Parathyroid Carcinoma Manifesting as Recurrent Nephrolithiasis

Abstract

Objective: To present a rare case of primary parathyroid carcinoma and discuss its clinical findings and management.
 Methods:
 Study Design: Case Report
 Setting: Tertiary Government Hospital
 Patient: One
 Results: A 54-year-old woman presented with a 3-year history of recurrent nephrolithiasis despite several courses of shock wave lithotripsy. She had persistent hypercalcemia and parathyroid hormone levels were noted to be elevated. Neck ultrasound showed a hypoechoic solid nodule measuring approximately 1.7 x 1.6 cm in the lateral inferoposterior aspect of the left thyroid lobe. Parathyroid scintigraphy revealed a focal uptake on the left lower thyroidal bed. The patient underwent left inferior parathyroidectomy with subtotal thyroidectomy and isthmusectomy Frozen section reported a parathyroid tumor and the final histopathologic results revealed a parathyroid carcinoma.
 Conclusion: A rare case of parathyroid carcinoma was presented, manifesting with recurrent nephrolithiasis. Elevated serum calcium and intact parathyroid hormone (iPTH) can confirm a primary hyperparathyroid problem. Neck ultrasound and parathyroid scintigraphy help in the localization of a parathyroid tumor. Only final histopathologic results can confirm the diagnosis of parathyroid carcinoma. Complete surgical excision is the treatment of choice and offers a good prognosis.
 Keywords: Parathyroid carcinoma, primary hyperparathyroidism