Endocrine Abstracts

Introduction: Parathyroid carcinoma is a very rare tumor. The reported incidence is between 0.5 to 5% of primary hyper parathyroidy in various series. This entity does not present any clinical or biological specificity compared to the parathyroid adenoma which exposes to diagnostic difficulties.

Objective: The aim of our presentation is to study the clinical, therapeutic and evolutionary aspects of parathyroid carcinomas.

Material and methods: This is a retrospective study of 3 cases of parathyroid carcinomas treated in our department over a period of 22 years (2000-2021).

Results: There are two women and one man, with a history of recurrent renal lithiasis in one case and a parathyroidectomy 10 years ago for parathyroid adenoma in one case. The average age was 54 years old. The average consultation time was 6 months. The reason for consultation was diffuse bone pain in two cases and a compressive anterior cervical swelling in one case. Calcium and parathormone levels were elevated in all our patients. Cervical ultrasound done in all cases and cervico-thoracic scan done in one case, did not suggest malignancy in all cases. The scintigraphy showed a fixation at the lower left parathyroid gland in two cases and lower right gland in one case. The treatment consisted of Para-thyroidectomy in all cases, associated with ipsilateral central dissection in two cases and ipsilateral lobo-isthmectomy in one case. Frozen section examination evoked malignancy in two cases. Definitive histology examination confirmed the diagnosis of parathyroid carcinoma with capsular rupture and vascular emboles in two cases. The lower left parathyroid gland was the most affected. The average tumor size was 4 cm (range 2 cm to 7 cm). The evolution was good in all cases with a mean follow-up of 4 years.

Conclusion: Diagnosis of parathyroid carcinoma can be difficult and the management still remains a challenge.