Management and surgical treatment of parathyroid crisis secondary to parathyroid tumors: report of four cases

Figures & data

Table 2 Histologic criteria for diagnosis of malignancy in parathyroid neoplasm

Absolute criteria of malignancy	Features associated with malignancy
Presence of any one of the following criteria is sufficient for a diagnosis of malignancy	In the absence of the absolute criteria, at least 2, preferably 3 or more, of the following features have to be present in order to establish a diagnosis of malignancy
Invasion into surrounding tissues:	Capsular invasion
– thyroid	Vascular invasion
– esophagus	Readily identifiable mitotic figures (>5/10 high-powered field)
– nerves or	Broad intratumoral fibrous bands splitting the parenchyma and separating expansible nodules
– soft tissues	Coagulative tumor necrosis (has to be distinguished from infarction, which can occur in parathyroid adenoma)
Histologically documented regional or distant metastasis	Diffuse sheet-like monotonous small cells with high nuclear/cytoplasmic ratio
	Diffuse cellular atypia
	Macronucleoli present in many tumor cells

Note: This article was published in Seminars in Diagnostic Pathology. Chan JK, Tsang WY. Endocrine malignancies that may mimic benign lesions. Semin Diagn Pathol. 1995;12:45–63. Copyright© Elsevier 1995.¹¹

Table 1 Effect of medical treatment on serum calcium levels

Case	Total serum calcium on admission (mmol/L)	Medical treatment	Preoperative total serum calcium (mmol/L)	Postoperative total serum calcium (mmol/L)
1	4.12	Normal saline infusion, calcitonin, alendronate	3.52	2.15
2	3.89	Normal saline infusion, calcitonin, pamidronate	3.60	2.14
3	4.16	Normal saline infusion	3.91	1.98
4	4.52	Normal saline infusion, calcitonin	4.32	2.32

ChanJKTsangWYEndocrine malignancies that may mimic benign lesionsSemin Diagn Pathol19951245637770674

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