Abstract


Background
The diagnosis and treatment of parathyroid carcinoma (PC) can be challenging due to rarity of the disease, similarity of clinical features to parathyroid adenoma, and limited effective treatment options for patients with advanced metastatic disease.
Clinical case view more

Background
The diagnosis and treatment of parathyroid carcinoma (PC) can be challenging due to rarity of the disease, similarity of clinical features to parathyroid adenoma, and limited effective treatment options for patients with advanced metastatic disease.
Clinical case
A 64-year old woman was diagnosed a primary hyperparathyroidism: high level of serum Ca – 3.3 mmol/l (2.19-2.55) and PTH 259 pg/ml (9.5-75), in combination with 3.5*2.9*2.2 cm tumor behind the thyroid gland at US exam, confirmed by CT-scan and 99mTc-Sestamibi scintigraphy. During a surgery, cancer was suspected, so “en bloc” removal of the tumor was performed. PC was confirmed by histological examination. PTH and Ca levels decreased down to 9.5 pg/ml and 2.3 mmol/l respectively after the surgery. Six months after the surgery the local recurrence was diagnosed with the increase of PTH up to 432 pg/ml and subsequent "en bloc" removal of the tumor. Three months later a second recurrence was revealed by high PTH and Ca with FDG-PET showing an increased radiotracer uptakes at the level of C6-7, 2.5*1.3 cm; maximal cytoreductive selective neck lymph node dissection at levels II-V right and selective neck lymph node dissection at level VI left was performed after which her Ca was 3.06 mmol/l, PTH – 302 pg/ml. MRI determined a 1.4 cm tumor behind the sternal end of the left clavicle. The patient had 3 sessions of radiation therapy (SOD 87.4 Gy). Four months after the radiation therapy, PET/CT scan showed the increased capture of the FDG behind the left clavicle lymph node 1.5*1.0 cm, in new tumors in lungs 0.7 cm, liver (S4) 1.0 cm (Ki-67 16-27%) in, L4 vertebra 0.9 cm, right acetabulum 0.8 cm. Chemotherapy cycle with carboplatinum + paclitaxel was ineffective. «Molecular intelligence tumor report» by Caris Life Sciences showed that 2 out of 44 tested genes had actionable mutations: pathogenic mutation in PTEN and pathogenic nonsense mutation R213X in TP53. The sensitivity to therapies was analyzed by IHC, which showed a potential benefit from capecitabinum, which was appointed, but also had no effect: Ca 3,10 mmol/l (2,20-2,55), PTH 2090 pg/ml. Diffusional MRI showed multiple mts in liver (C4-1.2 cm, C6-3.9 cm, in the left lobe 1.9 cm), in lungs 0.8-0.7 cm and new tumors in the bodies of the thoracic and lumbar spine.
Based on the reports [1] and our personal successful experience of using sorafenib to treat metastatic PC we started therapy with 400 mg of sorafenib 2 times a day. After 4 weeks, we saw a dramatic decrease in PTH to 38,6 pg/ml (tested twice) and in Ca to 2,32 mmol/l.
Conclusions
Sorafenib seems to be a promising drug for targeted therapy for PC. Contemporary algorithms of cancer treatment selection may not be reliable for patients with PC. 

show less
Files:

Support our sponsors


Share this PosterTalk

About PosterTalks

PosterTalks allows meeting attendees the ability to view these presentations, download or bookmark their favorite presentations, download PDF versions of the posters, ask questions, leave comments, and share presentations with their colleagues – all from the convenience of a smart phone.

Contact Us

Have a question? Click here to contact us. Need technical support? Click here to email support.

© 2018 PosterTalks and Connect BioMed. All other content and data, including data entered into this website are copyrighted by their respective owners.