Local recurrence as a first sign of parathyroid malignancy! Need to redefine the criteria for diagnosis of parathyroid carcinoma.

Pathological criteria alone do not make an accurate diagnosis of parathyroid carcinoma in cases of well-defined organ contained lesion without local and distant metastasis. Intra-operative appearance of pale, grayish, firm tumor is highly suggestive of parathyroid carcinoma, even though this finding is not included in the pathological criteria for diagnosing a malignancy. Gross features of the tumor also should be added to the pathological criteria so as to ensure an accurate assessment of the biological behavior of the parathyroid tumor.