Parathyroid glands: Difference between revisions
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===Intraoperative consultation=== | ===Intraoperative consultation=== | ||
Necessary components are: | Necessary components are: | ||
*'''Weight''' of the parathyroid gland or fragment thereof. | *'''Weight''' of the parathyroid gland or fragment thereof. Generally, there should ''not'' be any subjective description of "enlarged" or similar.<ref group=note name=weight>The average weight of each parathyroid gland is about 30 mg in men and 35 mg in women,<sup>A</sup> but with a great variability: 90% of normal parathyroid glands weight less than 100g, and 96% less than 160g.<sup>B</sup> Thus, by weight alone, a pathologists generally can't tell whether a parathyroid is enlarged, or whether it is of its normal weight, such as being one of the 4% that are normally over 160g.<br>- A. {{cite journal|last=Johnson|first=S J|title=Best Practice No 183: Examination of parathyroid gland specimens|journal=Journal of Clinical Pathology|date=1 April 2005|volume=58|issue=4|pages=338–342|doi=10.1136/jcp.2002.002550|pmid=15790694|pmc=1770637}}<br>- B. {{cite journal|last1=Yao|first1=Kathy|last2=Singer|first2=Frederick R.|last3=Roth|first3=Sanford I.|last4=Sassoon|first4=Aaron|last5=Ye|first5=Cynthia|last6=Giuliano|first6=Armando E.|title=Weight of Normal Parathyroid Glands in Patients with Parathyroid Adenomas|journal=The Journal of Clinical Endocrinology & Metabolism|volume=89|issue=7|year=2004|pages=3208–3213|issn=0021-972X|doi=10.1210/jc.2003-031184}} | ||
</ref> | </ref> | ||
*'''Presence of parathyroid tissue''' upon frozen section. | *'''Presence of parathyroid tissue''' upon frozen section. In particular, exclude sampling from the [[thyroid]]. It is not necessary to specify any particular parathyroid pathology on intraoperative consultation (which in case of hyperparathyroidism relies on imaging and intraoperative parathyroid hormone levels rather than the histopathology)<ref name="pmid30090736">{{cite journal| author=Naik AH, Wani MA, Wani KA, Laway BA, Malik AA, Shah ZA| title=Intraoperative Parathyroid Hormone Monitoring in Guiding Adequate Parathyroidectomy. | journal=Indian J Endocrinol Metab | year= 2018 | volume= 22 | issue= 3 | pages= 410-416 | pmid=30090736 | doi=10.4103/ijem.IJEM_678_17 | pmc=6063190 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30090736 }}</ref>. | ||
===Autopsy=== | ===Autopsy=== | ||
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*'''Parathyroid hyperplasia''': Typically involves all 4 glands with diffuse enlargement.<ref name=MurroLin2020>{{cite web|url=https://www.pathologyoutlines.com/topic/parathyroidpthadenoma.html|title=Thyroid & parathyroid - Parathyroid nonmalignant - Parathyroid adenoma|author=Diana Murro Lin|website=Pathology Outlines}} Topic Completed: 27 October 2020. Minor changes: 2 June 2021.</ref> | *'''Parathyroid hyperplasia''': Typically involves all 4 glands with diffuse enlargement.<ref name=MurroLin2020>{{cite web|url=https://www.pathologyoutlines.com/topic/parathyroidpthadenoma.html|title=Thyroid & parathyroid - Parathyroid nonmalignant - Parathyroid adenoma|author=Diana Murro Lin|website=Pathology Outlines}} Topic Completed: 27 October 2020. Minor changes: 2 June 2021.</ref> | ||
*Parathyroid '''adenoma''': Typically nodular growth with compressed rim of normal tissue.<ref name=MurroLin2020/> | *Parathyroid '''adenoma''': Typically nodular growth with compressed rim of normal tissue.<ref name=MurroLin2020/> | ||
Either is indicated by a decreased amount of intra-gland adipose tissue, and increased weight. A weight of 35-160 mg is above average but not | Either is indicated by a decreased amount of intra-gland adipose tissue, and increased weight. A weight of 35-160 mg is above average but not in itself "enlarged" in the absence of other findings.<ref group=note name=weight/> | ||
<gallery mode=packed heights=220> | <gallery mode=packed heights=220> | ||
File: | File:Parathyroid oxyphil and chief cells - annotated.jpg|Histology of the parathyroid glands | ||
File:Histopathology of parathyroid chief cell hyperplasia.jpg|Parathyroid '''chief cell hyperplasia''': An increase in the parenchymal cell mass,as a result of the proliferation of chief cells, oncocytes, and transitional oncocytes in multiple parathyroid glands.<ref>{{cite journal|last1=Piciucchi|first1=Sara|last2=Barone|first2=Domenico|last3=Gavelli|first3=Giampaolo|last4=Dubini|first4=Alessandra|last5=Oboldi|first5=Devil|last6=Matteuci|first6=Federica|title=Primary Hyperparathyroidism: Imaging to Pathology|journal=Journal of Clinical Imaging Science|volume=2|year=2012|pages=59|issn=2156-7514|doi=10.4103/2156-7514.102053}}<br>- This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</ref> | File:Histopathology of parathyroid chief cell hyperplasia.jpg|Parathyroid '''chief cell hyperplasia''': An increase in the parenchymal cell mass,as a result of the proliferation of chief cells, oncocytes, and transitional oncocytes in multiple parathyroid glands.<ref>{{cite journal|last1=Piciucchi|first1=Sara|last2=Barone|first2=Domenico|last3=Gavelli|first3=Giampaolo|last4=Dubini|first4=Alessandra|last5=Oboldi|first5=Devil|last6=Matteuci|first6=Federica|title=Primary Hyperparathyroidism: Imaging to Pathology|journal=Journal of Clinical Imaging Science|volume=2|year=2012|pages=59|issn=2156-7514|doi=10.4103/2156-7514.102053}}<br>- This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</ref> | ||
File:Histopathology of parathyroid adenoma.jpg|thumb|Parathyroid '''adenoma''', with chief cells and eosinophilic follicles | File:Histopathology of parathyroid adenoma.jpg|thumb|Parathyroid '''adenoma''', with chief cells and eosinophilic follicles | ||
File:Parathyroid Adenoma, FNA (5691039847).jpg|Parathyroid '''adenoma''', fine needle aspiration | File:Parathyroid Adenoma, FNA (5691039847).jpg|Parathyroid '''adenoma''', fine needle aspiration | ||
</gallery> | </gallery> | ||
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| Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia. | | Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia. | ||
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<noinclude> | |||
==See also== | ==See also== | ||
*[[Thyroid]] | *[[Thyroid]] | ||
{{Bottom}} | {{Bottom}} | ||
</noinclude> | |||