Journal List > J Korean Endocr Soc > v.22(5) > 1003386

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Lee, Kim, Hwang, Hwang, Eum, Seo, Choi, Kang, Noh, Nam-Goong, Kim, and Kim: A Case of Parathyroid Carcinoma Underwent Radiation Therapy on the Metastatic Bone Lesions
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2007; 22(5): 344-352.

Published online: 20 October 2007

DOI: https://doi.org/10.3803/jkes.2007.22.5.344

A Case of Parathyroid Carcinoma Underwent Radiation Therapy on the Metastatic Bone Lesions

Jun Ho Lee, Young Min Kim, 1, Dae Seong Hwang, Young Tae Hwang, Jun Bum Eum, Jung Min Seo, Dae Hwa Choi2, Byeong Seong Kang3, Young Ju Noh4, Il Seong Nam-Goong, Young Il Kim, Eun Sook Kim

Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Korea.

1Department of Pathology, Ulsan University Hospital, College of Medicine, University of Ulsan, Korea.

2Department of Surgery, Ulsan University Hospital, College of Medicine, University of Ulsan, Korea.

3Department of Radiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Korea.

4Department of Radiation Oncology, Ulsan University Hospital, College of Medicine, University of Ulsan, Korea.

Received 15 June 2007       Accepted 27 July 2007

Copyright © 2007 Korean Endocrine Society

Abstract

Parathyroid carcinoma is a rare malignancy that is responsible for only 0.5 to 4% of all cases of primary hyperparathyroidism. Surgery is the only curative treatment. We report a case of a 46-year-old woman referred for a severe osteoporosis with frequent bone fracture associated with hypercalcemia. Initially, though she had multiple osteolytic lesions, we thought that the lesions were brown tumors resulting from hyperparathyroidism. The patient underwent surgery and was diagnosed with parathyroid carcinoma. After surgery, her intact PTH level normalized for brief period of time, but it was again elevated at 6 weeks after surgery. We suggest that the multiple osteolytic lesions were metastases because there was no evidence of local recurrence of parathyroid carcinoma, and the lesions looked like metastases on CT and PET-CT. The patient was treated with radiation therapy on the lumbar vertebra, one a site of the metastatic lesions. After radiotherapy, her serum intact PTH was decreased.

Keywords: Multiple bone metastases, Parathyroid carcinoma, Radiation therapy

Figures and Tables

Fig. 1
Ultrasonographic finding of the neck shows a 2 × 2 × 2.5 cm sized round mass density under the right lobe of the thyroid grand.
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Fig. 2
99mTc-sestamibi scan shows focal abnormal uptake in right lower thyroid area in early (A) and 3-hour delayed imaging (B).
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Fig. 3
Radiologic findings of the patient show multiple bone resorptive lesions on skull (A) with "punch-out lesions" (thin arrow), lumbar spine (B) and hands (C). Right hand shows the status of post K-wire fixations and bone graft materials (thick arrow) on the 4th metacarpal bone.
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Fig. 4
Abdominal CT scan shows multiple osteolytic lesions on the 1st lumbar vertebra (A), right 7th rib (B) and pelvic bone (C). Intraabdominal organs, including pancreas are seen normal except a 0.5 cm sized calcified renal stone in the left (D).
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Fig. 5
Gross finding of resected parathyroid carcinoma with thyroidal tissue. The cut surface of the mass is homogenously yellowish tan, solid and granular with hemorrhages. The mass (3 × 2.7 × 2.2 cm) is surrounded by thick fibrous capsule with focal extension into the thyroid parenchyma (arrow).
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Fig. 6
Microscopic finding: Parathyroid gland shows hyperplasia and several cystic lesions (A), but no atypical cell in whole resected mass. Parathyroid tissue invades the vessel (B) and extends to thyroidal parenchyma via capsule (C) (H&E stain, ×200 (A, B), ×20 (C)).
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Fig. 7
Course of serum calcium and iPTH levels.
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Fig. 8
PET-CTscan shows multifocal hypermetabolic lesions on left 2nd (A) and right 7th ribs (B), right pedicle of 1st lumbar vertebra (C, D), left iliac bone (E) and left femur shaft (F).
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