Parathyroid carcinoma: diagnosis and treatment

This paper describes the diagnostic search, treatment, and follow-up of a patient with parathyroid carcinoma. The authors analyzed the clinical signs and results of the investigations. Despite the long-term clinical presentation of urolithiasis, parathyroid hyperfunction was not suspected. Hyperparathyroidism was detected only when damage to the musculoskeletal system became clinical. The differential diagnoses included parathyroid carcinoma, iliac osteosarcoma, and anterior mediastinal tumor. The main difficulty in the verification of the diagnosis in this case was the atypical localization of the affected parathyroid gland. Conventional imaging is not effective in detecting this location of parathyroid carcinoma. Parathyroidectomy allowed for the final diagnosis of parathyroid carcinoma. Follow-up of the case after surgery revealed improvement, including less pain, improvement in parathyroid hormone and calcium levels, restoration of the iliac cortex, and reossification of the brown tumor. In general, this patient exhibited signs suggestive of parathyroid carcinoma, including very high parathyroid hormone and calcium levels, simultaneous renal and bone involvement, and a large mediastinal mass together with high corrected calcium levels. However, because the disease is rare and the tumor had an atypical localization, the diagnostic search for the tumor was long. The authors highlight the importance of early detection and a multidisciplinary approach for improving the prognosis of patients with this rare condition.