Huge parathyroid carcinoma: clinical considerations and literature review.
BACKGROUND
Parathyroid carcinoma is a rare malignancy, with an incidence of 0.5 to 4% of all cases of primary hyperparathyroidism. Surgery is the only curative treatment.


METHODS
We report the case of a 66-year-old man referred for a large suspicious substernal goitre associated with severe hypercalcemia due to hyperparathyroidism. After normalization of serum calcium levels, patient underwent surgery. The voluminous cervicomediastinal firm mass could not be removed through the cervical incision; therefore a cervicothoracic approach was employed. Histopathology revealed a giant parathyroid cancer of 450 grams. A review of the literature was also undertaken to summarize the current treatment approaches for this rare malignancy.


CONCLUSIONS
Parathyroid cancer is usually not recognized either preoperatively or intra-operatively. En bloc resection of the tumour with the adjacent tissue is the treatment of choice and it is very important to avoid the rupture of the capsule during operation. Neither tumour size, nor the lymph node status appears to play a role in prognosis. The management of parathyroid carcinoma is a challenge even for experienced surgeons.
Chiofalo
Maria Grazia
MG
Department of Surgical Oncology, National Cancer Institute of Naples, Naples, Italy. mgchiofalo@libero.it
Scognamiglio
Francesco
F
Losito
Simona
S
Lastoria
Secondo
S
Marone
Ugo
U
Pezzullo
Luciano
L