SAT-813 - A Case Series of Variable Presentations of Parathyroid Carcinoma-A Single Center Experience

Introduction
Parathyroid carcinoma (PC) is an extremely rare entity, with a frequency of 0.005% of all malignancies. Although surgery and histopathology (HPE) predominate the diagnostic workflow, clues from clinical encounters often expedite this process allowing timely intervention.
Case 1:42-year female with L shoulder pain, generalized weakness for 10 months. S Ca: 11.9 mg/dl ;S. P: 1.9
mg/dl ;S ALP: 263IU/L ; Intact PTH: 300pg/ml ; Bone & Sestamibi scan: multiple bone lytic lesions &
L lower Parathyroid Adenoma (PA), HPE: L lower parathyroid carcinoma size 3x2.5 cm ,widely invasive
parathyroid carcinoma with vascular emboli , infiltrating esophageal muscle.
Case2: 35-year male with Hypothyroidism(Hashimotos thyroiditis),hypertension presented with multinodular
goiter. S Ca: 12.6 mg/dl;P: 1.1mg/dl ;S ALP: 721IU/L ; Intact PTH :119.8 pg/ml; Bone & Sestamibi scan
: multiple bone lytic lesions & R lower PA HPE: R lower parathyroid carcinoma size 3.5x3x3 cm
,adherent (noninfiltrating) to lower pole of R thyroid lobe.
Case 3: 40-year male with chronic pancreatitis, secondary diabetes, multiple intraductal calculi on ERCP in
head & body of pancreas for 2 years. S Ca: 14.0 mg/dl ;P: 2.1mg/dl ; S ALP: 110 IU/L ; Intact PTH
:1331 pg/ml ; Bone & Sestamibi scan: multiple bone lytic lesions & R lower PA USG neck: well defined
echoic nodule 1.9x1.6x1.4 cm with area of central necrosis HPE: R lower well differentiated parathyroid
carcinoma size 2x2x1.5 cm , Capsular invasion present
Case 4: 38-year female Chronic Hepatitis B ,past Non-Hodgkin’s lymphoma in remission with R renal calculus
presented with S Ca: 12.0 mg/dl ;P: 2.1mg/dl ;S ALP: 110 IU/L ; Intact PTH :323 pg/ml ; PET CT:
Increased uptake in L lower parathyroid Sestamibi Scan: L lower PA HPE: L lower well differentiated
parathyroid carcinoma size 1.5x1x0.5 cm , no Capsular invasion present
Case 5: 43 year female with MEN 1 & neck pain for 2 months .S Ca: 11.8 mg/dl ;P: 2.1mg/dl ;S ALP: 110
IU/L ; Intact PTH :696 pg/ml ; Bone & Sestamibi scan: multiple bone lytic lesions & R lower PA not
visualized USG neck: bilateral lower PAs R bigger 2.4 cm than L 1.4 cm DOTA scan: 2 gastric & 1
ileal focus of increased somatostatin uptake HPE: R lower well differentiated parathyroid carcinoma size
2x2x1cm ,with vascular invasion present, 3 & a half gland removal: L lower PA size 2.5x2x0.5cm , R
upper PA size 1.2x1x1cm Gastric nodules: Neuroendocrine hyperplasia

Discussion: The findings from this series of cases were suggestive of a middle-aged demographic, a large size of a suspected adenoma and concurrent neuroendocrine tumors to be factoids of high clinical suspcion for PC and that the early detection of these allows treatment with curative intent.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*