Recurrent Parathyroid Carcinoma

The cervical region is by far the most common site for implants and local metastatic disease. However, parathyroid carcinoma does metastasize distantly, predominantly to the lungs, the liver, and the skeleton. Before any reoperative procedure, a careful study of previous operative notes to determine the initial location of the tumor and that of the other glands is recommended. Also, any previous archival tumor sections should be reviewed because the initial diagnosis may be incorrect. Time to recurrent disease is variable. In a series of 40 patients with metastatic disease, the median time to recurrence was 33 months (range, 1 to 228 months).16 An aggressive surgical approach to recurrent diseases is often beneficial to the patient, and even repeated surgical procedures such as wedge resections for lung metastases are indicated. Surgical excision of metastatic lesions has been the single most effective treatment in palliating hypercalcemia.16'42 For the histopathologic evaluation, it is advisable to obtain multiple sections. Whenever possible, some tumor tissue should be snap frozen in liquid nitrogen and stored at -70° C. This allows some of the molecular studies that still require fresh frozen tumor tissue. The technical considerations for reoperative HPT are outlined in another chapter.

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