Hyperparathyroidism-jaw tumor syndrome: Results of operative management

• Published in: Surgery 2014-12, Vol.156 (6), p.1315-1325
• Main Authors: Mehta, Amit, BA, Patel, Dhaval, MD, BS, Rosenberg, Avi, MD, Boufraqech, Myriem, PhD, Ellis, Ryan J., BS, Nilubol, Naris, MD, Quezado, Martha M., MD, Marx, Stephen J., MD, Simonds, William F., MD, Kebebew, Electron, MD
• Format: Article
• Language: English
• Subjects: Adenoma - genetics; Adenoma - pathology; Adenoma - surgery; Adolescent; Adult; Cell Transformation, Neoplastic - pathology; Cohort Studies; Female; Fibroma - genetics; Fibroma - pathology; Fibroma - surgery; Germ-Line Mutation; Heterozygote; Humans; Hyperparathyroidism - genetics; Hyperparathyroidism - pathology; Hyperparathyroidism - surgery; Immunohistochemistry; Jaw Neoplasms - genetics; Jaw Neoplasms - pathology; Jaw Neoplasms - surgery; Male; Middle Aged; Monitoring, Physiologic; Parathyroid Neoplasms - genetics; Parathyroid Neoplasms - mortality; Parathyroid Neoplasms - pathology; Parathyroid Neoplasms - surgery; Parathyroidectomy - methods; Pedigree; Prognosis; Rare Diseases; Retrospective Studies; Statistics, Nonparametric; Surgery; Survival Rate; Treatment Outcome; Tumor Suppressor Proteins - genetics; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2014.08.004

Background Hyperparathyroidism-jaw tumor syndrome (HPT-JT) is a rare, autosomal-dominant disease secondary to germline-inactivating mutations of the tumor suppressor gene HRPT2/CDC73 . The aim of the present study was to determine the optimal operative approach to parathyroid disease in patients with HPT-JT. Methods A retrospective analysis of clinical and genetic features, parathyroid operative outcomes, and disease outcomes in 7 unrelated HPT-JT families. Results Seven families had 5 distinct germline HRPT2/CDC73 mutations. Sixteen affected family members (median age, 30.7 years) were diagnosed with primary hyperparathyroidism (PHPT). Fifteen of the 16 patients underwent preoperative tumor localization studies and uncomplicated bilateral neck exploration at initial operation; all were in biochemical remission at most recent follow-up. Of these patients, 31% had multiglandular involvement; 37.5% of the patients developed parathyroid carcinoma (median overall survival, 8.9 years; median follow-up, 7.4 years). Long-term follow-up showed that 20% of patients had recurrent PHPT. Conclusion Given the high risk of malignancy and multiglandular involvement in our cohort, we recommend bilateral neck exploration and en bloc resection of parathyroid tumors suspicious for cancer and life-long postoperative follow-up.