Parathyroid Carcinoma

Kerstin Sandelin, MD, PhD

Malignant transformation of a parathyroid gland is a truly rare phenomenon, and in most reported series of patients with primary hyperparathyroidism (PHPT) the incidence of carcinoma is less than 1%. The inability to distinguish between some benign and malignant neoplasms still remains an important problem. Furthermore, the clinical course of malignant parathyroid tumors is quite variable. It is not uncommon to ascertain the diagnosis only after the tumor recurs locally or distant metastases develop. There are a few collective reviews and series from major cancer and endocrine surgical centers in which both clinicians and pathologists have presented data.1"5 Still, our knowledge about this unusual tumor has not increased much, and the treatment modalities are limited. Surgical excision remains the only potential method of curing this tumor, providing it is locally resectable. With the introduction of bisphosphonates, symptomatic, nontoxic, short-term palliation became available. In this chapter, the characteristic features of parathyroid carcinoma are emphasized, including its mode of presentation, clinical course, histopathologic findings, and biologic characteristics. Treatment options are discussed.

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