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We report a case of a 75-year-old female presenting with chest pain, hypercalcemia, and severely elevated parathyroid hormone level. Intraoperatively, a 40-g gland was found displacing adjacent structures, raising concern for malignancy. The parathyroid lesion was determined to be an atypical parathyroid tumor. This case highlights the diagnostic challenge in distinguishing atypical parathyroid tumors and highlights the importance of advanced imaging in surgical planning and management of atypical presentations of primary hyperparathyroidism.<\/jats:p>","DOI":"10.1093\/jscr\/rjag731","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:15:25Z","timestamp":1786101325000},"source":"Crossref","is-referenced-by-count":0,"title":["A rare case of giant atypical parathyroid tumor presenting as a parathyroid adenoma \u2013 discussion of intraoperative challenges"],"prefix":"10.1093","volume":"2026","author":[{"given":"Mehnaaz","family":"Mohammed","sequence":"first","affiliation":[{"name":"Department of General Surgery, Arrowhead Regional Medical Center , 400 N. Pepper Ave., Colton, CA 92324 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmila","family":"Raju","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Arrowhead Regional Medical Center , 400 N. Pepper Ave., Colton, CA 92324 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Salami","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Arrowhead Regional Medical Center , 400 N. Pepper Ave., Colton, CA 92324 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Un","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Arrowhead Regional Medical Center , 400 N. 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