MKI67 and pachyonychia congenita: This case highlights the need for multidisciplinary collaboration in the diagnostic process, recognizing atypical symptoms and carefully interpreting histopathological markers in suspected PC cases.<h4>Conclusion</h4>Persistent hyperparathyroidism, elevated Ki-67 levels, and unexplained lower urinary tract symptoms (LUTS) should prompt re-evaluation for malignancy, highlighting the rarity yet clinical significance of hypercalcemia-induced AUR as a presenting symptom of underlying parathyroid pathology.