2016;8:31.
18. Kentwell J, Gundara JS, Sidhu SB. Noncoding RNAs in endocrine malignancy. The oncologist. 2014;19(5):483-91.
19. Kumari N, Chaudhary N, Pradhan R, Agarwal A, Krishnani N. Role of Histological Criteria and Immunohistochemical Markers in Predicting Risk of Malignancy in Parathyroid Neoplasms. Endocrine pathology. 2016;27(2):87-96.
20. Zhao J, Hu Y, Liao Q, Niu Z, Xing X, Xia W, et al. Gene identification of potential malignant parathyroid tumors phenotype in Chinese population. Endocrine journal. 2014;61(6):597-605.
21. Al-Kurd A, Mekel M, Mazeh H. Parathyroid carcinoma. Surgical oncology. 2014;23(2):107-14.
22. Mohebati A, Shaha A, Shah J. Parathyroid carcinoma: challenges in diagnosis and treatment. Hematology/oncology clinics of North America. 2012;26(6):1221-38.
23. Butt WT, Azim A, Abbas A, Gauhar TM, Afzal A, Azim KM. Parathyroid carcinoma. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2012;22(9):588-90.
24. Oh MY, Oh SB, Seoung HG, Kim JH, Kim SS, Kim BH, et al. Concurrent parathyroid carcinoma and hyperplasia in hyperparathyroidism. The Korean journal of internal medicine. 2012;27(3):356-9.
25. Schulte KM, Talat N. Diagnosis and management of parathyroid cancer. Nature reviews Endocrinology. 2012;8(10):612-22.
26. Hughes DT, Sorensen MJ, Miller BS, Cohen MS, Gauger PG. The biochemical severity of primary hyperparathyroidism correlates with the localization accuracy of sestamibi and surgeon-performed ultrasound. Journal of the American College of Surgeons. 2014;219(5):1010-9.
27. Whitcroft KL, Sharma A. Sestamibi scintigraphy for parathyroid localisation: a reminder of the dangers of false positives. BMJ case reports. 2014;2014.
28. Dytz MG, Souza RG, Lazaro AP, Goncalves MD, Vidal AP, dos Santos Teixeira Pde F, et al. Parathyroid carcinoma and oxyphil parathyroid adenoma: an uncommon case of misinterpretation in clinical practice. Endocrine journal. 2013;60(4):423-9.
29. Givi B, Shah JP. Parathyroid carcinoma. Clinical oncology. 2010;22(6):498-507.
30. Lang B, Lo CY. Parathyroid cancer. Surgical oncology clinics of North America. 2006;15(3):573-84.
31. Lumachi F, Basso SM, Basso U. Parathyroid cancer: etiology, clinical presentation and treatment. Anticancer research. 2006;26(6C):4803-7.
32. Enomoto K, Uchino S, Ito A, Watanabe S, Shibuya H, Enomoto Y, et al. The surgical strategy and the molecular analysis of patients with parathyroid cancer. World journal of surgery. 2010;34(11):2604-10.
33. Crea N, Pata G, Casella C, Cappelli C, Salerni B. Predictive factors for postoperative severe hypocalcaemia after parathyroidectomy for primary hyperparathyroidism. The American surgeon. 2012;78(3):352-8.
34. Ohe MN, Santos RO, Hojaij F, Neves MC, Kunii IS, Orlandi D, et al. Parathyroid carcinoma and hungry bone syndrome. Arquivos brasileiros de endocrinologia e metabologia. 2013;57(1):79-86.
35. Artinyan A, Guzman E, Maghami E, Al-Sayed M, D'Apuzzo M, Wagman L, et al. Metastatic parathyroid carcinoma to the liver treated with radiofrequency ablation and transcatheter arterial embolization. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008;26(24):4039-41.
36. Clines GA. Mechanisms and treatment of hypercalcemia of malignancy. Current opinion in endocrinology, diabetes, and obesity. 2011;18(6):339-46.
37. Minisola S, Pepe J, Piemonte S, Cipriani C. The diagnosis and management of hypercalcaemia. Bmj. 2015;350:h2723.
38. Reagan P, Pani A, Rosner MH. Approach to diagnosis and treatment of hypercalcemia in a patient with malignancy. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2014;63(1):141-7.
