Case series of diagnosis and surgery challenges in parathyroid carcinoma

Parathyroid Carcinoma and Recurrent Hyperparathyroidm: Challenges and Management Options

“…Imaging studies were crucial before surgical intervention .in our series neck US was fundamental in preoperative localization. Five of six patient with PC were diagnosed by neck US, which matches with other series [13,15,16] . All cases of recurrent HPT due to PC did sestamibi scan which were positive in all cases suggesting parathyroid tumor.…”

“…Fine needle aspiration cytology (FNAC) not done in our cases of parathyroid tumors as the sensitivity of FNAC in diagnosis of PC is very low and with possibility of seedling of cells with subsequent parathyromatosis and recurrence. Most of reports not recommended FNAC [13,15,16] .…”

“…While Diani K et al used frozen section in all neck procedures. And Intraoperative frozen section diagnosed two cases of six cases of PC [16] .…”

“…Diani K et al concluded that recurrences developed 3 years after the primary surgery, and the recurrence mainly occurred in the neck regional operative field, and the main presentation of recurrent case is recurrent hypercalcemia and recurrent HPT [16] . While in our study the recurrence of manifestation occurred from 7 months to 26 months from the initial surgery, in most of cases (5 cases) the reoperation weren't curative as after the 2 nd surgery the patients developed manifestation of hypercalcemia HPT mostly due to distant metastases , most of studies [18,19] concluded no statistical significant difference between radical en bloc resection and local excision of parathyroid tumor especially that there is no evidence confirmed malignancy before the initial surgery , while other reports suggested radical resection from the start when there is any suspicion of malignancy as severe hypercalcemia or 10 time above the normal serum parathormone to obtain adequate control and decrease the incidence of recurrence [20][21] Radiotherapy is indicated only in one case of our study as the tumor was very aggressive with gross infiltration of sternomastoid muscle and surrounding thyroid tissue and vessels but chemotherapy was not indicted in this study because PC is considered chemoresistant.…”