Lab Value


A patient with primary hyperparathyroidism undergoes surgical exploration. A single irregularly enlarged parathyroid gland is found that invades into surrounding tissue. The specimen histology is shown in the image.

What is the most appropriate surgical resection?

The figure presented in the question demonstrates parathyroid carcinoma, which is a rare cause of primary hyperparathyroidism (<1%). The diagnosis is made with evidence of invasion into surrounding structures. Parathyroid carcinoma is resistant to chemotherapy or radiation therapy; therefore, complete surgical resection is the only option for long-term cure. Appropriate surgery includes en bloc resection of the affected parathyroid gland, thyroid lobe, cervical thymus, and central neck dissection. Lateral neck lymphadenectomy is generally not indicated unless grossly involved. Meticulous technique must be used to avoid rupture of the capsule to prevent tumor spillage, because it increases the risk of recurrence.