Endocrine Abstracts

JOINT2038

Introduction: Parathyroid carcinoma is a rare endocrine malignant tumor accounting for less than 1% of all cases of primary hyperpara¬thyroidism. Preoperative diagnosis and management stills a real challenge. Here we report an unusual case of parathyroid carcinoma developing on secondary hyperparathyroidism and we identify diagnostic and management challenges of parathyroid carci-noma.

Observation: A 53-year-old man, with a chronic renal insufficiency on hemodialysis, operated 10 years ago of subtotal parathyroidectomy for secondary hy¬perparathyroidism with favorable outcome, was hospital¬ized for bone pain with hypocalcaemia and elevated serum Para Thyroid Hormone (PTH). Explorations showed hyper¬plasia of lower right parathyroid gland. Surgical exploration revealed polylobulated mass of 4 cm adherent firmly to the oesophagus and to recurrent nerve. Lower right para¬thyroidectomy was so performed. Histological examination concluded to parathyroid carcinoma. Patient normalized calcium and PTH levels. No recurrence was observed after 48 months of follow up.

Conclusion: Para¬thyroid carcinoma described in patients with secondary and ter¬tiary hyperparathyroidism caused by chronic renal failure, such as the case of our patient are rare. Parathyroid carcinoma is a rare malignant tumor which still presents challenges in diagnosis and treatment. Surgery with en-block resection of the tumor and involved surrounding structures is the principal modality of treatment. The prognosis is variable due to frequent recurrences.