Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases.

Background and Objectives: Parathyroid carcinoma (PC) is a rare disease; experience with its management is limited. The aim of this retrospective study was to evaluate a relatively large series of patients suffering from PC. Methods: Since 1980, PC was diagnosed in the 4.7% of cases of primary hyperparathyroidism (HPT) (19 patients). Clinical and biochemical features, and surgical outcome were analyzed. Results: In patients with PC, the mean serum calcium was 3.34 mmol/L; the tumor size 30.5 mm. Malignancy was never diagnosed preoperatively. Thirty-two operations were performed; six patients underwent repeated surgery. Recurrence of HPT was observed in 100% of patients. The median disease-free interval was 15 months (range 2-74 months). Fifteen patients died because of the disease; median survival was 29 months (range 20-146 months). A significant correlation was found between late recurrences and prolonged survival; less advanced age and higher preoperative calcium levels predicted early recurrences. Conclusions: Preoperative diagnosis of PC is difficult. Preoperative severe hypercalcemia should alert the surgeon. En bloc resection of the PC and the adjacent structures is the treatment of choice. Unfortunately, recurrences are common and long-term survival rate is low.