SURGICAL TREATMENT OF RECURRENT METASTATIC PARATHYROID GLAND CARCINOMA/KIRURSKO LIJECENJE RECIDIVIRAJUCEG METASTATSKOG KARCINOMA DOSTITNE ZLIJEZDE

Aim: We present the case of a 48-year-old male patient who underwent surgery for a recurrent metastatic parathyroid gland carcinoma in the patient's right paratracheal space of the neck. The patient had undergone surgery for lower right parathyroid gland carcinoma 28 months earlier. Results: The metastases were resected en bloc with an ipsilateral central neck dissection and with the removal of the enlarged lower left parathyroid gland. After exploration of the remnant parathyroid glands we noticed that lower left parathyroid gland was macroscopically enlarged so we decided to remove it to prevent possible hypercalcemia in future and to also prevent possible recurrence of cancer or development of a new primary, considering the identical embryological origin of the lower parathyroid glands and possibility of synchronous, multiple tumors, which generally follow the same embryological origin if they occur. The patient was also treated with radiation therapy after the surgery. Conclusion: With the present surgical approach to recurrent metastatic parathyroid gland carcinoma, we aimed to prevent the recurrence of cancer or development of new primary and prevent or delay hypercalcemia in the future with all severe adverse metabolic states associated with high serum calcium levels. Key words: recurrent metastatic parathyroid gland carcinoma, embryological origin, surgical treatment Prikaz slucaja 48 godisnjeg muskog bolesnika koji je operiran zbog recidvirajuceg metastatskog karcinoma dostitne zlijezde u paratrahealnom prostoru vrata desno. 28 mjeseci prije bolesnik je operiran poradi karcinoma donje desne dostitne zlijezde. Rezultati: Metastaze su odstranjene zajedno s ipsilateralnom centralnom disekcijom desne strane vrata kao i povecana donja lijeva dostitna zlijezda. Naime, nakon eksploracije preostalih dostitnih zlijezda, primjetili smo da je donja lijeva dostitna zlijezda makroskopski povecana, pa smo je odlucili odstraniti zbog te cinjenice te da preveniramo razvoj moguce hiperkalcemije u buducnosti, a takoder i da preveniramo moguci recidiv karcinoma ili razvoj novog primarnog karcinoma uzimajuci u obzir istu embriolosku osnovu nastanka donjih dostitnih zlijezda i mogucnost razvoja istodobnih, sinhronih karcinoma dostitnih zlijezda koji, ukoliko se pojave, uglavnom prate istu embriolosku osnovu. Bolesnik je lijecen i radioterapijom nakon operacije. Zakljucak: Prikazanim kirurskim pristupom lijecenju recidivirajuceg metastatskog karcinoma dostitne zlijezde