Parathyroid carcinoma: Current understanding and new insights into gene expression and intraoperative parathyroid hormone kinetics

Mohamed Abdelgadir Adam, Brian R. Untch, John A. Olson

Research output: Contribution to journalReview articlepeer-review

37 Scopus citations

Abstract

Parathyroid carcinoma is an indolent but ultimately life-threatening malignancy. Due to the lack of definitive diagnostic markers and overlapping clinical features of benign primary hyperparathyroidism (PHPT), this disease is often misdiagnosed as parathyroid adenoma. Therefore, a high index of suspicion preoperatively and early intraoperative recognition with en bloc surgical resection are crucial for favorable outcome. Owing to the rarity of the disease, little is known about the molecular pathogenesis of parathyroid carcinoma. Here, we review the literature to present current understanding of the disease and provide new information on gene expression and use of intraoperative parathyroid hormone (PTH) monitoring in the surgical management of this rare malignancy. Specifically, using microarray transcriptome analysis of an unequivocal case of parathyroid carcinoma and a biopsy from the same patient's normal parathyroid gland, we identify APP, CDH1, KCNJ16, and UCHL1 as differentially expressed genes in parathyroid carcinoma. Further, using case records from four cases of unequivocal parathyroid carcinoma, we compared intraoperative PTH kinetics of these patients to 475 patients with benign PHPT, and show that intraoperative PTH monitoring is accurate in predicting postoperative normocalcemia in initial en bloc operations for parathyroid carcinoma.

Original languageEnglish
Pages (from-to)61-72
Number of pages12
JournalOncologist
Volume15
Issue number1
DOIs
StatePublished - 2010

Keywords

  • Gene expression
  • Intraoperative PTH
  • Parathyroid carcinoma

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