Letter 2: Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenoma (Br J Surg 2007; 94: 566–570)

the authors’ experience with parathyroid carcinomas (PC) and we have the same view on pathological features regarding parathyroid cancer and atypical parathyroid adenoma (APA). Nevertheless, we would like to point out that in our experience, intact parathyroid hormone (PTH) serum levels were significantly elevated in patients with PC but not with APA. This is in agreement with other reports, which found intact PTH and mid PTH significantly elevated in PC (P = 0·027 and P = 0·019 respectively)1 – 3. The authors also sacrificed the recurrent laryngeal nerve (RLN) in one patient with cancer, while it is not clear why they decided to sacrifice the RLN even in three cases with APA, without reporting preoperative dysphonia. In our study, 11 out of 17 cases of PC underwent en bloc resection. The RLN was sacrificed only in one patient with pre-operative dysphonia. Therefore, even if it is difficult to predict PC prior to operation, it can be suspected on the basis of a peculiar clinical presentation consisting of high blood levels of calcium and PTH, a palpable mass and recurrent nerve paralysis. A high rate of local relapse in four patients with en bloc resection was reported. It is not recorded if these patients were offered adjuvant radiotherapy, that would have allowed better local control4,5. None of our patients who received adjuvant radiotherapy had local recurrence1. A. Toniato and M. R. Pelizzo Surgical Pathology, University of Padua, School of Medicine, Policlinico Universitario, via Giustiniani 2, 35128 Padua, Italy DOI: 10.1002/bjs.5973