Parathyroid carcinoma is the least common malignancy among endocrine tumors. It varies in malignant potential from a minimally invasive local tumor with slow progression to an aggressive tumor with hematogenous metastasis and a rapid course, often with a fatal outcome because of unremitting hypercalcemia. The histopathologic pattern of these tumors more often shows prominent nuclear atypia, frequent mitosis, and an aberrant ploidy pattern with chromosomal rearrangements compared with benign parathyroid neoplasms. Recognition by the surgeon that the parathyroid tumor is malignant and performance of an adequate en bloc removal of the primary lesion, when appropriate, offer the best chance of local cure for a patient with this unusual malignancy.


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