ABSTRACT
Parathyroid carcinoma (PAC) is a rare cause of primary hyperparathyroidism which presents with clinical manifestations of severe hypercalcaemia. PAC occurs equally in males and females, unlike parathyroid adenomas, which have a female preponderance. PAC has been reported in patients with secondary and tertiary hyperparathyroidism. To treat PAC effectively, the clinician should have a high index of suspicion prior to initial surgery so that an appropriate operative approach may be undertaken. This requires an awareness of the differences in presentation between primary hyperparathyroidism due to benign disease and cancer. Surgical resection is the main therapeutic modality for PAC, even in the presence of metastatic disease. A. Schantz and B. Castleman developed a set of criteria for the histopathologic diagnosis of PAC in 1973. These included the presence of a fibrous capsule or fibrous trabeculae, rosette-like cellular architecture, presence of mitotic figures, and capsular or vascular invasion. Medical control of hypercalcaemia is important pre-operatively and also in cases of inoperable PAC.
