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Learning From Three Cases of Parathyroid Carcinoma

By: Celeste L. Dixon
Posted: Friday, August 23, 2019

Despite the rarity of parathyroid carcinoma—with fewer than 1,000 cases described in the literature—Italian researchers including encountered three cases in 5 years at their institution, University Medical School of Bari, Italy. To illustrate the varied features of parathyroid carcinoma, Lucia Ilaria Sgaramella, MD, and colleagues described their patients’ clinical presentations in BMC Endocrine Disorders. They also reviewed findings on laboratory tests and imaging as well as the need for lifelong follow-up monitoring for patients with this tumor.

After analysis, they concluded that parathyroid carcinoma should be suspected in patients with primary hyperparathyroidism when severe hypercalcemia exists along with a large cervical mass, renal disease, and skeletal disease. The optimal treatment is complete surgical resection as soon as possible, Dr. Sgaramella and colleagues concluded.

The three cases were discovered among 358 patients with parathyroid diseases. The first was in a 62-year-old man hospitalized for left-sided palpable neck mass, hypercalcemia, and elevated parathyroid hormone. “Genetic studies framed a pathologically confirmed parathyroid carcinoma within MEN1 syndrome,” wrote the authors. “The patient’s brother was [also] diagnosed with parathyroid carcinoma, and a germline mutation (c.1252 G > A) was found in the MEN1 gene of the patient and of two relatives.”

In the second case, a 48-year-old woman with hypothyroidism had a total thyroidectomy performed for a right follicular thyroid lesion. Pathology revealed parathyroid carcinoma, and she remained disease-free at 30 months after discharge from the hospital.

The third case involved a 47-year-old man with primary hyperparathyroidism, admitted for hypercalcemic crisis and renal failure. He was diagnosed with parathyroid carcinoma and underwent a complete hemithyroidectomy and central neck dissection.

Disclosure: The study authors reported no conflicts of interest.

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