39. Legrand SB. Modern management of malignant hypercalcemia. The American journal of hospice & palliative care. 2011;28(7):515-7.
40. Crowley R, Gittoes N. How to approach hypercalcaemia. Clinical medicine. 2013;13(3):287-90.
41. Bowyer SE, White AM, Ransom DT, Davidson JA. Resistant hypercalcaemia in metastatic parathyroid carcinoma. The Medical journal of Australia. 2013;198(10):559-61.
42. Vellanki P, Lange K, Elaraj D, Kopp PA, El Muayed M. Denosumab for management of parathyroid carcinoma-mediated hypercalcemia. The Journal of clinical endocrinology and metabolism. 2014;99(2):387-90.
43. Horie I, Ando T, Inokuchi N, Mihara Y, Miura S, Imaizumi M, et al. First Japanese patient treated with parathyroid hormone peptide immunization for refractory hypercalcemia caused by metastatic parathyroid carcinoma. Endocrine journal. 2010;57(4):287-92.
44. Barker HS, Podoll MB, Parker JR, Parker JC, Jr., Crim J, Yang X. Parathyroid carcinoma with intracranial metastasis at diagnosis in a patient with uncontrolled hypercalcemia. Annals of clinical and laboratory science. 2014;44(4):484-8.
45. O'Neill CJ, Chan C, Symons J, Learoyd DL, Sidhu SB, Delbridge LW, et al. Parathyroid carcinoma encountered after minimally invasive focused parathyroidectomy may not require further radical surgery. World journal of surgery. 2011;35(1):147-53.
46. McClenaghan F, Qureshi YA. Parathyroid cancer. Gland surgery. 2015;4(4):329-38.
47. Mori H, Okada Y, Arao T, Tanaka Y. Case of parathyroid carcinoma with a highly aggressive clinical course. Journal of UOEH. 2014;36(4):243-9.
48. Tan GC, Shiran MS, Swaminathan M, Phang KS, Rohaizak M. Large retrosternal parathyroid carcinoma with primary hyperparathyroidism. Asian journal of surgery / Asian Surgical Association. 2007;30(4):286-9.
49. Dudney WC, Bodenner D, Stack BC, Jr. Parathyroid carcinoma. Otolaryngologic clinics of North America. 2010;43(2):441-53, xi.
50. Wang O, Wang C, Nie M, Cui Q, Guan H, Jiang Y, et al. Novel HRPT2/CDC73 gene mutations and loss of expression of parafibromin in Chinese patients with clinically sporadic parathyroid carcinomas. PloS one. 2012;7(9):e45567.
2. Betea D, Potorac I, Beckers A. Parathyroid carcinoma: Challenges in diagnosis and treatment. Annales d'endocrinologie. 2015;76(2):169-77.
3. Do Cao C, Aubert S, Trinel C, Odou MF, Bayaram M, Patey M. Parathyroid carcinoma: Diagnostic criteria, classification, evaluation. Annales d'endocrinologie. 2015;76(2):165-8.
4. Duan K, Mete O. Parathyroid Carcinoma: Diagnosis and Clinical Implications. Turk patoloji dergisi. 2015;31 Suppl 1:80-97.
5. Alperstein A, Bhayani R. Parathyroid carcinoma, a rare cause of primary hyperparathyroidism. BMJ case reports. 2014;2014.
6. Sharretts JM, Kebebew E, Simonds WF. Parathyroid cancer. Seminars in oncology. 2010;37(6):580-90.
7. Wei CH, Harari A. Parathyroid carcinoma: update and guidelines for management. Current treatment options in oncology. 2012;13(1):11-23.
8. Kassahun WT, Jonas S. Focus on parathyroid carcinoma. International journal of surgery. 2011;9(1):13-9.
9. Selvan B, Paul MJ, Seshadri MS, Thomas N, Paul T, Abraham D, et al. High index of clinical suspicion with optimal surgical techniques and adjuvant radiotherapy is critical to reduce locoregional disease progression in parathyroid carcinoma. American journal of clinical oncology. 2013;36(1):64-9.
10. DeLellis RA. Parathyroid tumors and related disorders. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. 2011;24 Suppl 2:S78-93.
