Case report: Abdominal lymph node metastases of parathyroid carcinoma

• Verfasst von: Lenschow, Christina [VerfasserIn]
• Verfasst von: Fuss, Carmina Teresa [VerfasserIn]
• Verfasst von: Kircher, Stefan [VerfasserIn]
• Verfasst von: Buck, Andreas [VerfasserIn]
• Verfasst von: Kickuth, Ralph [VerfasserIn]
• Verfasst von: Reibetanz, Joachim [VerfasserIn]
• Verfasst von: Wiegering, Armin [VerfasserIn]
• Verfasst von: Stenzinger, Albrecht [VerfasserIn]
• Verfasst von: Hübschmann, Daniel [VerfasserIn]
• Verfasst von: Germer, Christoph Thomas [VerfasserIn]
• Verfasst von: Fassnacht, Martin [VerfasserIn]
• Verfasst von: Fröhling, Stefan [VerfasserIn]
• Verfasst von: Schlegel, Nicolas [VerfasserIn]
• Verfasst von: Kroiss, Matthias [VerfasserIn]
• Titel: Case report: Abdominal lymph node metastases of parathyroid carcinoma
• Titelzusatz: diagnostic workup, molecular diagnosis, and clinical management
• Verf.angabe: Christina Lenschow, Carmina Teresa Fuss, Stefan Kircher, Andreas Buck, Ralph Kickuth, Joachim Reibetanz, Armin Wiegering, Albrecht Stenzinger, Daniel Hübschmann, Christoph Thomas Germer, Martin Fassnacht, Stefan Fröhling, Nicolas Schlegel and Matthias Kroiss
• E-Jahr: 2021
• Jahr: 23 March 2021
• Umfang: 7 S.
• Fussnoten: Gesehen am 09.06.2021
• Titel Quelle: Enthalten in: Frontiers in endocrinology
• Ort Quelle: Lausanne : Frontiers Research Foundation, 2010
• Jahr Quelle: 2021
• Band/Heft Quelle: 12(2021), Artikel-ID 643328, Seite 1-7
• ISSN Quelle: 1664-2392
• DOI: doi:10.3389/fendo.2021.643328
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: abdominal lymph node metastases
• Sach-SW: FDG-PET/CT
• Sach-SW: Molecular diagnosis
• Sach-SW: parathyroid carcinoma
• Sach-SW: Repeated surgery
• K10plus-PPN: 1760117773

Abstract

Parathyroid carcinoma (PC) is an orphan malignancy accounting for only ~1% of all cases with primary hyperparathyroidism. The localization of recurrent PC is of critical importance and can be exceedingly difficult to diagnose and sometimes futile when common sites of recurrence in the neck and chest cannot be confirmed. Here we present the diagnostic workup, molecular analysis and multimodal therapy of a 46-year old woman with the extraordinary manifestation of abdominal lymph node metastases 12 years after primary diagnosis of PC. The patient was referred to our endocrine tumor center in 2016 with the aim to localize the tumor causative of symptomatic biochemical recurrence. In view of the extensive previous workup we decided to perform [18F]FDG-PET/CT. A pathological lymph node in the liver hilus showed slightly increased FDG-uptake and hence was suspected as site of recurrence. Selective venous sampling confirmed increased parathyroid hormone concentration in liver veins. Abdominal lymph node metastasis was resected and histopathological examination confirmed PC. Within four months, the patient experienced biochemical recurrence and based on high tumor mutational burden detected in the surgical specimen by whole exome sequencing the patient received immunotherapy with pembrolizumab that led to biochemical response. Subsequent to disease progression repeated abdominal lymph node resection was performed in 10/2018, 01/2019 and in 01/2020. Up to now (12/2020) the patient is biochemically free of disease. In conclusion, a multimodal diagnostic approach and therapy in an interdisciplinary setting is needed for patients with rare endocrine tumors. Molecular analyses may inform additional treatment options.