[Parathyroid carcinoma: diagnosis and treatment]

Pre operative and per-operative suspicion, and recognition of parathyroid carcinoma are essential in the effective approach and the prognosis of this type of tumor. On the basis of our experience over 20 years, helped by the literature we review our 179 cases of primary hyperparathyroidism out of which 5 were malignant tumors and the 174 others were benign (adenomas and hyperplasias). We conclude that patients with primary hyperparathyroidism, reflected by high levels of serum calcium (75%) and elevated levels of parathormone (100%) are suspect of carrying a parathyroid malignancy particularly when these levels are profoundly abnormal. Furthermore, a severe clinical presentation featuring, palpable cervical mass, renal symptoms in 30% to 60% of all, bone disease in 90%, is suspect of malignancy. The operative findings such as important size of tumour, local seeding, local invasion are also significant features of malignancy. All this data gathered by comparing carcinomas to adenomas suggest and confirm what many reviews on the subject have reported, early recognition of the parathyroid carcinoma is of primal importance, because aggressive initial surgical management should be applied, as total extirpation of the malignancy is the only treatment allowing maximal survival rates.