Neslihan Soysal Atile1, Betül Ekiz Bilir1, Sibel Güldiken1, Atakan Sezer2, Neşe Torun3, Arzu Çalık4, Betül Uğur Altun1, Armağan Tuğrul1

Keywords: parathyroid carcinoma, metastasis


Parathyroid carcinoma (PC) is an uncommon malignancy and rare cause of primary hyperparathyroidism. Hypercalcemia caused by PC frequently leads to metabolic bone disease and renal complications with a high morbidity. Local cervical invasion, spread to cervical lymph nodes and lung and bone metastasis are frequently seen.
Case: A 56-year-old female was admitted with the complaint of bone pain on the right side of the pelvis. On clinical examination, a nontender mass was palpated on the left side of the neck. Pelvis X-ray revealed a suspected fracture line on the right side. The laboratory investigations revealed as Ca:15,5 mg/dl, P: 2,1 mg/dl and intact PTH: 880,2 pg/ml. Neck ultrasound and Tc-99m MIBI scan revealed parathyroid adenoma. MRI and MIBI detected multiple bone lesions suspected as metastases. PET/CT was performed to clarify the presence of metastasis. Parathyroidectomy was performed. Pathological examination showed parathyroid carcinoma. Hungry bone syndrome after the surgical procedure was developed and Ca replacement was given. Radiotherapy (RT) was applied for bone metastases.
PC is a rare but aggressive malignant disease with high recurrence rates and mortality. Surgery is the main treatment for PC. If there is a preoperative suspicion for PC, more aggressive excision should be preferred which may cause a higher cure rate. High serum Ca, PTH levels and palpable neck mass should alert the clinician for malignancy. Hypocalcemia crisis (hungry bone syndrome) is frequently expected after the surgery so patient should be monitorized for serum Ca levels. RT is the second line treatment in the case of recurrent disease or metastasis.