2002, Number 4
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ABSTRACTIntroduction: Carcinoma of the parathyroid gland is extremely rare; it represents 0.5_3% of cases of primary hyperparathyroidism. It is functionally active and early clinical behavior is similar to that of parathyroid benign neoplasias. Diagnosis and treatment represent a true challenge for the surgeon. Case presentation: A 28 year-old woman with history of tumor in right malar region and bone pain in extremities since 1995 was treated with tumor resection on two occasions, both surgical specimens with histopathologic features of reparative granuloma of giant cells. We detected multiple bone disease, hypercalcemia and high levels of alkaline fosfatasa. MIBI radionuclide scanning showed functioning tumor located in right thyroid lobe. We performed surgical exploration of neck in August 1998 with operative features of tumor of right superior parathyroid gland; we resected the gland, frozen section indicating parathyroid adenoma. Serum calcium decreased to second day after surgery. Complete histopathologic study of surgical specimen revealed parathyroid carcinoma. Abnormal uptake in neck on radionuclide scanning and elevation of calcium and parathyroid hormone levels led to new surgical explorations with total resection of thyroid and parathyroid glands and cervical lymphatic tissue; however, we have not documented malignant activity in the histologic study of surgical specimens.
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