Parathyroid carcinoma accounts for 0.5 to 5% of all cases of hyperparathyroidism.
We reviewed the clinical, surgical, and pathologic features observed in all patients
with parathyroid carcinoma evaluated at the Mayo Clinic from 1920 through 1991. Forty-three
patients (22 women, 21 men; mean age, 54 yrs, range 29-72) were identified, including
2 with familial hyperparathyroidism. Information on initial presentation was available
in 40 patients: 15 (38%) presented with polydipsia or polyuria, 11 (27%) with myalgias
or arthralgias, 7 (17%) with weight loss, and 4 (10%) with nephrolithiasis; 3 patients
(7%) were asymptomatic at presentation. Of 31 patients in whom the initial neck examination
was recorded, 14 (45%) had a palpable neck mass. The mean serum calcium and serum
phosphorus levels were 14.6 mg/dl and 2.3 mg/dl, respectively. Parathyroid hormone
levels were elevated in 21 of 21 patients (mean elevation, 10.2 times upper limit
of normal). Complications included nephrolithiasis in 14 of 25 patients (56%), bone
disease in 20 of 22 patients (91%) and both in 8 of 15 patients (53%). All patients
underwent primary surgical resection of parathyroid carcinoma. Twenty-six of 43 patients
(60%) required a second operation with 18 patients requiring multiple re-explorations.
At the second operation, residual tumor was found in the neck (68%), mediastinum (16%),
or both (12%). Six patients received radiation therapy to the neck (5 patients) or
bones (1 patient) for recurrent or metastatic disease. Of these, 1 patient appeared
cured of parathyroid carcinoma by radiation therapy 11 years after documented tumor
invasion of his trachea. Repeated excision of tumor recurrences was an effective means
of controlling hypercalcemia in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)