Uğur TOPAL, Aysun Hatice UGUZ, Isa Burak GUNAY, Gurhan SAKMAN, Ahmet RENCUZOGULLARİ, Kubilay DALCİ

The importance of intraoperative evaluation for parathyroid cancer

Aim: There is no examination to determine the exact diagnosis of parathyroid cancer before surgery. The aim of this study wasto discuss our surgical experience and the intraoperative findings suggestive of cancer, in parathyroid cancers operated with thediagnosis of primary hyperparathyroidism.Material and Methods: Six patients with parathyroid cancer who were operated on between May 2012 and January 2017, in theDepartment of General Surgery, Cukurova University were included in the study. Age, sex, complaints of the patients, calcium andparathormone values, imaging methods for localization, intraoperative findings from surgical notes were evaluated retrospectively.Results: Of the patients, 4 were females and 2 were males. The mean age was 61.6+7.28 (50-71). While the lesion was spottedincidentally in three patients, swelling in the neck, back and hip pain, pancreatitis were other reasons for admission. The mean calciumlevels were 13.05+1.86 (10.5-15.7) mg/dL, mean parathormone values were 937.4+756.9 (370-1814) pg/ml. Ultrasonography (USG)and parathyroid scintigraphy were performed to all patients. Thyroid scintigraphy was additionally performed on one patient forhyperthyroidism and then FNAB-FNAS was performed. This patient was operated on with suspected thyroid cancer. In intraoperativeevaluation, all of the lesions were firm, adherent to the thyroid capsule and surrounding tissues. One patient had inferior laryngealnerve invasion. In frozen examination, four patients with suspected parathyroid cancer was specified. Three patients had a lobectomyand 2 patients had en bloc lesion resection with total thyroidectomy. Lesion excision was performed in one patient. After finalpathology results, re-operation was suggested, however the patient did not accept.Conclusion: The definitive diagnosis in parathyroid cancer is made by postoperative pathological examination. In cases ofprimary hyperparathyroidism, in case of intravesical invasion of the thyroid capsule and surrounding tissues during intraoperativeexamination, parathyroid cancer should be suspected. In case of suspicious findings in frozen examination and intraoperativefindings, the surgical plan may be changed and the necessity of secondary surgery can be eliminated.

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