Regular Article
Parathyroid carcinoma: diagnosis and management

https://doi.org/10.1053/ejso.2001.1043Get rights and content

Abstract

Parathyroid carcinoma is a rare and difficult diagnosis to make based on the histological features alone. We review five cases of parathyroid carcinoma in the past 30 years and the clinical and biochemical features that facilitate the making of the diagnosis. A favourable outcome can be expected with adequate surgical treatment.

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    These lesions have a clinical presentation similar to typical parathyroid adenomas but may have lower uptake on sestamibi scans, because of internal fat tissue.28,29 Parathyroid carcinoma comprises a small subset of solid parathyroid lesions, appearing in approximately 0.5% to 3% of all patients with primary hyperparathyroidism.30–33 Clinically, parathyroid carcinomas present with higher serum PTH and calcium levels than do parathyroid adenomas.30,32

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    Therefore, a lobulated, white, fibrotic mass is suspicious for carcinoma.2 Pathological diagnosis of parathyroid carcinoma may be difficult.3 Although the presence of capsular or vascular invasion and local or distant metastases are confirmatory, in the absence of these characteristics, a combination of clinical and biochemical features, gross appearance, the degree of pleomorphism, and the frequency of mitoses may help make the diagnosis.

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Correspondence to: Prof. Niall O»Higgins, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Tel: 353 1 269 4533; Fax: 353 1 269 6018; E-mail: [email protected]

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