Endocrine Abstracts

Background: In most cases of parathyroid carcinoma (PC) only recurrence could be a credible feature of malignancy.

Clinical case: At the age of 19 years a woman was diagnosed with urolithiasis. At the age of 22 years she had a surgical resection of the neck nodule at the right site in the projection of carotid triangle. After the histological study, ectopic parathyroid tumor was misdiagnosis with paraganglioma (material is available for review). At the age of 37 years the patient noted deteriorating state of health: severe weakness, nausea, vomiting (10 times per day), rapid loss of body weight (10 kg in 6 months). She noted the appearance of nodule in the neck to the right in the projection carotid triangle again. A month later she was diagnosed with a primary hyperparathyroidism: total calcium – 3.0 mmol/l (2.19–2.55), PTH-786 pg/ml (15–65). CT-scan showed two tumors sized up to 3.3*1.7 cm; 3.2*1.3 cm between right m. sternocleidomastoideus and the common carotid artery. The next day the hypercalcemic crisis developed (total calcium – 5.33 mmol/l) and therefore, ectopic parathyroid tumors were urgently resected in our center. PC was diagnosed after a histological examination. At the age of 47 years the local recurrence was diagnosed: total calcium – 3.51 mmol/l, PTH-450 pg/ml. PET/CT showed a focus with the pathological accumulation of 18FDG in singles upper jugular lymph node on the right at the level of C3-4, 16,7*19,7 cm. After another surgery, the tumor went through the immunocytochemical analysis which showed a diffuse intensive expression of PTH, Ki-67- 15%.

Conclusions: The diagnosis of PC is challenging due to the lack of credible diagnostic criteria. The treatment of choice in PC is an en bloc resection of the mass with total ipsilateral thyroid loboistmectomy and central compartment lymphadenectomy and timely detection and resection of mts.