They should therefore not be considered cancer-specific. Diagnosis is more problematic in non-functional lesions, and the prognosis is worse. A visible or palpable lump in the front of the neck or ultrasound or CT evidence may give rise to the suspicion of parathyroid carcinoma. Where the lesion can be palpated, it appears as a hard, solid mass of from a few millimeters to some centimeters selleck products in size, strongly adherent to the thyroid and infiltrating the adjacent structures. High serum calcium (>14 mg/dL) and PTH (especially when twice the normal value) are considered as indicative of carcinoma. Diagnosis In most cases, the suspected diagnosis of parathyroid carcinoma was reached on the basis of clinical signs and the finding of hypercalcemia, hypophosphatemia and elevated alkaline phosphatase and osteocalcin, markers of increased osteoclast activity.
As already noted, the diagnosis is almost certain when there are particularly high PTH and calcium levels, which are unlikely to be seen in cases of benign hyperparathyroidism. Although instrumental diagnosis is non-specific, ultrasound can reveal some signs of malignancy, such as echostructure, irregular margins, any pathological adenopathies and any invasion of the adjacent structures. Computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy with 99mTc-sestaMIBI and bone scintigraphy and fine-needle aspiration biopsy (FNAB) can help confirm the diagnosis. However, the definitive diagnosis is provided by the pathologist. On macroscopic examination, the tumor is hard; whitish with a very thick fibrous capsule.
It is strongly adherent to the surrounding tissues. Capsule invasion is considered a sign of malignancy. Under the microscope, capsule, blood vessel and lymph invasion, stromal calcifications, fibrous trabeculae, enlarged nuclei and strong mitotic activity are considered to be signs of malignancy. Treatment Surgery is the gold standard for the treatment of parathyroid carcinoma. En bloc dissection of the tumor with the thyroid lobe, the ipsilateral parathyroid and any other affected tissue is the most suitable treatment and leads to the best prognosis. The radicalism of the surgery is important and it is essential to avoid damaging the tumor capsule, as any residual or dispersed cells could lead to a fast recurrence. Sometimes it is possible to remove local recurrences.
Laterocervical and central lymphadenectomy is Cilengitide generally carried out only if necessary. Some authors consider radiotherapy to have some effect on preventing recurrences when used as a complementary treatment, while chemotherapy is agreed by all to be ineffective. The treatment of parathyroid carcinoma aims not only to cure the disease but to obtain its biochemical remission: normalization of blood calcium and PTH levels, arrest of bone calcium depletion and regression of vascular, renal and neurological disorders.