Difference between revisions of "Parathyroid glands"

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===Intraoperative consultation===
 
===Intraoperative consultation===
 
Necessary components are:
 
Necessary components are:
*'''Weight''' of the parathyroid gland or fragment thereof. For reference, 90% of normal parathyroid glands weight less than 100g, and 96% less than 160g.<ref name="YaoSinger2004">{{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>
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*'''Weight''' of the parathyroid gland or fragment thereof.<ref group=notes name=weight>The average weight of each parathyroid gland is about 30&nbsp;mg in men and 35&nbsp;mg in women.<sup>A</sup> 90% of normal parathyroid glands weight less than 100g, and 96% less than 160g.<sup>B</sup><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}}
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</ref>
 
*'''Presence of parathyroid tissue''' upon frozen section.
 
*'''Presence of parathyroid tissue''' upon frozen section.
  
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==Microscopic evaluation==
 
==Microscopic evaluation==
Look for the most common significant findings, which are:
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The main conditions to look for and distinguish are:
*'''Hyperplastic glands''', often nodular and asymmetric on inspection, and microscopy frequently show increased number of oxyphil cells.<ref name="ÅkerströmRudberg1986">{{cite journal|last1=Åkerström|first1=G.|last2=Rudberg|first2=C.|last3=Grimelius|first3=L.|last4=Bergström|first4=R.|last5=Johansson|first5=H.|last6=Ljunghall|first6=S.|last7=Rastad|first7=J.|title=Histologic parathyroid abnormalities in an autopsy series|journal=Human Pathology|volume=17|issue=5|year=1986|pages=520–527|issn=00468177|doi=10.1016/S0046-8177(86)80043-0}}</ref>
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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 '''adenoma'''.<ref name="ÅkerströmRudberg1986"/>
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*Parathyroid '''adenoma''': Typically nodular growth with compressed rim of normal tissue.<ref name=MurroLin2020/>
Serum calcium levels are generally elevated in patients with adenomas or hyperplastic glands containing large nodules, and often correlates with nephrosclerosis.<ref name="ÅkerströmRudberg1986"/>
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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 enough for a diagnosis in the absence of other findings.<ref group=notes name=weight/>
  
 
<gallery mode=packed heights=220>
 
<gallery mode=packed heights=220>
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===Microscopy report===
 
===Microscopy report===
Normal example:
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Whenever possible, make a single report for multiple fragments from the same location. Example:
*Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia.
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{|class=wikitable
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| A,B. Left inferior parathyroid gland, excision:<br>Hypercellular parathyroid gland (121 mg aggregate weight), consistent with parathyroid hyperplasia.
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C,D.  Right superior parathyroid gland, excision:<br>Parathyroid gland (94 mg aggregate weight) without significant histopathologic changes.
 +
 +
E.  Left superior parathyroid gland, excision:<br>Hypercellular parathyroid gland (142 mg aggregate weight), consistent with parathyroid hyperplasia.
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F.  Right inferior parathyroid gland, excision:<br>Hypercellular parathyroid gland (85 mg aggregate weight), consistent with parathyroid hyperplasia.
 +
|}
 +
 
 +
Normal example in '''autopsy''':
 +
{|class=wikitable
 +
| Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia.
 +
|}
  
 
==See also==
 
==See also==
 
*[[Thyroid]]
 
*[[Thyroid]]
 
{{Bottom}}
 
{{Bottom}}

Revision as of 18:56, 9 September 2021

Author: Mikael Häggström [note 1]

Presentations

Intraoperative consultation

Necessary components are:

  • Weight of the parathyroid gland or fragment thereof.[notes 1]
  • Presence of parathyroid tissue upon frozen section.

Autopsy

Optionally for a comprehensive autopsy, or where there is suspicion of parathyroid pathology, an effort is made to find the parathyroid glands, and inspect them for general or focal hyper-/neoplasia.

Microscopic evaluation

The main conditions to look for and distinguish are:

  • Parathyroid hyperplasia: Typically involves all 4 glands with diffuse enlargement.[1]
  • Parathyroid adenoma: Typically nodular growth with compressed rim of normal tissue.[1]

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 enough for a diagnosis in the absence of other findings.[notes 1]

Microscopy report

Whenever possible, make a single report for multiple fragments from the same location. Example:

A,B. Left inferior parathyroid gland, excision:
Hypercellular parathyroid gland (121 mg aggregate weight), consistent with parathyroid hyperplasia.

C,D. Right superior parathyroid gland, excision:
Parathyroid gland (94 mg aggregate weight) without significant histopathologic changes.

E. Left superior parathyroid gland, excision:
Hypercellular parathyroid gland (142 mg aggregate weight), consistent with parathyroid hyperplasia.

F. Right inferior parathyroid gland, excision:
Hypercellular parathyroid gland (85 mg aggregate weight), consistent with parathyroid hyperplasia.

Normal example in autopsy:

Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia.

See also

Notes

  1. 1.0 1.1 The average weight of each parathyroid gland is about 30 mg in men and 35 mg in women.A 90% of normal parathyroid glands weight less than 100g, and 96% less than 160g.B
    A. Johnson, S J (1 April 2005). "Best Practice No 183: Examination of parathyroid gland specimens ". Journal of Clinical Pathology 58 (4): 338–342. doi:10.1136/jcp.2002.002550. PMID 15790694. 
    B. Yao, Kathy; Singer, Frederick R.; Roth, Sanford I.; Sassoon, Aaron; Ye, Cynthia; Giuliano, Armando E. (2004). "Weight of Normal Parathyroid Glands in Patients with Parathyroid Adenomas ". The Journal of Clinical Endocrinology & Metabolism 89 (7): 3208–3213. doi:10.1210/jc.2003-031184. ISSN 0021-972X. 
  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.0 1.1 Diana Murro Lin. Thyroid & parathyroid - Parathyroid nonmalignant - Parathyroid adenoma. Pathology Outlines. Topic Completed: 27 October 2020. Minor changes: 2 June 2021.
  2. Piciucchi, Sara; Barone, Domenico; Gavelli, Giampaolo; Dubini, Alessandra; Oboldi, Devil; Matteuci, Federica (2012). "Primary Hyperparathyroidism: Imaging to Pathology ". Journal of Clinical Imaging Science 2: 59. doi:10.4103/2156-7514.102053. ISSN 2156-7514. 
    - 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.

Image sources