11. Kasaian K, Wiseman SM, Thiessen N, Mungall KL, Corbett RD, Qian JQ, et al. Complete genomic landscape of a recurring sporadic parathyroid carcinoma. The Journal of pathology. 2013;230(3):249-60.
12. Diaconescu MR, Glod M, Costea I, Grigorovici M, Diaconescu S. Clinicopathological phenotype of parathyroid carcinoma: therapeutic and prognostic aftermaths. Chirurgia. 2015;110(1):66-71.
13. Duan K, Gomez Hernandez K, Mete O. Clinicopathological correlates of hyperparathyroidism. Journal of clinical pathology. 2015;68(10):771-87.
14. Adam MA, Untch BR, Olson JA, Jr. Parathyroid carcinoma: current understanding and new insights into gene expression and intraoperative parathyroid hormone kinetics. The oncologist. 2010;15(1):61-72.
15. Rafferty A, England J. Current management of parathyroid tumours. British journal of hospital medicine. 2013;74(1):24-9.
16. Svedlund J, Auren M, Sundstrom M, Dralle H, Akerstrom G, Bjorklund P, et al. Aberrant WNT/beta-catenin signaling in parathyroid carcinoma. Molecular cancer. 2010;9:294.
17. Barazeghi E, Gill AJ, Sidhu S, Norlen O, Dina R, Palazzo FF, et al. 5-Hydroxymethylcytosine discriminates between parathyroid adenoma and carcinoma. Clinical epigenetics. 2016;8:31.
18. Kentwell J, Gundara JS, Sidhu SB. Noncoding RNAs in endocrine malignancy. The oncologist. 2014;19(5):483-91.
19. Kumari N, Chaudhary N, Pradhan R, Agarwal A, Krishnani N. Role of Histological Criteria and Immunohistochemical Markers in Predicting Risk of Malignancy in Parathyroid Neoplasms. Endocrine pathology. 2016;27(2):87-96.
20. Zhao J, Hu Y, Liao Q, Niu Z, Xing X, Xia W, et al. Gene identification of potential malignant parathyroid tumors phenotype in Chinese population. Endocrine journal. 2014;61(6):597-605.
21. Al-Kurd A, Mekel M, Mazeh H. Parathyroid carcinoma. Surgical oncology. 2014;23(2):107-14.
22. Mohebati A, Shaha A, Shah J. Parathyroid carcinoma: challenges in diagnosis and treatment. Hematology/oncology clinics of North America. 2012;26(6):1221-38.
23. Butt WT, Azim A, Abbas A, Gauhar TM, Afzal A, Azim KM. Parathyroid carcinoma. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2012;22(9):588-90.
24. Oh MY, Oh SB, Seoung HG, Kim JH, Kim SS, Kim BH, et al. Concurrent parathyroid carcinoma and hyperplasia in hyperparathyroidism. The Korean journal of internal medicine. 2012;27(3):356-9.
25. Schulte KM, Talat N. Diagnosis and management of parathyroid cancer. Nature reviews Endocrinology. 2012;8(10):612-22.
26. Hughes DT, Sorensen MJ, Miller BS, Cohen MS, Gauger PG. The biochemical severity of primary hyperparathyroidism correlates with the localization accuracy of sestamibi and surgeon-performed ultrasound. Journal of the American College of Surgeons. 2014;219(5):1010-9.
27. Whitcroft KL, Sharma A. Sestamibi scintigraphy for parathyroid localisation: a reminder of the dangers of false positives. BMJ case reports. 2014;2014.
28. Dytz MG, Souza RG, Lazaro AP, Goncalves MD, Vidal AP, dos Santos Teixeira Pde F, et al. Parathyroid carcinoma and oxyphil parathyroid adenoma: an uncommon case of misinterpretation in clinical practice. Endocrine journal. 2013;60(4):423-9.
29. Givi B, Shah JP. Parathyroid carcinoma. Clinical oncology. 2010;22(6):498-507.
30. Lang B, Lo CY. Parathyroid cancer. Surgical oncology clinics of North America. 2006;15(3):573-84.
31. Lumachi F, Basso SM, Basso U. Parathyroid cancer: etiology, clinical presentation and treatment. Anticancer research. 2006;26(6C):4803-7.
32. Enomoto K, Uchino S, Ito A, Watanabe S, Shibuya H, Enomoto Y, et al. The surgical strategy and the molecular analysis of patients with parathyroid cancer. World journal of surgery. 2010;34(11):2604-10.
