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Parathyroid glands

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==Presentations=====Intraoperative consultation===Necessary components are:*'''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&nbsp;mg in men and 35&nbsp;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>*'''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==
Look The main conditions to look for the main findings, which and distinguish are:*'''Hyperplastic glandsParathyroid hyperplasia''', often nodular and asymmetric on inspection, and microscopy frequently show increased number of oxyphil cells: Typically involves all 4 glands with diffuse enlargement.<ref name="ÅkerströmRudberg1986"MurroLin2020>{{cite journalweb|last1url=Åkerström|first1=G.|last2=Rudberg|first2=C.|last3=Grimelius|first3=Lhttps://www.|last4=Bergström|first4=Rpathologyoutlines.|last5=Johansson|first5=H.|last6=Ljunghall|first6=S.|last7=Rastad|first7=Jcom/topic/parathyroidpthadenoma.html|title=Histologic Thyroid & parathyroid abnormalities in an autopsy series- Parathyroid nonmalignant - Parathyroid adenoma|journalauthor=Human PathologyDiana Murro Lin|volumewebsite=17|issue=5|year=1986|pages=520–527|issn=00468177|doi=10.1016/S0046-8177(86)80043-0Pathology 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="ÅkerströmRudberg1986"MurroLin2020/>Serum calcium levels are generally elevated in patients with adenomas or hyperplastic glands containing large nodulesEither is indicated by a decreased amount of intra-gland adipose tissue, and often correlates with nephrosclerosisincreased 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="ÅkerströmRudberg1986"weight/>
<gallery mode=packed heights=220>
File:1814 The Parathyroid Glands.jpg|Location and histology of the parathyroid glands
File:Histopathology of parathyroid chief cell hyperplasia.jpg|Parathyroid Adenoma '''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 (4702993415)|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''', histologywith chief cells and eosinophilic follicles
File:Parathyroid Adenoma, FNA (5691039847).jpg|Parathyroid '''adenoma''', fine needle aspiration
File:Histopathology of parathyroid congestion.jpg|Parathyroid venous '''congestion''' in circulatory failure.
</gallery>
===Microscopy report===
Example for an '''intraoperative consultation''':
{|class=wikitable
| A. Left inferior parathyroid, excision:<br>24 mg of parathyroid tissue.
 
C. Right superior parathyroid, excision:<br>14 mg of parathyroid tissue.
|}
 
Whenever possible, make a single report for multiple fragments from the same location. Example of '''final report''', including additional fragments from the same locations:
{|class=wikitable
| A,B. Left inferior parathyroid gland, excision:<br>Hypercellular parathyroid gland (121 mg aggregate weight), consistent with parathyroid hyperplasia.
 
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.
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.
|}
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==See also==
*[[Thyroid]]
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