Different pathological findings in each of four parathyroid glands in a long-standing hemodialysis patient

A 51-year-old male patient with chronic renal failure, who had required dia lysis for 22 years, presented with a cervical mass. Laboratory data were co nsistent with secondary hyperparathyroidism due to chronic renal failure. C ervical exploration was performed with excision of four parathyroid glands and autotransplantation of the normal gland into the forearm. The cervical tumor of the right inferior gland demonstrated parathyroid carcinoma histol ogically. Adenoma of the right superior gland and hyperplasia of the left s uperior gland were also recognized. The left inferior gland was normal. A f ew cases of parathyroid carcinoma inpatients on maintenance hemodialysis ha ve been previously reported. However, this is the first report in which all four parathyroid glands revealed different pathological findings: carcinom a, adenoma, hyperplasia and normal gland. Chronic stimulation of the parath yroid glands to release parathyroid hormone might have caused the variety o f findings in the four parathyroid glands.