Parathyroid carcinoma: problems in diagnosis and the need for radical surgery even in recurrent disease

Introduction: From 1986 to 1999 we operated on 963 patients with primary hy perparathyroidism (pHPT). Methods and Results: Parathyroid carcinoma was diagnosed clinically and his tologically in four patients (0.4%). In two of these patients diagnosis of parathyroid cancer was delayed by misinterpretation of the histopathology l eading to an autotransplantation of malignant parathyroid tissue in one cas e, In two patients multivisceral surgery was performed: beside thyroidectom y, neck dissection, tracheal wall resection and resection of the muscular l ayer of the oesophagus one patient received oesophagectomy and gastric tran sposition and one patient a lung wedge resection. Both patients had a tempo rary palliation of tumour-associated symptoms after multivisceral surgery. The first patient died 2 years after oesophagectomy and 12 years after prim ary diagnosis from local tumour recurrence and cachexia. The second patient is living with tumour recurrence presenting a serum calcium level of 4.2 m mol/l (normal range 2.0 to 2.5 mol/l) and multiple brown tumours 2 years af ter lung resection and 6 years after the primary diagnosis. Conclusions: We conclude that parathyroid carcinomas, being difficult to diagnose, warrant radical surgery, including multivisceral resection to prolong survival and reduce tumour and hypercalcaemia associated symptoms. (C) 2001 Harcourt Pu blishers Ltd.