Rak przytarczycy jako przedoperacyjny dylemat diagnostyczny – opis przypadku i przegląd piśmiennictwa

ABSTRACT Introduction :  Parathyroid carcinoma is the least common endocrine-related malignancy and accounts for less than 1% of all cases of primary hyperparathyroidism. In comparison to benign parathyroid adenoma, the clinical signs (including the presence of a tumour with regional or distant nodal involvement), biochemical abnormalities and metabolic activity are usually more expressed in parathyroid carcinoma. In the presented case report, there were no typical signs and symptoms suggesting the preoperative diagnosis of parathyroid carcinoma. Case report :  The case was a 52-year-old woman with a history of recurrent renal stones, moderate hypertension, increased total and ionized calcium, low phosphorus, and increased intact parathyroid hormone. The clinical picture and imaging techniques (ultrasonography and SPECT/CT scintigraphy) suggested parathyroid adenoma. However, histological examination of the removed tumour revealed parathyroid carcinoma. Reoperation showed no regional lymph nodes involvement. After 12 months, normalisation of biochemical parameters and reduction of blood pressure from moderate grade to mild hypertension grade was achieved. Conclusions :  1. In patients with parathyroid carcinoma-associa­ted hyperparathyroidism, successful surgical treatment not only restores serum calcium, phosphorus and parathyroid hormone levels, but may also improve blood pressure control. 2. Parathyroid carcinoma may demonstrate faint metabolic activity in the SPECT/CT study, and its biochemical secretion of parathyroid hormone may be placed in ranges more characteristic for benign parathyroid pathology.