Parathyroid carcinoma: A rare cause of primary hyperparathyroidism

Abstract

Aim-background

Parathyroid carcinoma is an exceedingly rare endocrine malignancy. Patients usually present with a severe form of hyperparathyroidism. Herein, we present a rare case of parathyroid carcinoma and hypercalcaemic crisis.

Case report

A 45-year-old male was admitted to our surgical department for surgical management of primary hyperparathyroidism. Upon clinical examination, a mass was palpated on the inferior left lobe of the thyroid gland. The imaging diagnostic procedures of ultrasonography, scintigraphy and MRI revealed a mass in the anatomical region of the left parathyroid. The diagnosis of hypercalcaemic crisis was established upon the presence of the triad: mass size (3.3 x 2.7 cm), PTH levels (> twice the normal value) and Ca levels (>14 mmol/L). The patient underwent an excision of the left lower parathyroid.

Results

Histopathology revealed an emarginated mass weighing 11gr, measuring 3.3 x 2.7 cm wide in cross-section, which was consistent with parathyroid cancer. The patient did not undergo complementary radiotherapy. During re-evaluation one year later, the patient was asymptomatic with PTH levels of 37 pg/ml and Ca levels 9.2 mmol/L.

Conclusion

PC is an extremely rare malignancy. Patients usually present with a severe form of hyperparathyroidism and a palpable mass >3cm. The treatment of choice is surgical while adjuvant external beam radiation therapy may be considered in only very selected cases.