Parathyroid Carcinoma: The Importance of High Clinical Suspicion for a Correct Management

Background. Parathyroid carcinoma is an infrequent clinical entity whose diagnosis is very challenge. Indeed a pre-operative or intraoperative diagnosis of parathyroid carcinoma is reported in less than half cases described in the literature. Patients and Methods. A systematic review of pathological reports of our secondary referral hospital was done. From 2003 to 2011 one hundred and forty-four patients were operated for hyperparathyroidism. One patient with atypical adenoma and three patients with parathyroid carcinoma were included in this paper. Results. An en bloc resection of the tumor was performed in three patients. Two of this patients with diagnosis of parathyroid carcinoma are alive with no evidence of recurrence or metastasis, respectively, 48 and 60 months after the operation; one patient with diagnosis of atypical adenoma died for other disease 16 months after the operation. In the last patient a simple parathyroidectomy was performed. After that histology revealed the diagnosis of parathyroid carcinoma the patient underwent reoperation for left hemithyroidectomy and central compartment lymph node clearance. After 30 months a lung lobectomy was done due to metastasis. Conclusion. Parathyroid carcinoma should be considered in the differential diagnosis of PTH-dependent hypercalcemia because optional outcomes are associated with complete resection of the tumor at the time of initial operation. 1. Introduction Parathyroid carcinoma is an infrequent clinical entity accounting for 0,5% to 5% of all cases of primary hyperparathyroidism [1–4]. It represents a diagnostic and therapeutic challenge because this rare endocrine malignancy usually is not recognized preoperatively and often is not conclusively identified during the operation or at histological examination. Despite its rarity it is very important for every endocrine surgeon to be aware of the disease because the initial en bloc resection represents the only chance for cure [1–8]. The objective of this paper is to elucidate the importance of high clinical suspicion in operative management of parathyroid carcinoma, analyzing retrospectively the cases treated in our service. 2. Patients and Methods A systematic review of pathological reports of our secondary referral hospital was done. From 2003 and 2011 one hundred and forty-four patients were operated for hyperparathyroidism at our service. Histology distribution of patients is reported in Table 1. One patient with atypical adenoma and three patients with the final diagnosis of parathyroid carcinoma were included in this review. None had