title: Parathyroid carcinoma presenting as normocalcemic hyperparathyroidism.
abstract: Parathyroid carcinoma (PC) is a rare malignancy, with an indolent but progressive course. Long-term survival is largely dependent on the extent of the primary surgical resection. Hence, pre- or intraoperative suspicion of malignancy is of great importance. We describe the case of a 62-year-old woman with a 2-year history of asthenia and mental depression. Her past medical history was significant for osteoporosis. A diagnosis of primary normocalcemic hyperparathyroidism was established and the patient underwent surgery. PC was suspected intraoperatively because of the size and appearance of the parathyroid mass (a grayish, lobulated 3.5 cm mass). Thus, aggressive surgery (en bloc resection) was performed, along with bilateral neck exploration. Pathological examination of the specimens confirmed the suspicion of PC, demonstrating vascular invasion and extracapsular infiltration into adjacent soft tissue. Immunohistochemical staining revealed an elevated Ki-67 score (8.43%; cut-off value 5%). The mean area of silver-stained nucleolar organizer regions (AgNOR) was high (4.972 μm(2)), indicating an elevated proliferation rate. Serum calcium and parathyroid hormone levels normalized postoperatively, and the patient's 5-year outcome was good. The present case provides evidence that parathyroid malignancy cannot be excluded a priori based on normocalcemic hyperparathyroidism, emphasizing the variability in clinical presentation. Moreover, Ki-67 expression and AgNOR analysis confirmed their additional value in complementing the histological evaluation of a parathyroid malignant mass.
authors.affiliation: Unità di Medicina Nucleare, Dipartimento di Scienze Radiologiche, Padiglione E, piano terra, Policlinico Universitario G. Martino, University of Messina, v. Consolare Valeria, 98125, Messina, Italy. acampenni@unime.it
authors.forename: Alfredo
authors.initials: A
authors.lastname: Campennì
authors.forename: Rosaria M
authors.initials: RM
authors.lastname: Ruggeri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sindoni
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giovinazzo
authors.forename: Enrico
authors.initials: E
authors.lastname: Calbo
authors.forename: Antonio
authors.initials: A
authors.lastname: Ieni
authors.forename: Letterio
authors.initials: L
authors.lastname: Calbo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tuccari
authors.forename: Sergio
authors.initials: S
authors.lastname: Baldari
authors.forename: Salvatore
authors.initials: S
authors.lastname: Benvenga
mesh_terms: D002118:Calcium / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D007150:Immunohistochemistry; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011877:Radionuclide Imaging; D014463:Ultrasonography
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium