Parathyroid Carcinoma and Recurrent Hyperparathyroidm: Challenges and Management Options

Abstract

Introduction: Parathyroid carcinoma is very rare, but it is resembling important cause of recurrent hyperparathyroidism. Till now no clear guidelines for treatment of parathyroid carcinoma and its associated conditions including hyperparathyroidism. The aim of the study to evaluate the incidence and management modalities of such challenging cases. Material and Methods: Retrospective study for 129 patients diagnosed as primary hyperparathyroidism From march 2012 to June 2020,. Recurrent hyperparathyroidism developed in 7 cases 6 patients of them due to parathyroid carcinoma .medical records and patients characteristics and pathological evaluation and treatment modalities were reviewed. Results: Parathyroid carcinoma diagnosed in 6 patients (4.6%):, 4 males and 2 females with a mean age of years (61.5) range 54-72 years. The mean serum calcium at the initial diagnosis of parathyroid carcinoma cases was 12.73 mg/ dL (10.8.-14.2 mg/dL). Elevated serum parathormone were noted in all patients preoperatively, with a mean of 1691.5 pg/ mL (630 -3366 pg/ mL). parathyroidectomy done in 5 patients and en block resection in one case in the initial operation, all cases developed recurrence of manifestation from (7 month-26 months) , reoperation needed for all cases and one case needed radiotherapy. Conclusion: Parathyroid carcinoma is very challenging disease with high rate of recurrence, multidisciplinary approach including surgery, medical treatment for hypercalcemia is needed to improve patients outcome .