PMID- 24014011
OWN - NLM
STAT- MEDLINE
DCOM- 20140721
LR  - 20210204
IS  - 1934-2403 (Electronic)
IS  - 1530-891X (Linking)
VI  - 19
IP  - 6
DP  - 2013 Nov-Dec
TI  - 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.
PG  - e163-7
LID - 10.4158/EP13267.CR [doi]
AB  - OBJECTIVE: To describe a unique case of a metastatic thymic carcinoma to the 
      hyperplastic parathyroid gland and to present a challenging management dilemma. 
      METHODS: Our 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 x 2.5 
      x 1.5 cm 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. RESULTS: We 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. CONCLUSION: Metastatic 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.
FAU - Shifrin, Alexander L
AU  - Shifrin AL
AD  - Department of Surgery, Jersey Shore University Medical Center, Neptune, New 
      Jersey.
FAU - LiVolsi, Virginia A
AU  - LiVolsi VA
FAU - Zheng, Min
AU  - Zheng M
FAU - Lann, Danielle E
AU  - Lann DE
FAU - Fomin, Svetlana
AU  - Fomin S
FAU - Naylor, Evan C
AU  - Naylor EC
FAU - Mencel, Peter J
AU  - Mencel PJ
FAU - Fay, Angela M
AU  - Fay AM
FAU - Erler, Brian S
AU  - Erler BS
FAU - Matulewicz, Theodore J
AU  - Matulewicz TJ
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Endocr Pract
JT  - Endocrine practice : official journal of the American College of Endocrinology 
      and the American Association of Clinical Endocrinologists
JID - 9607439
RN  - 0 (Parathyroid Hormone)
SB  - IM
MH  - Forearm/*pathology
MH  - Humans
MH  - Immunohistochemistry
MH  - Intellectual Disability
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/*pathology
MH  - Neck/surgery
MH  - Necrosis
MH  - *Neoplasm Transplantation
MH  - Parathyroid Hormone/metabolism
MH  - Parathyroid Neoplasms/*secondary/surgery
MH  - Pedigree
MH  - Positron-Emission Tomography
MH  - Thymoma/*pathology
MH  - Thymus Neoplasms/*pathology
MH  - Tomography, X-Ray Computed
EDAT- 2013/09/10 06:00
MHDA- 2014/07/22 06:00
CRDT- 2013/09/10 06:00
PHST- 2013/09/10 06:00 [entrez]
PHST- 2013/09/10 06:00 [pubmed]
PHST- 2014/07/22 06:00 [medline]
AID - S1530-891X(20)43137-4 [pii]
AID - 10.4158/EP13267.CR [doi]
PST - ppublish
SO  - Endocr Pract. 2013 Nov-Dec;19(6):e163-7. doi: 10.4158/EP13267.CR.