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Objective: To evaluate the clinical characteristics and preoperative predictive factors in patients with parathyroid carcinoma. Methods: From January 2010 to December 2016, 150 patients with pathologically and biochemically confirmed primary hyperparathyroidism were enrolled in this study. The clinical data were reviewed to define 28 cases of parathyroid hyperplasia, 14 cases of parathyroid carcinoma (PC), and 108 cases of parathyroid adenoma (PA). The clinical characteristics between PC and PA group were compared and analyzed to explore predictive factors for PC. Results: Patients in PC group were significantly younger than those in PA group (47.9±13.9 vs 57.2±14.6 years, P =0.026). The diameter of tumor in PC group was larger than that in PA group (3.6±1.8 vs 2.2±1.4 cm, P =0.005). The levels of albumin-corrected serum calcium, parathyroid hormone (PTH), and alkaline phosphatase (AKP) were all higher in PC group than those in PA group (3.4±0.6 vs 2.9±0.3 mmol/l; 1 157.1 vs 201.6 pg/ml; 168 vs 97 IU/L; all P <0.05). PC correlated with age( r =-0.241, P =0.007), albumin-corrected serum calcium ( r =0.324, P <0.001), PTH levels ( r =0.301, P =0.001), serum AKP ( r =0.217, P =0.019) and tumor size( r =0.238, P =0.011). Receiver operator characteristic curve analysis showed that the optimum cut-off values as follows: albumin-corrected serum calcium 3.15 mmol/L, serum PTH concentration 1 011 pg/ml and tumor diameter 3.35 cm. These indicators can be helpful in the preoperative diagnosis of PC. Conclusions: Patients with PC were younger than the patients with PA. Albumin-corrected serum calcium, serum PTH concentration, and tumor diameter can be helpful in preoperative diagnosis of PC.

Objective: To highlight the characteristics of metastatic pulmonary calcification(MPC) of a patient with primary hyperparathyroidism., Methods: The clinical, radiological, pathological and (99)mTc-MDP bone scanning data of the patient with primary hyperparathyroidism were studied and relevant literature was reviewed., Results: This 56 year-old female patient presented with cough and shortness of breath. The chest CT scan showed multiple, bilateral infiltrates and calcification in the left lung and ventricular wall. Transbronchial lung biopsy was performed, and the pathological study showed that there was diffuse calcification in the alveoli and alveolar septa.(99)mTc-MDP bone-scanning showed pulmonary uptake mostly. The patient showed significant clinical and radiological improvement after surgical removal of the parathyroid gland., Conclusions: Patients of primary hyperparathyroidism with respiratory symptoms were easily misdiagnosed as primary pulmonary diseases.(99)mTc-MDP bone-scanning can be used to help differentiate MPC from other diseases with similar clinical and radiological findings, thus allowing prompt therapy.