The gene expression pattern was significantly different in adenomas and carcinomas, showing only 26 shared DEGs, including DMBT1, UCHL1, CEMIP, and DHRS2. Although we were not able to perform additional sequencing to check further somatic variants or CNAs due to a lack of available adenoma samples at this point, our findings support the notion that parathyroid carcinoma may commonly arise de novo rather than evolving from adenoma. This evidence concerns the gene DHRS2 and adenoma.