Neuroendocrine Thymic Carcinoma Metastatic to the Parathyroid Gland that was Reimplanted into the Forearm in Patient with Multiple Endocrine Neoplasia Type 1 Syndrome: A Challenging Management Dilemma |
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| Affiliation: | 1. Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey;2. Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;3. Department of Pathology, Jersey Shore University Medical Center, Neptune, New Jersey;4. Department of Endocrinology, Jersey Shore University Medical Center, Neptune, New Jersey;5. Shore Endocrinology Associates, Pt. Pleasant, New Jersey;6. Southern Ocean Medical Center, Manahawkin, New Jersey;7. Atlantic Hematology Oncology, Manasquan, New Jersey;8. Hereditary Cancer Risk Program, Meridian Health System, Neptune, New Jersey.;1. Department of Internal Medicine, Scottsdale, Arizona;2. Division of Endocrinology Mayo Clinic, Scottsdale, Arizona;1. School of Medicine and Health Sciences, George Washington University, Washington DC;2. Center for Andrology and Division of Endocrinology, George Washington University, Washington DC.;1. Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.;2. Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California.;1. Department of Endocrinology, Diabetes and Metabolism;2. Department of Hospital Medicine and Medical Genetics;3. Department of Rheumatology, Mayo Clinic;1. UAB School of Medicine, University of Alabama at Birmingham;2. Center for Clinical and Translational Sciences, University of Alabama at Birmingham;3. Department of Pediatrics/Division of Pediatric Endocrinology and Metabolism, Children’s of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.;1. Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, and Kaleida Health;2. Division of Diabetes, Endocrinology & Metabolism, Rochester General Hospital, Rochester, New York,;3. Division of Pharmacy, St. John Fisher College, Rochester, New York. |
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| Abstract: | ObjectiveTo describe a unique case of a metastatic thymic carcinoma to the hyperplastic parathyroid gland and to present a challenging management dilemma.MethodsOur patient is 60-year-old, intellectually disabled man with history of the multiple endocrine neoplasia type 1 (MEN1) syndrome, a surgery in 1985 for hypercalcemia with removal of one parathyroid gland, surgery in 2007 with findings of extensively necrotic well differentiated neuroendocrine carcinoma (carcinoid tumor) of the thymus. In 2012, he presented with persistent hypercalcemia (calcium level 11.7 mg/dL [range, 8.6-10.2]), and a parathyroid hormone (PTH) level of 225 pg/mL (range, 15-65 pg/mL). He underwent a repeat neck exploration with removal of 2 small inferior and a large left superior 4.5 × 2.5 × 1.5cm parathyroid glands, all of which showed hyperplasia on intraoperative frozen section. A small portion of the superior gland was reimplanted into the patient’s forearm. Final pathology showed the presence of a focus of neuroendocrine tumor within the left superior parathyroid gland with immunostain identical to the thymic carcinoma. His postoperative PTH level was 14 pg/mL and calcium 8.5 mg/dL. A positron emission tomography – computed tomography (PET-CT) and octreotide scans revealed an extensive metastatic disease within the lung, mediastinum, and bones.ResultsWe decided to leave a portion of the reimplanted parathyroid gland with possible metastatic thymic carcinoid in his forearm because of the presence a widespread metastatic disease and his intellectual disability that would result in noncompliance with calcium replacement in case of permanent hypocalcemia.ConclusionMetastatic thymic carcinoma to the parathyroid gland has never been reported in the literature. We have described the first case and presented a challenging management dilemma. (Endocr Pract. 2013;19:e163-e167) |
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