title: Is parathyroid carcinoma indeed a lethal disease?
abstract: BACKGROUND
  Parathyroid carcinoma is a rare malignancy with a wide range of aggressiveness. There is no current staging system. Our primary aim was to review the presentation, diagnosis, surgical treatment, and outcomes of patients, with the goal of assessing the incidence of death related to parathyroid carcinoma.
  
  
  METHODS
  The authors present a retrospective chart review on patients with parathyroid carcinoma from 1975 to 2004, identified by the tumor registry of a single tertiary-care center. Diagnoses were confirmed histologically, clinical and radiographical data were recorded, and statistical analyses were performed.
  
  
  RESULTS
  Twenty-three cases were identified. The mean patient age was 54 years. The female:male ratio was 1.5:1. Follow-up ranged from 1 month to 23 years (median, 134 months). Mean preoperative calcium was 12.9 mg/dL. Median parathyroid hormone was 290 pg/mL. Two patients (9%) had an asymptomatic presentation, and five (22%) presented with a palpable neck mass. Only nine (39%) underwent initial comprehensive en-bloc resection. Median survival was 22 years. Five- and 10-year survival was 85.9% and 69.4%, respectively. Five- and 10-year survival with en-bloc resection was 90% and 67.5%, respectively. Local resection resulted in survival rates of 82.5% and 70.7%. Three of ten deaths were attributed to parathyroid carcinoma. In recurrent disease, computed tomography and scintigraphy had localization rates of 53% and 67%, respectively, with a concordance of 22%.
  
  
  CONCLUSIONS
  Long-term survival is possible with parathyroid carcinoma. Death associated with parathyroid carcinoma was uncommon. A staging may be warranted despite the rarity of this disease.
authors.affiliation: Department of General Surgery, Wake Forest University, Winston-Salem, North Carolina 27157, USA.
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Kleinpeter
authors.forename: James F
authors.initials: JF
authors.lastname: Lovato
authors.forename: Paige B
authors.initials: PB
authors.lastname: Clark
authors.forename: Tom
authors.initials: T
authors.lastname: Wooldridge
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Norman
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D002277:Carcinoma / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium