Localization and surgical resection of metastatic parathyroid carcinoma

Abstract

Abstract Six cases of recurrent parathyroid carcinoma were reviewed. Four patients presented with local recurrence, which followed a simple tumor resection more frequently than an en bloc initial operation. The fact that the mode of recurrence varied made preoperative localization difficult. In 3 earlier patients (1978–1980), careful palpation of the neck and venous sampling for parathyroid hormone concentrations were the means of localization. In 4 recent patients (1980–1985), including 1 of the former 3, thallium‐201 scan was the most useful method for detecting the local recurrence and the regional lymph node metastases, but the method failed to localize the lung metastases. Chest x‐rays and computed tomographic (CT) scan were useful in delineating metastatic pulmonary lesions. Wide excision of the local recurrent tumor, once or twice, was curative in 3 of the 4 patients. En bloc radical dissection of the neck and mediastinum in 1 patient resulted in normocalcemia for the past 2 years. Thoracotomies carried out in 2 patients with multiple pulmonary metastases were palliative in 1 case for 5 years and curative at least at the present time (3 months after the operation) in the other case. Thus, the results in our series justify aggressive surgical treatment for the recurrence of parathyroid carcinoma .