33. Crea N, Pata G, Casella C, Cappelli C, Salerni B. Predictive factors for postoperative severe hypocalcaemia after parathyroidectomy for primary hyperparathyroidism. The American surgeon. 2012;78(3):352-8.
34. Ohe MN, Santos RO, Hojaij F, Neves MC, Kunii IS, Orlandi D, et al. Parathyroid carcinoma and hungry bone syndrome. Arquivos brasileiros de endocrinologia e metabologia. 2013;57(1):79-86.
35. Artinyan A, Guzman E, Maghami E, Al-Sayed M, D'Apuzzo M, Wagman L, et al. Metastatic parathyroid carcinoma to the liver treated with radiofrequency ablation and transcatheter arterial embolization. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008;26(24):4039-41.
36. Clines GA. Mechanisms and treatment of hypercalcemia of malignancy. Current opinion in endocrinology, diabetes, and obesity. 2011;18(6):339-46.
37. Minisola S, Pepe J, Piemonte S, Cipriani C. The diagnosis and management of hypercalcaemia. Bmj. 2015;350:h2723.
38. Reagan P, Pani A, Rosner MH. Approach to diagnosis and treatment of hypercalcemia in a patient with malignancy. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2014;63(1):141-7.
39. Legrand SB. Modern management of malignant hypercalcemia. The American journal of hospice & palliative care. 2011;28(7):515-7.
40. Crowley R, Gittoes N. How to approach hypercalcaemia. Clinical medicine. 2013;13(3):287-90.
41. Bowyer SE, White AM, Ransom DT, Davidson JA. Resistant hypercalcaemia in metastatic parathyroid carcinoma. The Medical journal of Australia. 2013;198(10):559-61.
42. Vellanki P, Lange K, Elaraj D, Kopp PA, El Muayed M. Denosumab for management of parathyroid carcinoma-mediated hypercalcemia. The Journal of clinical endocrinology and metabolism. 2014;99(2):387-90.
43. Horie I, Ando T, Inokuchi N, Mihara Y, Miura S, Imaizumi M, et al. First Japanese patient treated with parathyroid hormone peptide immunization for refractory hypercalcemia caused by metastatic parathyroid carcinoma. Endocrine journal. 2010;57(4):287-92.
44. Barker HS, Podoll MB, Parker JR, Parker JC, Jr., Crim J, Yang X. Parathyroid carcinoma with intracranial metastasis at diagnosis in a patient with uncontrolled hypercalcemia. Annals of clinical and laboratory science. 2014;44(4):484-8.
45. O'Neill CJ, Chan C, Symons J, Learoyd DL, Sidhu SB, Delbridge LW, et al. Parathyroid carcinoma encountered after minimally invasive focused parathyroidectomy may not require further radical surgery. World journal of surgery. 2011;35(1):147-53.
46. McClenaghan F, Qureshi YA. Parathyroid cancer. Gland surgery. 2015;4(4):329-38.
47. Mori H, Okada Y, Arao T, Tanaka Y. Case of parathyroid carcinoma with a highly aggressive clinical course. Journal of UOEH. 2014;36(4):243-9.
48. Tan GC, Shiran MS, Swaminathan M, Phang KS, Rohaizak M. Large retrosternal parathyroid carcinoma with primary hyperparathyroidism. Asian journal of surgery / Asian Surgical Association. 2007;30(4):286-9.
49. Dudney WC, Bodenner D, Stack BC, Jr. Parathyroid carcinoma. Otolaryngologic clinics of North America. 2010;43(2):441-53, xi.
50. Wang O, Wang C, Nie M, Cui Q, Guan H, Jiang Y, et al. Novel HRPT2/CDC73 gene mutations and loss of expression of parafibromin in Chinese patients with clinically sporadic parathyroid carcinomas. PloS one. 2012;7(9):e45567.
Publicado
2018-09-08
Como Citar
BARBOSA, Ana Luísa Castro; COSTA, João Capela.
Carcinoma da Paratiróide.
Revista Portuguesa de Cirurgia, [S.l.], n. 44, p. 25 - 36, sep. 2018.
ISSN 2183-1165.
Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/631>. Acesso em: 25 mar. 2023.
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