title: Synchronous parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma in a patient with severe and long-standing hyperparathyroidism.
abstract: OBJECTIVE
  To describe a patient presenting with the rare constellation of synchronous parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma.
  
  
  METHODS
  We summarize the clinical presentation, diagnostic work-up, surgical management, and pathologic features of our patient and review the pertinent literature.
  
  
  RESULTS
  The patient was a 59-year-old man who presented with severe clinical manifestations of long-standing primary hyperparathyroidism, a serum calcium concentration of 14.4 mg/dL, and a parathyroid hormone level of 2,023 pg/mL. He was found to have a 3.4-cm parathyroid carcinoma on the left side and a 3.2-cm papillary carcinoma in the right thyroid lobe. In addition, a 917-mg parathyroid adenoma was found on the right side.
  
  
  CONCLUSIONS
  Synchronous parathyroid and thyroid carcinomas are extremely rare. To our knowledge, our patient is the first documented case with a parathyroid adenoma in addition to synchronous parathyroid and thyroid carcinomas. The presence of concurrent parathyroid carcinoma and parathyroid adenoma can cause diagnostic confusion and should be considered in patients presenting with severe hyperparathyroidism. Any concomitant thyroid nodules must be investigated to rule out thyroid carcinoma.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Goldfarb
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Neal
authors.forename: Judy L
authors.initials: JL
authors.lastname: Shih
authors.forename: Pamela
authors.initials: P
authors.lastname: Hartzband
authors.forename: James
authors.initials: J
authors.lastname: Connolly
authors.forename: Per-Olof
authors.initials: PO
authors.lastname: Hasselgren
mesh_terms: D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology