World Journal of Surgery

, Volume 35, Issue 1, pp 147–153 | Cite as

Parathyroid Carcinoma Encountered After Minimally Invasive Focused Parathyroidectomy may not Require Further Radical Surgery

  • Christine J. O’Neill
  • Conan Chan
  • James Symons
  • Diana L. Learoyd
  • Stan B. Sidhu
  • Leigh W. Delbridge
  • Anthony Gill
  • Mark S. Sywak



Parathyroid carcinoma accounts for <1% of tumors in primary hyperparathyroidism (PHPT). Distinguishing parathyroid malignancy from benign disease is difficult both before and after initial surgery. Despite the improved specificity of a malignant diagnosis with immunohistochemistry for parafibromin and PGP9.5, proven metastatic behavior remains the gold standard of diagnosis. Minimally invasive focused parathyroidectomy (MIP) is widely performed in patients with PHPT and positive localization studies; thus, it is inevitable that some parathyroid caricnomas will be encountered at MIP. We present our experience of this rare entity.


The present study represents a surgical case series of patients with parathyroid carcinoma encountered after MIP. The clinicopathological features of benign and malignant parathyroid tumors were compared. Multiple regression analysis was undertaken to compare indicators of malignancy.


Between May 1999 and April 2010, a total of 1,292 patients underwent MIP at the University of Sydney Endocrine Surgical Unit, and a histopathological diagnosis of parathyroid carcinoma was made in seven patients (0.5%). Staining for parafibromin and/or PGP9.5 was abnormal in five carcinomas (71%). Despite subsequent unilateral thyroid lobectomy and lymphadenectomy in six patients, no further malignancy was identified in any specimens. Compared to controls, preoperative calcium (p = 0.04) and parathyroid hormone (p = 0.01) were significantly higher in patients with malignancy. The positive predictive value of these parameters for carcinoma was 56 and 75%, respectively.


In patients diagnosed with parathyroid carcinoma after MIP where preoperative imaging had already demonstrated localized disease, revision en bloc surgery did not reveal any residual disease. The benefits of further radical surgery for parathyroid carcinoma after MIP remain controversial.


Primary Hyperparathyroidism Cinacalcet Parathyroid Carcinoma Central Neck Dissection Bilateral Neck Exploration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr. C. J. O’Neill is supported by a grant from the New South Wales Cancer Institute. Stan B. Sidhu is a New South Wales Cancer Institute Fellow. An earlier form of this article was presented as a poster presentation at the Society of Surgical Oncology, St. Louis, MO, March 2010.


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Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Christine J. O’Neill
    • 1
  • Conan Chan
    • 1
  • James Symons
    • 1
  • Diana L. Learoyd
    • 2
  • Stan B. Sidhu
    • 1
  • Leigh W. Delbridge
    • 1
  • Anthony Gill
    • 3
    • 4
  • Mark S. Sywak
    • 1
  1. 1.University of Sydney Endocrine Surgical UnitSt. LeonardsAustralia
  2. 2.Department of EndocrinologyRoyal North Shore HospitalSt. LeonardsAustralia
  3. 3.Department of Anatomical PathologyRoyal North Shore HospitalSt. LeonardsAustralia
  4. 4.University of SydneySydneyAustralia

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