Parathyroid carcinoma: from diagnostic challenges to surgical management and long-term outcomes: A single-center...

Parathyroid carcinoma (PC) is a rare malignant tumor, accounting for <1% of all cases of primary hyperparathyroidism. It is typically characterized by markedly elevated parathyroid hormone (PTH) levels, severe hypercalcemia, and target organ damage. This study presents a single-center experience in the management of patients with PC and provides a review of the relevant literature. The clinical and laboratory data of 8 patients diagnosed with PC based on pathological examination between September 2008 and February 2024 at the Endocrinology Clinic of Akdeniz University Hospital (Antalya, Turkey) were retrospectively reviewed. Eight patients (3 males) were identified, with a median age of 49 years at diagnosis (range: 46-71 years) and a median follow-up period of 93 months. All patients presented with hypercalcemia, with a median serum calcium level of 13.39 mg/dL (range: 11.2-19) and a median PTH level of 690 ng/L (range: 105-1625). Organ involvement related to hyperparathyroidism was common, most frequently affecting the kidneys (n = 3) and bones (n = 3). All patients underwent en bloc surgical resection, and 2 received adjuvant radiotherapy. Disease recurrence occurred in 3 patients (37.5%) after a median of 24 months following surgery. The cohort size was insufficient to reliably evaluate predictors of recurrence. The 5-year overall survival and disease-specific survival rates were both 87.5%. PC is characterized by a high recurrence rate and limited treatment options beyond complete surgical excision. The diagnosis should be considered in patients presenting with markedly elevated PTH and calcium levels accompanied by a neck mass. En bloc resection remains the mainstay of treatment. The role of adjuvant radiotherapy remains uncertain and warrants further investigation in larger cohorts.