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Hong, Kim, Kim, Cha, Ahn, Yoo, Kim, Seo, Kim, Kim, Kim, Choi, Lee, Baik, and Choi: Successful Localization of Distant Metastasis in Parathyroid Carcinoma Using Intraoperative Parathyroid Hormone Assay
Case Report
Endocrinology and Metabolism

Endocrinology and Metabolism 2011; 26(1): 92-96.

Published online: 31 March 2011

DOI: https://doi.org/10.3803/EnM.2011.26.1.92

Successful Localization of Distant Metastasis in Parathyroid Carcinoma Using Intraoperative Parathyroid Hormone Assay

Ho Cheol Hong, Sun Won Kim, Tae Hyung Kim, In Hye Cha, Jae Hee Ahn, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Hyun Koo Kim1, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Jae Bok Lee2, Sei Hyun Baik, Dong Seop Choi

Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

1Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea.

2Department of General Surgery, Korea University College of Medicine, Seoul, Korea.

Corresponding author: Hye Jin Yoo. Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3045, Fax: +82-2-2626-1096, deisy21@naver.com

Received 12 July 2010       Accepted 16 September 2010

Copyright © 2011 Korean Endocrine Society

Abstract

Intra-operative parathyroid hormone (IOPTH) assay is a useful tool to confirm complete excision of all hyper-functioning parathyroid gland tissue. In this report, we describe a case with successful localization of distant metastasis in a patient with parathyroid carcinoma using the IOPTH assay. A 53-year-old man presented to our clinic with a serum calcium level of 11.8 mg/dL and an intact PTH level of 233.3 pg/mL. He had been treated for parathyroid carcinoma eleven years ago. Two suspected metastatic lesions were detected on the chest computed tomography. Due to the vastly different surgical field necessary to excise each lesion, we preferentially removed only one lesion and we monitored the other remaining suspected lesion without resection via IOPTH assay. Six months later, the patient's serum calcium and intact PTH levels remained within their normal ranges. To the best of our knowledge, this is the first case to effectively utilize IOPTH assay for the management of metastatic parathyroid carcinoma.

Keywords: Intra-operative parathyroid hormone assay, Parathyroid carcinoma

Figures and Tables

Fig. 1
Intraoperative parathyroid hormone (PTH) level remained high even after removal of the two remaining parathyroid glands (A). Intraoperative parathyroid hormone fell to < 50% of baseline within five minutes after the resection of right pulmonary nodule (B).
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Fig. 2
Positron emission tomography (PET) imaging shows no abnormal radioactivity.
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Fig. 3
Chest CT shows a discrete nodule in the right middle lobe (arrow) (A). Mediastinal chest CT shows a small nodule (arrow) in the right paratracheal area, requiring follow-up to distinguish metastatic lymphadenopathy from reactive hyperplasia (B).
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Fig. 4
The tumor cells with pleomorphic nuclei are surrounded by vascular structures, and forming trabecular appearance (H&E staining, × 400) (A). On immunohistochemical staining, the tumor cells are positive for PTH (B).
enm-26-92-g004

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