Parathyroid carcinoma: update and guidelines for management.

Area of Science:

• Endocrinology
• Oncology
• Surgical Oncology

Background:

• Parathyroid carcinoma is an exceptionally rare endocrine malignancy, accounting for about 1% of primary hyperparathyroidism cases.
• The majority of parathyroid cancers (90%) are hormonally active, leading to significant hypercalcemia and associated symptoms.
• Preoperative diagnosis can be challenging due to overlapping clinical features with benign parathyroid conditions.

Purpose of the Study:

• To review the diagnosis, treatment, and management of parathyroid carcinoma.
• To highlight the challenges in preoperative diagnosis and the efficacy of various treatment modalities.
• To emphasize the importance of surgical resection and the management of recurrent disease.

Main Methods:

• Literature review focusing on diagnosis, surgical management, and adjuvant therapies for parathyroid carcinoma.
• Analysis of clinical presentation, diagnostic workup, and treatment outcomes.
• Evaluation of the role of imaging, fine-needle aspiration, and surgical techniques.

Main Results:

• Complete surgical resection with clear margins is the cornerstone of curative treatment for parathyroid carcinoma.
• Recurrence rates exceed 50%, with reoperation being the primary management for palliation and metabolic control.
• Chemotherapy and radiation therapy have shown limited efficacy, and palliative options like calcimimetics may help manage hypercalcemia.

Conclusions:

• Parathyroid carcinoma requires a multidisciplinary approach, prioritizing surgical expertise for optimal outcomes.
• Effective management hinges on achieving complete resection and addressing the high likelihood of recurrence.
• Hypercalcemia remains the primary cause of mortality, underscoring the need for vigilant metabolic monitoring and management.