A Rare Case of Parathyroid Carcinoma Initially Misdiagnosed as a Parathyroid Adenoma

Sep 30, 2026

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Parathyroid carcinoma is an uncommon endocrine malignancy that can mimic a benign parathyroid adenoma, often presenting with hypercalcaemia and nonspecific symptoms that complicate preoperative identification. The report describes a 38-year-old woman from Birmingham with recurrent hypercalcaemia, body aches, lethargy, polydipsia, and voice changes. After elevated calcium and parathyroid hormone were found and imaging suggested a functioning adenoma, left superior parathyroidectomy normalized biochemistry, yet histopathology revealed carcinoma. Parafibromin immunohistochemistry and second-pathologist review confirmed the diagnosis, with no metastasis on postoperative imaging and continued asymptomatic follow-up.

LanguageEnglish

CategoryHealthcare

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Pages4

Reading Time10 min

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Abstract

Introduction

Case Presentation

Clinical assessment and family history

Laboratory and imaging findings

Surgery and follow-up

How to cite this article

Notes

Review began 11/26/2025 Review ended 12/04/2025 Published 12/09/2025 © Copyright 2025 Khan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98794 Open Access Case Report A Rare Case of Parathyroid Carcinoma Initially Misdiagnosed as a Parathyroid Adenoma Jawad A. Khan 1 , Naveed Ahmad 2 1. Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR 2. Endocrinology and Diabetes, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR Corresponding author: Jawad A. Khan, [doctorjawad2010@yahoo.com](doctorjawad2010@yahoo.com) Abstract Parathyroid carcinoma is an uncommon endocrine malignancy that can resemble a benign parathyroid adenoma, typically presenting with hypercalcaemia and nonspecific symptoms that make preoperative diagnosis difficult. We report the case of a 38-year-old woman from Birmingham, United Kingdom, who presented with recurrent hypercalcaemia associated with body aches, lethargy, polydipsia, and voice changes. Initial laboratory tests revealed elevated calcium and elevated parathyroid hormone levels. Imaging studies identified a small left parathyroid lesion consistent with a functioning adenoma. The patient underwent left superior parathyroidectomy, with postoperative normalization of calcium and parathyroid hormone levels. Histopathological examination unexpectedly revealed parathyroid carcinoma, confirmed by parafibromin immunohistochemistry and review by a second pathologist. Postoperative imaging showed no evidence of metastasis, and the patient remains asymptomatic with normal biochemical values during follow-up. This case highlights the diagnostic challenge of distinguishing parathyroid carcinoma from adenoma and emphasizes the importance of histopathological evaluation and multidisciplinary management. Categories: Internal Medicine, Endocrinology/Diabetes/Metabolism Keywords: case report, endocrine neoplasms, hypercalcemia, immunohistochemistry, parafibromin, parathyroid adenoma, parathyroid carcinoma, primary hyperparathyroidism, surgical excision Introduction Parathyroid carcinoma is exceptionally rare, accounting for less than 1% of cases of primary hyperparathyroidism [1,2] . It can closely resemble benign parathyroid adenoma, making preoperative diagnosis particularly challenging [1-3]. Most patients with primary hyperparathyroidism have benign adenomas, but carcinoma should be suspected in cases with markedly elevated calcium levels, a large parathyroid mass, or evidence of local invasion [1-3]. Preoperative differentiation between adenoma and carcinoma is difficult, as imaging and biochemical features often overlap [3] . Early recognition and complete surgical excision are crucial to prevent recurrence and metastatic spread [1,2] . We present a rare case of parathyroid carcinoma in a 38-year-old woman who was initially diagnosed with a benign parathyroid adenoma. This case underscores the importance of thorough histopathological evaluation and multidisciplinary discussion in the management of parathyroid lesions [4] . Case Presentation A 38-year-old woman with no significant past medical history was referred to the endocrine clinic for evaluation of recurrent hypercalcaemia detected during multiple hospital admissions. She reported generalized body aches, polydipsia, lethargy, and a recent onset of voice changes. There was no history of nephrolithiasis, fractures, or neuropsychiatric symptoms. Her father had a history of thyroid carcinoma. Given this family history, evaluation for multiple endocrine neoplasia (MEN) syndromes was undertaken. Biochemical screening, including plasma metanephrines to exclude pheochromocytoma, was normal. There were no clinical features or laboratory findings suggestive o

FAQs

Why was parathyroid carcinoma difficult to diagnose in this case?

Parathyroid carcinoma resembled a benign parathyroid adenoma, and the patient had hypercalcaemia with nonspecific symptoms. Imaging and biochemical features overlapped, making preoperative differentiation challenging.

What key findings supported a preoperative diagnosis of parathyroid adenoma?

Laboratory tests showed elevated calcium and elevated parathyroid hormone. Neck ultrasound and a 99mTc-sestamibi (MIBI) SPECT scan identified a small lesion/posterior nodule consistent with a functioning parathyroid adenoma.

How was the final diagnosis of parathyroid carcinoma confirmed?

Histopathological examination unexpectedly revealed parathyroid carcinoma. The diagnosis was confirmed using parafibromin immunohistochemistry and review by a second pathologist.

Sep 30, 2026

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