[Tertiary hyperparathyroidism: parathyroid cancer with liver metastases in a hemodialyzed patient]

Parathyroid cancer is very rare in chronic renal failure. Only twelve cases have been described, but the actual incidence might be under estimated. Monoclonal proliferation have been demonstrated in hyperplasic parathyroid glands of uremic patients and the diagnosis between benign or malignant tumor may be difficult. Evidence for a deletion of the "Retinoblastoma Tumor Suppressor gene" (RB gene) is helpful for the diagnosis of parathyroid cancer, especially in the absence of dissemination. A 46-years old male patient on dialysis since 1989 for polycystic kidney disease developed a refractory and persistent hyperparathyroidism after parathyroidectomy with vascular and osteoarticular complications. Liver nodules were localised by sestaultrasonography. MIBI radionucleid scan and were confirmed by CT-scan, and ultrasonography. Diagnosis of parathyroid cancer was confirmed by the immuno-histochemical study of the biopsied liver nodules and the histopathological review of the removed parathyroid glands.